Hoarding

Hoarding disorder (HD) is considered an obsessive–compulsive spectrum disorder with key features of difficulty parting with possessions due to strong urges to save and/or distress about discarding. The saving leads to substantial clutter in the home that prevents use of spaces for their intended purpose and leads to impairment in functioning. Acquiring behaviors and low insight are common accompaniments. Standard cognitive and behavioral treatment and pharmacotherapy used to treat OCD are less effective for people with hoarding problems. A cognitive and behavioral theoretical model of hoarding that is supported by research evidence has led to a specialized cognitive and behavioral treatment for hoarding that yields moderate benefits. Treatment can be delivered individually, in groups, in self-help group workshops, or virtually with similar outcomes. Limited insight and low motivation are obstacles for some people with HD. Animal, attachment, and genetic models are under development and likely to expand understanding of this complex problem. Subgroups including children, older adults and non-treatment seeking adults with hoarding disorder require additional research and specialized treatment approaches, including community-based interventions that reduce public health and safety effects of severe hoarding.