Therapies for hoarding focus on the underlying beliefs and motivations.
Most people have possessions they find useful or meaningful. It would probably be difficult to part with your favorite sweater, the tickets from your first music concert, or even your best coffee mug.
But a person with hoarding disorder is more likely to attach meaning to every item, regardless of its value. They may believe that every piece of mail is important or that an empty bottle might be useful one day. This can lead to a large accumulation of possessions that are extremely difficult to part with.
Hoarding disorder is not rare. It affects about 2.6% of the population, about the same as bipolar disorder, which has a prevalence of 2.8%.
While living with hoarding disorder can be challenging, the condition — like most mental health conditions — is treatable.
Hoarding disorder, or compulsive hoarding, is a complex condition in which an individual has persistent difficulty parting with their possessions.
When severe, hoarding disorder can result in a very difficult living situation. In some cases, a person may have a hard time reaching or using their stove, front door, or toilet.
Hoarding disorder was given its own diagnostic criteria in the most recent, fifth edition of the DSM. Previously, it was considered a subtype of obsessive-compulsive disorder (OCD).
Over time, it became clear that most people with hoarding disorder don’t have typical OCD symptoms, as they’re not experiencing intrusive and disturbing thoughts.
So while hoarding disorder is still considered a condition related to OCD, it’s now labeled as a distinct disorder under “compulsive spectrum disorders.”
Compulsive hoarding can be difficult to treat because people with the disorder tend to experience pleasurable feelings when they acquire a new belonging. They don’t necessarily feel distressed about clutter. Rather, they experience most of their distress at the thought of parting with their items.
In addition, people with hoarding disorder often have another psychiatric disorder that may need to be treated. The most common is major depression, which affects up to 50% of people with hoarding disorder.
Attention deficit hyperactivity disorder (ADHD) is also commonly seen among people with compulsive hoarding — particularly the inattentive symptoms of ADHD.
Hoarding may begin in adolescence but will often worsen with age. It tends to become clinically significant in middle-aged people.
Hoarding disorder is primarily treated with cognitive behavioral therapy (CBT), in which a therapist helps a person identify and change their dysfunctional beliefs. This therapy can also involve exposure to sorting and discarding items.
Some people find improvement with medication, particularly if they have major depression.
CBT is the best-studied therapeutic intervention for hoarding disorder.
A 26-session CBT program specifically designed for hoarding disorder was written by Gail Steketee, a professor of social work at Boston University, and Randy Frost, a professor of psychology at Smith College in Massachusetts.
The program is described in the therapist guide “Treatment for Hoarding Disorder” and includes the following techniques:
Motivational interviewing is a client-centered therapy designed to help the individual find the internal motivation to make a change. Many people with hoarding disorder are reluctant to change their habits, as the clutter and accumulation of things don’t necessarily cause significant distress.
Motivational interviewing helps the individual identify what they want for themselves, not what the therapist thinks they should do. As a result, people with hoarding disorder don’t feel like they’re being forced to give up something they love. Rather, they are motivated to start living a life they’ve chosen for themselves.
For instance, a client might be motivated to clear their clutter so they can move freely through their home or have friends over again.
Cognitive rehabilitation and exposure/sorting therapy (CREST) is modeled on interventions for people with traumatic brain injury. It was developed by Catherine Ayers, PhD, ABPP, a professor of psychiatry at the University of California, San Diego.
This therapy helps individuals categorize, plan, and solve problems. A person with hoarding disorder might be asked to go through each of their items and decide what they need to keep and what to let go. Over time, a person with hoarding disorder learns that they can handle the distress of letting things go.
In one 2018 study , older people with hoarding disorder participated in a 26-session CREST treatment. Participants experienced a 40% reduction in hoarding symptoms, and these improvements were sustained 6 months later.
There are no specific medications approved or marketed for treating hoarding disorder. But some individuals may improve with selective serotonin reuptake inhibitors (SSRIs), medications that can help with comorbid conditions that include anxiety, depression, and insomnia.
More research is needed to find effective medications and therapies for treating hoarding disorder.
