OCD Treatment Compulsive Hoarding Treatment By Owen Kelly, PhD Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. Learn about our editorial process Updated on November 13, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Getty Images Compulsive hoarding is more than really 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 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 listsSevere cluttering of the person’s home so that the home is no longer able to function as a viable living spaceSignificant distress or impairment in work or social life Hoarding and Its Connection to OCD Treatments for Hoarding 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. Dr. Randy Frost is credited with establishing compulsive hoarding as a problematic behavior in the psychological literature in the early 1990s. Subsequently Frost worked with Dr. Gail Steketee to develop a CBT protocol designed specifically for hoarding. 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 with organization, categorization, and making decisions regarding whether to keep possessions or not. 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 possessions 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. Barriers to Hoarding Treatment Insight into the severity of symptoms and the necessity for change is essential to the success of almost any form of treatment. When people do not have insight into their illness, they are much more likely to either stop taking 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, 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 secondary to the consequences 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. 10 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Grisham JR, Baldwin PA. Neuropsychological and neurophysiological insights into hoarding disorder. Neuropsychiatr Dis Treat. 2015;11:951–962. doi:10.2147/NDT.S62084 Boerema YE, De boer MM, Van balkom AJLM, Eikelenboom M, Visser HA, Van oppen P. Obsessive compulsive disorder with and without hoarding symptoms: characterizing differences. J Affect Disord. 2019;246:652-658. doi:10.1016/j.jad.2018.12.115 Muroff J, Bratiotis C, Steketee G. Treatment for hoarding behaviors: a review of the evidence. Clin Soc Work J. 2011;39:406–423. doi:10.1007/s10615-010-0311-4 Frost RO, Gross RC. The hoarding of possessions. Behav Res Ther. 1993 May;31(4):367-381. Steketee G, Frost RO. Compulsive Hoarding and Acquiring: Therapist Guide (Treatments That Work). New York: Cambridge University Press; 2006. Grisham JR, Norberg MM. Compulsive hoarding: current controversies and new directions. Dialogues Clin Neurosci. 2010;12(2):233–240. Dozier ME, Ayers CR. The etiology of hoarding disorder: a review. Psychopathology. 2017;50(5):291-296. doi:10.1159/000479235 International OCD Foundation. Hoarding fact sheet (.pdf). Williams M, Viscusi JA. Hoarding disorder and a systematic review of treatment with cognitive behavioral therapy. Cogn Behav Ther. 2016;45(2):93-110. doi:10.1080/16506073.2015.1133697 Tolin DF, Frost RO, Steketee G, Fitch KE. Family burden of compulsive hoarding: results of an internet survey. Behav Res Ther. 2008;46(3):334–344. doi:10.1016/j.brat.2007.12.008 Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Fifth edition. Arlington, Va.: American Psychiatric Association; 2013. By Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for OCD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.