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Compulsive hoarding is defined as the excessive collection and saving of things to the point that it impedes daily functioning and creates a hazard or potential hazard for the individual. Hoarding frequently develops into a vicious cycle whereby individuals almost literally become trapped in their own homes due to the sheer amount of clutter that amasses. This excess clutter often results in both decreased mobility within the home as well as decreased home utility (i.e., showers and ovens are often sacrificed for extra storage space). Hoarding disorder may be diagnosed in cases where clutter is controlled by roommates and/or family members, but difficulty discarding nevertheless causes difficulty in relationships.
Hoarders may experience a fear of losing items that may be needed later and exaggerated beliefs about the importance of material possessions. Hallmarks of people who hoard typically include an excessive emotional attachment to possessions; difficulties with decision-making, categorization, and organization; perfectionism; and procrastination. Compulsions may include excessive shopping or collecting as well as other forms of acquisition (e.g., compulsive saving of postal mail, e-mail, and phone messages). Hoarding has been found to be much more common than previously thought with more than half of those with lifetime obsessive-compulsive disorder (OCD) endorsing at least some hoarding behaviors.
Hoarding has traditionally been considered a form of OCD, but researchers now consider it to be significantly different. Hoarders tend to have fewer intrusive thoughts about possessions and fewer urges to perform rituals. Further, many are actually content with their surroundings until friends, family, or local authorities attempt to intervene. In other words, distress only becomes prominent when faced with the prospect of losing possessions. For these and other reasons, in the absence of other OCD symptoms, hoarding as officially been reclassified as a separate but related disorder.
Research has shown that a type of cognitive-behavioral therapy (CBT) called exposure and ritual prevention (EX/RP) is effective for hoarding.
However, while EX/RP is effective for hoarding, studies show that it does not respond as well as OCD. So, there have been some new developments in treatments specifically for hoarding. Drs. Gail Steketee and Randy Frost developed a specialized treatment for compulsive hoarding, which involves EX/RP, motivational interviewing, and weekly home visits over the span of 6-12 months. At Louisville OCD Clinic, we offer a combined treatment program, that includes exposure and ritual prevention, motivational interviewing with a psychologist, and weekly home visits with a behavioral coach. Clients will learn how to organize, prioritize, discard unneeded items, and prevent ongoing accumulation.
Medication can be helpful in reducing hoarding symptoms, but it is rarely adequate as a stand alone treatment. Forced "clean outs" of the individual's home are extremely distressing and not effective in the long run, as the person does not learn how to combat the disorder, resulting in a reaccumulation of items. Medication can be arranged when appropriate.