How Hoarding Disorder Is Treated

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Hoarding disorder is a mental health condition marked by excessively saving items and having extreme difficulty discarding things that aren't needed or are not objectively valuable.

Hoarding disorder used to be considered a subtype of obsessive-compulsive disorder (OCD) and was treated using methods designed for OCD.

While it is now classified and treated as a unique condition, it is still not well understood and can be difficult to treat, particularly as many people with hoarding disorder do not recognize that they have a problem.

The most common approaches to treatment for hoarding disorder are cognitive behavioral therapy (CBT), medication, and in-house decluttering, which are discussed in this article.

A man holding a badminton racket sits on a chair surrounded by clutter.


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Therapies

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is the go-to form of treatment for hoarding disorder, particularly a form of CBT that has been tailored to hoarding disorder.

During CBT, a person with hoarding disorder learns to:

  • Discard unnecessary items with less distress
  • Lessen extreme perceived need/desire to save possessions
  • Increase organization skills
  • Increase decision-making skills
  • Increase relaxation skills

A 2015 meta-analysis showed a significant decrease in symptom severity after CBT treatment—particularly in the areas of difficulty discarding, clutter, and acquiring.

Better outcomes were associated with:

  • Female sex
  • Younger age
  • A greater number of CBT sessions
  • A greater number of home visits

Even with these promising results in symptom improvement, most people in the studies still had hoarding disorder at the end of treatment, showing CBT to be less helpful for hoarding disorder than for other disorders such as depression or anxiety.

Symptom reduction can still make a significant difference to a person's quality of life.

Group Therapy

Group CBT treatment may be helpful for people with hoarding disorder by:

  • Decreasing social isolation
  • Decreasing stigma
  • Increasing motivation
  • Increasing access to clinicians trained for hoarding disorder
  • Being cost-effective (for both therapy participants and clinics that provide treatment)

Buried in Treasures Workshop

Buried in Treasures is a workshop led by a non-psychologist facilitator or peer that uses CBT principles.

These workshops were by developed by three psychologists—Frost, Tolin and Steketee—and are offered in at least a dozen states, as well as in countries outside the United States.

A 2012 study showed that participants in the workshops had reduced hoarding symptoms compared with those in a waitlist control group, indicating Buried in Treasures workshops may be an effective complement to CBT for hoarding disorder, or for use when CBT is not an option.

A study done in 2018 indicated that peer-led groups were as effective as psychologist-led groups for treating hoarding disorder.

Web-Based Treatments

A study of a web-based self-help program showed that hoarding disorder symptoms in participants decreased after six months of membership, but the improvement was not as high as that seen with highly structured in-person group treatments.

Web-based programs are still considered helpful by:

  • Helping to relieve symptoms
  • Building motivation
  • Reducing loneliness
  • Extending access to mental health care
  • Complementing existing evidence-based practices
  • Reducing treatment costs
  • Appealing to people who are concerned about the stigma

As web-based treatments are in high demand, more research into how to make these programs more effective is essential.

Support Groups

While support groups are not a substitute for professional treatment, they can be a good complement to therapy by:

  • Being part of a relapse prevention plan
  • Decreasing loneliness and feelings of isolation
  • Fostering feelings of connection to others
  • Helping people feel understood by others
  • Giving an opportunity to share resources

Support groups can be helpful both for individuals who have hoarding disorder and for people affected by the hoarding behavior of a family member or loved one.

Support Groups for Hoarding Disorder

Prescription Medications

Very few studies have been done on the efficacy of using medication to treat hoarding disorder.

Most of the studies that have been done focus on symptom reduction of hoarding as a subtype of OCD. These studies have generally shown that people who have OCD with hoarding symptoms tend to have an equal or worse treatment response to selective serotonin reuptake inhibitors (SSRIs) than do those without prominent hoarding symptoms.

A 2019 analysis showed that despite being separated from OCD as a diagnosis, there continue to be very few studies on the treatment of hoarding disorder alone, particularly when it comes to medication.

Despite the lack of research, medications are prescribed to treat hoarding disorder, usually in combination with other therapies.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Types of SSRIs:

  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Citalopram (Celexa)
  • Escitalopram (Cipralex)
  • Sertraline (Zoloft)

Side effects of SSRIs can include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Weight gain
  • Dry mouth
  • Headaches
  • Anxiety
  • Sedation
  • Sexual problems
  • Jittery/restless feeling
  • Sleep difficulties

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Types of SNRIs:

  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Levomilnacipran (Fetzima)
  • Desvenlafaxine (Pristiq)

Side effects of SNRIs can include:

  • Nausea
  • Drowsiness
  • Dizziness
  • Nervousness/anxiety
  • Fatigue
  • Loss of appetite
  • Sexual problems
  • Increased blood pressure (in higher doses)

Alternative Treatments

In-Home Decluttering Sessions

Unlike most mental health conditions, people with hoarding disorder often derive pleasure from their problem behavior. This can make motivation for treatment, as well as carrying through with it, difficult.

Researchers are studying the implementation of decluttering training in treatment, including working with “clutter interns”—students who both work with psychotherapists and visit people with hoarding disorder at home to help them manage their belongings.

One study found that a combination of in-home decluttering sessions and the Buried in Treasures workshop resulted in a decrease in hoarding symptoms, decreased clutter, and improvements in daily living activities.

Virtual Decluttering

While not currently in practice, researchers are exploring ways for people with hoarding disorder to practice sorting their belongings in a clinical setting through the use of virtual reality systems that scan their homes.

Hoarding Coalitions

Hoarding disorder can endanger not just the person with the condition, but others in the community, including neighbors who may be affected by infestation and unsanitary conditions, and first responders who may need to enter the dwelling during an emergency.

For this reason, some communities have developed teams to address living conditions affected by hoarding behavior.

The goal of these response teams is not usually to stop the hoarding, but rather to provide temporary help by way of:

  • Improving health and safety
  • Avoiding eviction
  • Connecting residents with support such as treatment referrals or emergency shelter

These programs may involve the services of:

  • Social services
  • Public health
  • Housing code enforcement
  • Animal control
  • Health system
  • Fire and rescue prevention
  • Members of the community

There are also professional decluttering services trained in cleaning up hoarding environments. Some of these require payment; others are provided as a service to those who qualify, such as those at risk of eviction.

While this approach takes care of the existing clutter, the problem will continue and the clutter is likely to return without treatment.

Questions to Ask Yourself When Making Decisions About Items

Questions include:

  • When was the last time you needed it?
  • When was the last time you used it?
  • How likely is it that you will use it in the future?
  • What is your track record of using items like this?
  • What is the impact of keeping the things in relation to your problem?
  • Do you have enough space for the object?
  • Is the item usable?
  • Do you have time to use the item?
  • How many similar objects do you already have?
  • Does keeping the item help you achieve your goals?

Lifestyle

Treating hoarding disorder requires a personal commitment to making changes, and putting in the work to make it happen. In addition to professional help, there are ways to help yourself at home.

Decide to Make a Change

Finding the motivation to change can be one of the biggest obstacles to treatment.

Try making a pros and cons list for changing your hoarding behavior.

Some of the advantages might include (but are not limited to):

  • Being able to invite friends and family into your home
  • Improving/preserving your relationship with loved ones or other people in the house
  • Improving your health
  • Getting control over your finances
  • Making day-to-day activities easier

Start Small and Build Up

To help make the task of decluttering less overwhelming, break down your belongings into categories by creating a "fear ladder."

From 1 (easiest to discard) to 10 (hardest to discard), rank all the different items you’ve been hoarding and make a list.

An example of a fear ladder from HelpGuide looks like this:

  1. Boxes, bags, old containers
  2. Bills, receipts
  3. Newspapers, magazines
  4. Ticket stubs
  5. Shoes, hats, belts
  6. Other clothing
  7. Postcards, greeting cards, letters
  8. Souvenirs
  9. Gifts
  10. Photos

Your fear ladder should reflect the items in your home and the extent to which discarding them causes you distress.

Break It Down Into Tasks

Some tips for tackling one thing at a time include:

  • Create a timer: Set an alarm, designate a certain number of songs, or use any other measure of time, and work in one area for that allotment of time.
  • Divide up the tasks: Clean one area fully and then move to another area, or tackle one type of item such as clothing and then move on to another type of item.
  • Make lists: Plan out what you have and what you are going to do with it, make a checklist you can cross off as you go, or use any other type of list that helps you stay on track.
  • Set simple, specific, realistic goals: Decide to throw out five things per day, for example, instead of planning to have the home spotless by sundown.
  • Make things easier for yourself: Find things that make the tasks easier to get through, such as having garbage bags in every room so you can move between rooms without having to remember to bring them with you.
  • Create a schedule: For example, your schedule might include putting laundry in the washer after breakfast, sorting mail during your favorite midmorning radio program, doing dishes after lunch, etc.
  • Track your progress: Take before and after photos, record what you have completed—anything that shows you that you are getting somewhere with all your hard work.
  • Assign items to categories: Make piles such as “keep,” “throw away,” “recycle,” “donate.”
  • Use the “OHIO” rule: "Only Handle It Once" means that once you pick up an item, you decide what you are going to do with it—no putting it aside for later.
  • Limit yourself to 10 to 20 seconds per item: Decide in under half a minute whether or not you are discarding an item. Longer than that makes the decision to get rid of it harder.
  • Set rules: This includes rules for yourself such as "I will only keep 100 books," and rules for your helpers such as "newspapers and magazines can go, but photos and letters must stay."

Go Digital

Technology gives the opportunity to "hang on to" items without accumulating clutter.

Some ways to digitize clutter include:

  • Read e-books instead of paper books (or read and return library books).
  • Stream movies instead of collecting DVDs.
  • Scan photos and store them online.
  • Switch to online billing, bank statements, and receipts wherever possible.
  • Scan paper documents to store digitally.
  • Choose online subscriptions for newspapers and magazines. (Many publications will also send back issues as PDF files.)
  • Take digital photos of items you want to remember but cannot physically keep.

Accept and Acknowledge Discomfort

Remember that the distress felt when letting items go may feel intense at the time, but lasts for only a short while.

Practice "urge surfing" as a way to cope with discomfort:

  • Notice how you’re experiencing the discomfort: Get comfortable, breathe deeply, and pay attention to your body, noting where in your body you are feeling the discomfort. Name and acknowledge the sensations you are experiencing.
  • Choose one area where you’re experiencing discomfort to focus on: Describe the sensations in that area. Do you feel hot, cold, or numb? Do you have tense muscles? Anything else? Focus on each sensation.
  • Repeat the steps for each part of your body that experiences the discomfort: Describe how the sensations change and how the negative emotion comes and goes.

With regular practice of this technique, negative emotions will become more familiar and easier to ride out.

Recognize, Avoid, and Handle Triggers

There may be situations that make you feel tempted to acquire more items, such as a specific store, a sale item, or an attractive item on someone's curb. There may also be things that increase your stress levels and make it difficult to stick to your commitment to discard items. Learning to resist the urge to bring items home or to hang on to things you don't need is crucial for controlling hoarding symptoms.

Some ways to help manage triggers and resist urges include:

  • Keep a diary to look for patterns in your behavior, habits, and emotions.
  • Practice stress management techniques such as exercise, relaxation, meditation, etc.
  • Distract yourself with a walk, a bath or shower, watching TV, etc.
  • Talk to a friend or loved one.
  • Accept the urge and ride it out.
  • Delay acting on the urge until it passes.
  • Make a shopping list and stick to it.

Summary

Hoarding disorder is a mental health condition marked by excessively saving items and having extreme difficulty discarding things that aren't needed or are not objectively valuable.

The most common approaches to treatment for hoarding disorder are cognitive behavioral therapy (CBT), medication, and in-house decluttering.

A Word From Verywell

While hoarding disorder tends to be treatment-resistant, symptoms can be managed with therapy, medications, and/or lifestyle changes.

Even if a full recovery from hoarding disorder isn't achieved, these treatments can greatly improve quality of life, health, and safety.

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Article Sources
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