Treatment Of Compulsive Hoarding Research Articles

Open Trial of Inference-Based Therapy in the Treatment of Compulsive Hoarding

Open Trial of Inference-Based Therapy in the Treatment of Compulsive Hoarding

Using Virtual Reality in the Inference-Based Treatment of Compulsive Hoarding.

The present study evaluated the efficacy of adding a virtual reality (VR) component to the treatment of compulsive hoarding (CH), following inference-based therapy (IBT). Participants were randomly assigned to either an experimental or a control condition. Seven participants received the experimental and seven received the control condition. Five sessions of 1 h were administered weekly. A significant difference indicated that the level of clutter in the bedroom tended to diminish more in the experimental group as compared to the control group F(2,24) = 2.28, p = 0.10. In addition, the results demonstrated that both groups were immersed and present in the environment. The results on posttreatment measures of CH (Saving Inventory revised, Saving Cognition Inventory and Clutter Image Rating scale) demonstrate the efficacy of IBT in terms of symptom reduction. Overall, these results suggest that the creation of a virtual environment may be effective in the treatment of CH by helping the compulsive hoarders take action over their clutter.

Treatment of Compulsive Hoarding: A Case Study 

The present case report describes an intensive treatment approach combining aggressive pharmacotherapy with daily cognitive behavioral therapy (CBT) directed at helping “Dee,” a 63-year-old female suffering from compulsive hoarding. The successful intervention consisted of individualized exposure and response prevention (ERP), in addition to cognitive restructuring to improve insight, decrease depressive and general anxiety symptoms, and address distorted beliefs. Pretreatment evaluation included assessment of clutter for all living spaces, including rooms in the house in addition to the car. After the six-week intensive treatment program, clutter decreased substantially in each of the rooms targeted for intervention. In addition, Dee’s scores on self-reported measures of obsessive-compulsive symptoms and anxiety steadily decreased during the intervention. Compulsive hoarding, when present in patients with obsessive-compulsive disorder (OCD), has been associated with poor response to both antianxiety medications and typical CBT. This case report illustrates that specific CBT strategies targeting the characteristic features of compulsive hoarding may provide better results for patients suffering from compulsive hoarding syndrome.

Inference-Based Therapy for Compulsive Hoarding

Compulsive hoarding (CH) is a chronic and debilitating condition that generally shows poor treatment response to both psychopharmacotherapy and cognitive-behavioral therapy. The present case study describes the application of a cognitive inference-based therapy program to the treatment of a 39-year-old woman diagnosed with CH. During a 24-week treatment period, her hoarding behavior and associated beliefs significantly decreased. Specifically, Yale–Brown Obsessive-Compulsive Scale scores became subclinical at the 6-months follow-up. There was also a clinically significant decrease in Beck Depression Inventory–II, Beck Anxiety Inventory, Overvalued Ideas Scale, and Saving Inventory–Revised scores. The single case study has implications for the treatment of CH and other problems showing ego-syntonic beliefs.

Compulsive hoarding in children

This article discusses the nature and treatment of compulsive hoarding among children. We summarize the phenomenology of compulsive hoarding, including its clinical presentation, comorbidity with varied mental disorders, and associated impairment. The limited data on treatment outcome are presented along with a behavioral framework that we utilized to treat youth who hoard. Our approach is highlighted in the context of a case illustration of an 11-year-old girl suffering from compulsive hoarding and several comorbid mental health disorders. We conclude with recommendations for clinical work with this challenging and neglected population.

Ethical Considerations in the Treatment of Compulsive Hoarding

Although empirically supported treatment for compulsive hoarding is in its preliminary stages, some information has emerged regarding ethical challenges experienced in treating this population. Our aims are twofold: (a) to inform the clinical community of ethical complications when conducting treatment for hoarding clients, and (b) to provide a decision-making model for ensuring quality and ethical care of hoarding clients. The ethical challenges (boundary crossings, dual roles, privacy/confidentiality, record keeping, fees, and cultural competence in treatment) were discovered through multiple roundtable discussions, supervision, and in the course of delivering empirically supported treatment protocols. A literature search was conducted to identify research that addressed ethical concerns. A decision-making model addressing ethical challenges in treatment of compulsive hoarding was developed.

Zwanghaftes Horten – Eine Literaturübersicht

To provide an overview of empirical findings with regard to compulsive hoarding. A systematic literature search of medical and psychological journals was conducted using PubMed. Relevant publications from the reference lists and recent books were also identified and included. The article reviews the phenomenology, diagnosis, etiology, neurobiology, prevalence, conceptualization, and treatment of compulsive hoarding. Compulsive hoarding is characterized by excessive acquisition, difficulty discarding possessions, clutter that precludes activities for which living spaces where designed and it causes significant distress, family and socioeconomic burden. Neuropsychological studies and neuroimaging indicate dysfunction of the anterior cingulated cortex and other ventral and medial prefrontal cortical areas. Further research is required to resolve the controversy as to whether compulsive hoarding is characteristic of a subtype of OCD or an unique syndrome and to develop disorder specific treatments.

Recent advances in compulsive hoarding

Compulsive hoarding is a common and often disabling neuropsychiatric disorder. This article reviews the conceptualization, phenomenology, diagnosis, etiology, neurobiology, and treatment of compulsive hoarding. Compulsive hoarding is part of a discrete clinical syndrome that includes difficulty discarding, urges to save, excessive acquisition, indecisiveness, perfectionism, procrastination, disorganization, and avoidance. It was thought to be part of obsessive-compulsive disorder or obsessive-compulsive personality disorder, but recent evidence indicates that it should be classified as a separate disorder with its own diagnostic criteria. Compulsive hoarding is a genetically discrete, strongly heritable phenotype. Neuroimaging and neuropsychological studies are elucidating its neurobiology, implicating dysfunction of ventral and medial prefrontal cortical areas that mediate decision-making, attention, and emotional regulation. Effective treatments include pharmacotherapy and cognitive-behavioral therapy. More research will be required to determine the prevalence, etiology, and pathophysiology of compulsive hoarding and to develop better treatments.

Neurobiology and Treatment of Compulsive Hoarding

Compulsive hoarding is a common and often disabling neuropsychiatric disorder. This article reviews the phenomenology, etiology, neurobiology, and treatment of compulsive hoarding. Compulsive hoarding is part of a discrete clinical syndrome that includes difficulty discarding, urges to save, clutter, excessive acquisition, indecisiveness, perfectionism, procrastination, disorganization, and avoidance. Epidemiological and taxometric studies indicate that compulsive hoarding is a separate but related obsessive-compulsive spectrum disorder that is frequently comorbid with obsessive-compulsive disorder (OCD). Compulsive hoarding is a genetically discrete, strongly heritable phenotype. Neuroimaging and neuropsychological studies indicate that compulsive hoarding is neurobiologically distinct from OCD and implicate dysfunction of the anterior cingulate cortex and other ventral and medial prefrontal cortical areas that mediate decision-making, attention, and emotional regulation. Effective treatments for compulsive hoarding include pharmacotherapy and cognitive-behavioral therapy. More research will be required to determine the etiology and pathophysiology of compulsive hoarding, and to develop better treatments for this disorder.

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Although standard diagnostic classifications consider obsessive-compulsive disorder (OCD) to be a single diagnostic entity, it has become clear that it is a heterogeneous disorder, with great variability in clinical presentation. This heterogeneity has complicated the interpretation of clinical, neurobiological, and genetic studies in OCD. Therefore, researchers have sought to identify clinically meaningful phenotypes that might be more homogeneous and heritable to facilitate our understanding of the etiology and pathophysiology of OCD and ultimately lead to improved treatments (1). Factor analytic studies have consistently identified four principal OCD symptom dimensions: 1) harm-related, aggressive, sexual, and religious obsessions with checking compulsions; 2) symmetry obsessions with arranging and repeating compulsions; 3) contamination obsessions with cleaning compulsions; and 4) hoarding and saving symptoms (1, 2). These symptom factors are relatively stable over time and show different patterns of genetic inheritance, age at onset, comorbidity, and treatment response (see 1 for review). Cluster analyses, which seek to identify mutually exclusive, categorical subgroups, indicate that some of these symptom factors, such as hoarding, may constitute discrete subtypes of OCD (3, 4). Hoarding is defined as the acquisition of and inability to discard items, even though they appear (to others) to have no value (5). Hoarding behavior has been observed in several neuropsychiatric disorders, including schizophrenia, dementia, eating disorders, autism, and mental retardation, as well as in non-clinical populations, but it is most commonly found in OCD (6). 30% to 40% of OCD patients report hoarding and saving symptoms (6–8), and about 10% to 15% have hoarding as their most prominent symptom factor (3, 6). Compulsive hoarding is most commonly driven by obsessional fears of losing important items that the patient believes will be needed later, distorted beliefs about the importance of possessions, excessive acquisition, and exaggerated emotional attachments to possessions (5). Compulsive hoarding and saving leads to clutter that can cover living and work spaces, rendering them unusable. Hoarding frequently causes significant impairment in social and occupational functioning. In severe cases, it can produce health risks from infestations, falls, fires, and inability to cook or eat in the home (6). In this issue of the Journal, Jack Samuels, Ph.D., et al. report results from the OCD Collaborative Genetics Study, finding “suggestive” linkage of compulsive hoarding to a marker on chromosome 14 in families with OCD. The linkage became stronger when only families with two or more family members with compulsive hoarding were tested. Compulsive hoarding is well known to run in families. Hoarding behaviors are significantly more prevalent in the relatives of hoarding OCD patients than nonhoarding OCD patients (9). In the OCD Collaborative Genetics Study, hoarding was the most strongly familial of the OCD symptom factors, with robust correlations among sibling pairs (10). Only two previous genetic studies have examined the hoarding phenotype. Lochner et al. (8) found that the met/met (L/L) genotype of the catechol O-methyltransferase val158met polymorphism on chromosome 22q11 was significantly more prevalent in Afrikaner OCD patients with

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Treatment of Compulsive Hoarding

Compulsive hoarding and saving symptoms, found in many patients who have obsessive-compulsive disorder (OCD), are part of a clinical syndrome that has been associated with poor response to antiobsessional medications and cognitive-behavioral therapy (CBT). Specific CBT strategies targeting the characteristic features of the compulsive hoarding syndrome have had better results. This article provides an overview of the compulsive hoarding syndrome, a review of treatment approaches and their efficacy, a case presentation, and a detailed discussion of intensive, multimodal CBT for compulsive hoarding. New insights into the neurobiological characteristics of compulsive hoarding that might direct future treatment development are also presented. (Reprinted with permission from the Journal of Clinical Psychology 2004; 60(11): 1143–1154)

The Treatment of Compulsive Hoarding with Object-Affect Fusion Informed CBT: Initial Experimental Case Evidence

The central aim of this study was to assess the effectiveness of object-affect fusion informed cognitive-behavioural therapy, with a patient presenting with compulsive hoarding. The methodology employed an A/B single case experimental design. Experimental measures illustrated an increased ability to be able to discard objects and an increased sense of associated ease of discard during treatment, with clinically significant change across a variety of robust psychometric measures in the pre-post data. The study illustrates the utility of single-case approaches in the evaluation of innovative clinical approaches and also the potential for utilizing the object-affect fusion concept in the treatment of compulsive hoarding.

GROUP AND INDIVIDUAL TREATMENT OF COMPULSIVE HOARDING: A PILOT STUDY

Treatment of compulsive hoarding has rarely been described in the literature, apart from standard treatments for obsessive compulsive disorder of which hoarding is thought to be a subset. This paper presents preliminary findings from seven patients treated with cognitive and behavioral interventions derived from Frost and Hartl's (1996) theoretical model of hoarding. Six clients attended 15 group treatment sessions over 20 weeks plus individual home treatment sessions and one client received 20 weekly-sessions of individual treatment only. After 20 weeks, treatment resulted in noticeable improvement in several hoarding symptoms for five of the seven patients, especially reduction in excessive acquisition of possessions, although problems with clutter persisted. Three of four clients who continued in treatment for approximately 1 year showed substantial further improvement, although none felt entirely recovered. Findings are discussed in light of the model of hoarding and possible modifications to treatment to enhance motivation and benefits.

Issues in the treatment of compulsive hoarding

Compulsive hoarding is a symptom of obsessive-compulsive disorder (OCD) that has received very little attention in the research literature. This paper presents a brief review of existing research on this topic and an overview of a recently developed cognitive behavioral model of compulsive hoarding. Our attempts to develop a treatment program for compulsive hoarding are described, and issues of importance in the treatment of hoarding are discussed.

Continuing education quiz: Issues in the treatment of compulsive hoarding (Frost & Steketee, pp. 397–407)

Continuing education quiz: Issues in the treatment of compulsive hoarding (Frost & Steketee, pp. 397–407)