Hoarding Disorder: Models, Interventions, and Efficacy

Abstract

Hoarding disorder was once considered a subtype of obsessive-compulsive disorder or a symptom of obsessive-compulsive personality disorder but is now recognized as a distinct diagnostic category in DSM-5. Key features of hoarding include difficulty discarding or parting with possessions due to strong urges to save the items. Difficulty discarding often includes items that others consider to be of little use and results in accumulation of a large number of possessions that clutter the home, preventing use for the intended purpose. Cognitive-behavioral therapy with exposure and response prevention as well as administration of selective serotonin reuptake inhibitor medications traditionally used to treat obsessive-compulsive disorder are generally not efficacious for people with hoarding problems. A specialized cognitive-behavioral therapy approach for hoarding has shown some progress in reaching treatment goals and has been modified for delivery in group and peer-facilitated models. Research on hoarding remains in the early phases of development and is progressing. Special populations such as children, older adults, and people who do not voluntarily seek treatment need special consideration for intervention.