Treatment

Cognitive Behavioral Therapy - Exposure and Response Prevention

Although hoarding was lumped together with OCD in all but the latest version (DSM-5) of the Diagnostic and Statistical Manual of Mental Disorders, the treatments that work well for OCD often are not as effective in treating Hoarding Disorder.  In response to this, Dr. Gail Steketee, Dr. Robert Frost and Dr. David Tolin created a form of Cognitive Behavioral Therapy (CBT) specifically targeted at hoarding.  A type of Exposure and Response Prevention, this method combines motivational interviewing, cognitive therapy, certain methods of behavioral practice that have been used with OCD patients and skills training.

These four activities are combined to focus on three specific hoarding behaviors.  These are:

• Excessive acquisition of items
• difficulty in getting rid of already-acquired items
• disorganization and clutter that impairs function

This therapy occurs in weekly sessions over a 26 week period.  Some of the sessions take place in a therapist's office, and others take place in the patient's home.

While long-term data on the efficacy of this treatment is currently lacking, a recent study involving 40 severe hoarders showed that 70% of participants who were given this type of CBT were rated as "much" or "very much" improved by their therapists, and 75% rated themselves at the same level.

Group Therapy

Group therapy can be a desirable treatment for those with Hoarding Disorder for several reasons.  First, clinicians who specialize in hoarding are relatively rare.  By working with a larger group, more people can be given access to these specialized professionals.  Secondly, working in larger groups can help to defray the cost of treatment, which can be a problem for those with hoarding tendencies due to reasons discussed elsewhere on this site.  Most importantly, group therapy can give much needed support to those suffering with this mental disorder.  They can be shown that, despite their feelings to the contrary, they are not alone.  They can also see the successes in others who are dealing with similar issues, and can face other problems like social anxiety that may be exacerbating their hoarding.

While group therapy does not appear to be as effective as CBT, having only shown results of "moderate improvement" in hoarding, it can still be effective and should not be discounted as one aspect of a treatment plan.


Medications

The following Selective Serotonin Reuptake Inhibitor (SSRI) medications have been effective in treating OCD, and have been used in the treatment of Hoarding Disorder.

• luvoxamine 
• fluoxetine 
• sertraline 
• paroxetine 
• citalopram 
• clomipramine 
• escitalopram 
• venlafaxine 

Unfortunately, these medications appear to have much less efficacy on hoarding than they do on OCD.  In fact, a study of 18 hoarding patients given these types of antidepressants showed that 9 showed a very small improvement, 8 showed no improvement at all and only one showed improvement of any real significance.  If a patient is showing no response to the drugs listed above, one of the following antipsychotic medications may be added to their prescription:

• risperidone
• olanzapine
• quetiapine
• haloperidol
• fluphenazine

Currently no research exists as the the effectiveness of this additional medication on hoarding behavior.

As is often the case with mental disorders, the most difficult and time consuming of the treatments is the most effective.  While it would be wonderful if we could all just pop a pill and find ourselves cured of our ills, CBT is currently the treatment that offers the best chance at recovery from Hoarding Disorder.  For help finding skilled professionals who can help provide treatment for hoarding, please visit either the "Local Resources" tab or the "Online and Distance Resources" tab at the top of the page.