Compulsive hoarding is more than just having lots of things. It's a specific type of behavior that can have a severe impact on a person's life. Although hoarding treatment is often very difficult to undertake, new types of cognitive-behavior therapy offer hope. Let's explore more about about hoarding treatment.
What Is Compulsive Hoarding?
Compulsive or pathological hoarding is a problematic behavior characterized by:
- Acquiring and failing to throw out a large number of items that would appear to have little or no value to others, such as old magazines, containers, clothes, books, junk mail, receipts, notes or lists
- Severe cluttering of the person’s home so that it is no longer able to function as a viable living space
- Significant distress or impairment of work or social life
Hoarding, either alone or in the presence of OCD, usually does not respond well to medical or psychological treatments.
A number of studies have examined the effectiveness of selective serotonin reuptake inhibitors (SSRIs), such as Paxil (paroxetine), in the treatment of hoarding. Most investigations have found that only a third of patients who hoard show an adequate response to these medications. Results have been similar for other drugs affecting serotonin, such as the tricyclic antidepressant Anafranil (clomipramine).
Efforts at treating hoarding with traditional cognitive-behavior therapy (CBT) are also often ineffective. However, Drs. Gail Steketee and Randy Frost, clinical psychologists who have extensive expertise in hoarding, have developed a CBT protocol designed specifically for hoarding that shows considerable promise.
In addition to imparting information on the nature and consequences of hoarding, this hoarding CBT protocol focuses on four specific elements:
Information processing: People who hoard have trouble making decisions regarding whether to keep possessions or not, and with organization and categorization. As such, treatment focuses on skills in sorting, organizing and decision making.
Emotional Attachment to Possessions: It is not uncommon for people to hoard to report an intense sentimental attachment to objects. This attachment, of course, can make it difficult to discard objects that otherwise have little to no value. Therapy using techniques such as cognitive restructuring and exposure are used to challenge beliefs around these objects and explores the true consequences of discarding such objects.
Beliefs About Possessions: Hoarding often involves an intense belief that control must be maintained over possession and that there is a responsibility to ensure that possessions do not go to waste. Again, treatment focuses on cognitive restructuring and exposure to critically examine beliefs around possessions.
Behavioral Avoidance: Although hoarding can destroy a person’s home and relationships, this behavior does have the advantage of allowing the person to avoid making decisions, making mistakes, interacting with others, and facing the unpleasant task of organizing one’s possessions. This CBT protocol focuses on creating behavioral experiments that allow the person to face situations that generate anxiety, while at the same time replacing avoidance with more adaptive coping strategies.
Research into combining this protocol of treatment with different combinations of medication is ongoing.
Insight May be A Barrier to Hoarding Treatment
Insight into the severity of symptoms and necessity for change is essential to the success of just about any form of treatment. When people do not have insight into their illness, they are much more likely to either stop taking their medication or to drop out of treatment.
Research has shown that people who hoard often have worse insight into their symptoms than people with OCD who do not hoard. This lack of insight often causes people to avoid seeking treatment, withdraw early from treatment, and/or fail to complete homework assignments. Often, people who hoard only agree to enter treatment after being threatened with eviction or some other negative consequence that is secondary to those caused by their hoarding. In these cases, the person may carry out treatment simply to avoid negative consequences, rather than out of a belief that change is necessary.
This lack of insight can also be frustrating for family members and may drive them away. Family members often feel their loved one has become delusional, and they do not know what to do. Speak with your family doctor about resources available in your community if you are concerned about a loved one.
Frost, R.O., Steketee, G., & Green, K.A.I “Cognitive and Behavioral Treatment of Compulsive Hoarding" Brief Treatment and Crisis Intervention 2003 3: 323-337.
Saxena, S."Recent Advances in Compulsive Hoarding" Current Psychiatry Reports 2008 10: 297-303
Frost, R.O., Tolin, D.F., & Maltby, N. "Recent Advances in Compulsive Hoarding" Cognitive and Behavioral Practice 2010 e-published ahead of print