Hoarding is a complicated and understudied psychiatric condition that affects approximately 4% of the population. It affects not only those diagnosed, but also family members and friends who are often the first to seek treatment for their loved ones. Despite garnering media attention in recent years, there are still many questions that remain unanswered about this frequently impairing condition.
The good news is that there are effective treatment options and support groups available. Our clinic is dedicated to providing evidence-based treatment for hoarding. We currently offer individual cognitive behavioral therapy (CBT) and pharmacotherapy (medication) for hoarding.
What is Hoarding?
Hoarding is a psychiatric illness characterized by the following symptoms:
- An excessive collection of objects.
The objects may be free items or acquired during shopping. Examples of items include clothing, newspapers, and books.
- An inability to relinquish objects.
Though most objects being hoarded are worth little monetary value and may appear worthless to others, individuals who hoard struggle to dispose of the items. Getting rid of them can be very challenging and even emotionally traumatizing. Individuals who hoard are often concerned about avoiding waste or needing the items at a later time. Others may form a strong emotional attachment to the possessions.
The acquisition of items coupled with the struggle to dispose of them leads to severe clutter around the space where the items are hoarded. Individuals with hoarding may prohibit visitors from entering their home because they feel ashamed or embarrassed by the clutter. In severe cases, the clutter can pose a serious health or safety risk (e.g. electrical fires, mice infestations, mold, etc.). A person who engages in hoarding usually has at least one designated space, such as a room, house, or office filled with so much clutter that it is either no longer functional or uninhabitable.
- Impairment and/or distress
The behaviors associated with hoarding may cause sufferers to feel isolated, depressed, and anxious. They may feel guilty about the idea of throwing out any of their possessions or frustrated with a family member who suggests doing so. They may also refrain from socializing with friends, going to work or school, and engaging in other typical day-to-day activities.
Difficulty organizing items is also a common symptom of hoarding. Research suggests that the disorganization is in part caused by neurological impairment associated with information processing, memory, categorization, and decision-making. Further research is needed to better understand hoarding etiology.
Many people with hoarding also suffer from Obsessive Compulsive Disorder (OCD) which is why it falls under the umbrella of OC-spectrum disorders. In fact, approximately 25% of individuals with OCD also exhibit hoarding compulsions. The relationship between the two disorders is not entirely clear, and typical OCD treatments do not always improve hoarding symptoms.
Signs of Hoarding:
- Excessive acquisition of items.
- Refusal to throw out, donate, or recycle items that most people would consider worthless and/or becoming upset when others try to dispose of possessions.
- Significant clutter around the house, making it challenging to maneuver or find things.
- Interference with daily activities (e.g. leaving the house, maintaining a clean living space, socializing, etc.)
- Unsafe or unhygienic conditions (e.g. fire hazards, rotten food, vermin, etc.) resulting from the clutter.
- Embarrassment and/or refusal to allow visitors into the house.
Treatment for hoarding involves cognitive behavioral therapy (CBT) and/or medication. The therapy often requires the clinician to go into the patient's home in order to assess the conditions and facilitate effective treatment. Family and friends of individuals who hoard may also benefit from participating in hoarding support groups.
What is CBT for hoarding?
The goal of CBT is to identify the individual's attachment to his/her possessions and modify any distorted thoughts or beliefs he/she holds in relation to the items. In addition, the therapist assists the patient in learning to replace problematic rituals, such as impulsive purchasing and refusal to get rid of items with healthier behaviors using the following techniques:
- Practicing disposing of the hoarded items first with the help of a trained professional and then independently.
- Teaching the individual to question, challenge and eventually modify their thought patterns (e.g. challenging the notion that items need to be kept on hand or considering the negative consequences of hoarding on marriage or friendships)
- With the help of a clinician, learning how to go out without purchasing unnecessary items.
- Accepting that relapse might happen and creating a plan to prevent future clutter.
CBT is a collaborative process between the patient and their therapist. All exercises are done at a pace that patients are comfortable with and patients are never forced to do anything that they are not willing to do.
Which medications can help with hoarding?
Though CBT is typically considered the treatment of choice for hoarding, research studies have supported the use of a few medications in the management of hoarding-related symptoms. Antidepressants, such as paroxetine (brand-name Paxil) and venlafaxine (brand-name Effexor) may be prescribed in conjunction with, or in place of, therapy. These medications may prove useful even in the absence of clinical depression.
Deciding on which treatment strategies one may utilize depends on many factors, including the individual’s motivation and preference, severity of symptoms, and experience with previous treatment approaches. In many cases, CBT and medication work hand-in-hand and can together enhance overall improvement.
To receive further information about our program and clinical services, please contact Barbara Davidson at (617) 726-6766.
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