Top Hoarding Disorder Treatments

According to the American Psychological Association, approximately 2.5% of the US population fits the criteria for hoarding disorder, with higher rates for adults over 60 years old and those with other psychiatric conditions, especially anxiety and depression.

Hoarding behavior occurs early in life and becomes more severe with each decade. This condition is distinguished by a chronic difficulty in discarding items, regardless of their actual value, resulting in distress and impairment in everyday functioning.

Individuals with hoarding disorder frequently have disorganized living areas, strained relationships, and compromised quality of life. As awareness and understanding of this complex mental health issue grow, so too do the treatment options available.

This article will explore the best evidence-based treatments for hoarding disorder, aiming to provide a comprehensive guide for those seeking help. From the different types of therapy to emerging interventions, we will explore the strategies that offer hope and healing for those grappling with this challenging disorder.

1. Cognitive Behavioral Therapy (CBT)

Source: ThinkCBT

CBT, a type of talking therapy, is the primary treatment for individuals struggling with hoarding disorder. CBT helps treat hoarding disorder by focusing on changing thought patterns and behaviors related to acquiring and saving items.

CBT is widely recognized as the best treatment for hoarding disorder. A meta-analysis of 16 studies with 505 participants found that CBT significantly improved reducing hoarding disorder symptoms immediately after treatment and in follow-up assessments. Specifically, participants showed substantial reductions in hoarding behaviors after completing CBT.

The studies also indicated that women benefited slightly more from CBT than men. Additionally, CBT was found to moderately reduce depressive symptoms in individuals with hoarding disorder, although this effect was negligible compared to the reduction in hoarding behaviors.

Another study involving 87 adults with hoarding disorder proved that group CBT sessions were effective. Participants attended 16 weekly 90-minute group sessions focused on practicing discarding items, decision-making, problem-solving, managing emotional distress, and motivational strategies.

The results demonstrated that group CBT was significantly more effective than the waitlist in reducing hoarding symptoms. The study also found that changing maladaptive beliefs about possessions helped improve treatment outcomes, highlighting the importance of addressing cognitive aspects of hoarding behavior.

Overall, CBT is a proven and practical treatment for hoarding disorder. It has shown significant benefits in reducing hoarding behaviors and improving the quality of life for those affected.

2. Usage of Virtual Reality

Virtual reality (VR) is an innovative technology that enables the creation of simulated environments. VR facilitates virtual sorting and discarding by generating a virtual "home" using 3D scans of the person's actual possessions. This approach acts as a bridge to real-life discarding, beneficial for individuals who initially find it challenging to part with their belongings.

In a study involving 9 adults with hoarding disorder, an 8-week VR intervention was added to their 16-week group therapy, which provided peer support and cognitive behavioral skills related to hoarding. Individualized VR rooms modeled after each patient's home were used for sorting and discarding exercises.

Open-ended responses from participants revealed that VR sessions were well-tolerated and considered valuable. Self-reported hoarding symptoms decreased from baseline to the end of the study, with 7 out of 9 participants showing significant improvement and none experiencing deterioration.

3. Compassion-Focused Therapy (CFT)

CFT is emerging as a promising treatment for hoarding disorder. This therapy involves techniques to boost self-compassion, reduce self-blame, and manage negative emotions, often incorporating mindfulness to enhance emotional awareness.

A study assessed the feasibility and effectiveness of CFT for individuals with hoarding disorder who remained symptomatic after CBT. 40 participants were divided into two groups: one receiving CFT and the other undergoing a second round of CBT.

Results showed that 72% of participants in the CFT group and 37% in the CBT group completed the treatment. 77% of those who completed CFT had hoarding severity scores below the clinical threshold, and 62% showed a significant reduction of symptoms compared to 23% and 29% in the CBT group, respectively.

These findings suggest that CFT is not only feasible and acceptable but also potentially more effective than additional CBT sessions in reducing hoarding symptoms and addressing underlying mechanisms.

4. Coordinated Community Interventions

Hoarding disorder often needs a coordinated, multidisciplinary approach to address the complex social, environmental, and public health concerns associated with severe hoarding behaviors. Excessive accumulation of possessions and clutter can lead to unsafe living conditions, increased fire risks, sanitation issues, and other hazards, posing significant risks to the individuals affected and the broader community.

To tackle these challenges, communities have established programs implementing evidence-based treatments in community settings. One study evaluated the implementation of Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for adults with hoarding disorder.

The goal of CREST implementation was to use a multidisciplinary approach, which included individual therapy, care management, peer support, family psychoeducation, and after-care groups. This program significantly reduced hoarding symptoms by 43% and clutter volume by 28% after treatment.

5. Harm Reduction

Rather than completely eliminating hoarding behavior, the harm reduction approach focuses on decreasing the risks and hazards associated with excessive clutter and possession accumulation.

Implementing this approach requires actively involving the individual in decision-making and fostering a supportive, non-judgmental relationship between the client and service providers.

Adopting a harm reduction model can assist individuals in reducing clutter volume to maintain housing or reorganizing possessions into safer configurations instead of pushing for the complete removal of items. The underlying principle behind harm reduction is to mitigate risks while preserving the autonomy and decision-making capacity of the person with hoarding disorder.

6. Pharmacological Therapies

Currently, no medicines are approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Medicines often used as treatments for hoarding disorder are also those that treat conditions like anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD), which may occur alongside the disorder. Below are the medications used, as mentioned in clinical studies:

Paroxetine (Paxil®)

Source: KHealth

Paroxetine, commonly known by its brand name Paxil®, is a selective serotonin reuptake inhibitor (SSRI) that has been studied for its potential to treat hoarding disorder. SSRIs, which are commonly used to treat obsessive-compulsive disorder (OCD), have been explored as a treatment for hoarding disorder due to the similarities of both conditions. However, the effectiveness of SSRIs for hoarding disorder remains a subject of debate.

One open trial of paroxetine included participants with hoarding disorder and OCD. The study showed that 28% of patients with hoarding disorder responded fully to the treatment, while about half of the participants showed partial benefits.

The outcomes for patients with hoarding disorder were similar to those for OCD patients without hoarding disorder. However, many participants experienced difficulty tolerating paroxetine, indicating that while it may be effective for some, its side effects can be a significant drawback.

Venlafaxine (Effexor®)

Source: IndiaMart

Venlafaxine, marketed as Effexor®, is a serotonin-norepinephrine reuptake inhibitor (SNRI) that has also been investigated for treating hoarding disorder.

In an open trial involving 24 patients with hoarding disorder, extended-release venlafaxine was tested over a period of time. The study found a 32% decrease in symptoms of hoarding disorder, with 70% of participants showing a reasonable response rate to the treatment. This suggests that venlafaxine might be particularly effective for reducing hoarding behaviors, although further controlled trials are needed to confirm these findings.

Atomoxetine

Source: CamberPharma

Atomoxetine, a drug usually used for ADHD, has shown promising results for hoarding disorder.

In a 12-week study, participants saw a 41.3% drop in hoarding severity. This drug helped reduce inattention and impulsivity by 18.5%, which are behaviors linked to hoarding. Of the 12 people in the study, 6 participants had significant improvements, while 3 had moderate improvements. These findings suggest that atomoxetine could be a valuable treatment option for individuals struggling with hoarding disorder.

Methylphenidate

Source: CamberPharma

Methylphenidate is a stimulant also used to treat ADHD. A study investigated methylphenidate extended release (MPH-ER) in adults with hoarding disorder but without ADHD. Over four weeks, 3 of 4 participants experienced a ≥50% reduction in inattention symptoms, as measured by the ADHD Symptom Scale. Two participants also reported modest reductions in hoarding symptoms, particularly excessive acquisition.

Despite these benefits, all participants discontinued MPH-ER due to side effects like insomnia and palpitations. The study findings suggest that while MPH-ER can improve attention and reduce some hoarding behaviors, its adverse effects may limit its long-term use.

7. Lifestyle Remedies

In addition to the therapies and interventions mentioned, there are also some lifestyle remedies that individuals with hoarding disorder can practice, such as:

Following The Treatment Plan for Hoarding Disorder

Following the therapist's treatment plan can help improve self-esteem, enhance the desire to change, and reduce unwanted behaviors. Establishing a daily schedule to minimize clutter, especially during peak energy, can also be beneficial.

Furthermore, with professional assistance, it is recommended to tackle one area at a time when addressing hoarding disorder. Small and consistent victories can lead to significant overall progress.

Seeking and Accepting Help

Seeking assistance and motivation from professionals and loved ones can help you make effective decisions about organizing and decluttering your belongings.

Hoarding can cause isolation and loneliness, which may increase hoarding behavior. Joining a support group for people with hoarding disorder can also provide a sense of belonging, access to vital resources, and further knowledge about the condition.

Maintaining Self-Care and Ensuring Proper Well-Being

Proper hygiene and nutrition are essential to ensure overall health and well-being. It's crucial to remember that living in chaos and distress is unnecessary, and everyone deserves better. Focusing on personal goals and the benefits of reducing clutter can be motivating.

Takeaway

Overcoming hoarding disorder is a complex journey, but treatments like therapies, community interventions, harm reduction, medications, and lifestyle adjustments provide hope and a way forward. These approaches promote healthier thinking and habits.

Whether by challenging harmful beliefs, managing emotions, or creating routines to declutter, these therapies address the root causes of hoarding disorder, empowering individuals and supporting the recovery process.

Seeking professional guidance, exploring treatment options, and persisting through challenges is crucial in treating hoarding disorder. With the proper support and treatment, overcoming the challenges of hoarding disorder and improving quality of life is possible.

FAQs About Hoarding Disorder Treatments

What are the consequences that may arise from having a hoarding disorder?

Hoarding disorder can result in several consequences, such as having strained relationships with friends and family, isolation and loneliness, inability to perform daily tasks, and increased risk of having fire hazards, health code violations, and tripping hazards due to the accumulated items.

What causes hoarding disorder?

Hoarding disorder may be influenced by genetic, cognitive, emotional, and environmental factors. Twin studies suggest that up to 50% of the variance in hoarding behaviors may be genetically linked. Other significant factors include cognitive problems like poor organization and decision-making, a strong attachment to belongings, and the use of hoarding as a coping mechanism for trauma or negative emotions.

How do you differentiate hoarding disorder from collecting?

Hoarding disorder differs from collecting in that collectors actively seek out specific items, organize them meticulously, and display collections neatly. Collections can be extensive but typically remain orderly and do not lead to the distress and functional impairments associated with hoarding disorder.