Cognitive Behavioral Therapy for Hoarding Disorder in an Older Female

Abstract

Relationships toward objects can be part of healthy development; however, problems develop when collecting becomes excessive or when the individual has difficulty getting rid of the accumulated items. Hoarding disorder (HD) is defined as an enduring difficulty in discarding possessions as result of a need to save these items, and significant distress linked to disposing of them. Hoarding difficulties are still covered by the clinical guidelines for obsessive-compulsive disorder (OCD) (National Institute for Health and Clinical Excellence), which recommend utilizing psychological therapy at the client’s home. The psychological intervention with the strongest evidence-base is cognitive-behavioral therapy (CBT), but dropout rates are high and difficulties still persist for more than 50% of clients, suggesting that further research is required. Although HD has a higher prevalence in older adults, there is a lack of research into the use of CBT in this population. Preliminary research suggests that adjustments should be made around the difficulties commonly faced by these individuals. This case report outlines the use of CBT to treat “Lucy,” a 67-year-old female with HD complicated by other mental health and physical health difficulties. The case reflects on adaptations that could be made to the existing CBT model.