Hoarding Disorder

Finding The Right Treatment

Treatment for hoarding disorder

Treatment for hoarding is often dependent on receiving a full and accurate diagnosis of any other disorder which may play a role. It is not uncommon to find an underlying diagnosis of ADHD in addition to Hoarding Disorder. Treating the challenges of ADHD (persistent lifetime struggles with focusing, becoming easily distracted, following through on initiated projects, sustaining interest in low- stimulation or “boring” activities, organizing, setting priorities) with appropriate medications may significantly help reduce hoarding behaviors. Education about the relationship between the two conditions and the impact they have had upon the person throughout the lifespan can also be illuminating.

Cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT) is often a critical component of treatment for Hoarding Disorder. Therapists use cognitive behavioral therapy (CBT) to help individuals overcome their irrational fear associated with relinquishing accumulated items as well as their habit of saving the items. People with Hoarding Disorder usually have a set of beliefs that perpetuates the cycle of collection and saving. For instance, they may fear that they will one day need the item, even though they have not needed it in the past. This may account for stacks of old magazines with recipes, or articles they hope to someday read. They may believe that the item is not replaceable; to discard it is to impose undue hardship in the future. This is often the case with mail, documents, and old records.

Some may feel that the excessive items are attached to the memory of a loved one, and removing those things from the home would dishonor the loved one’s legacy. Many people who hoard are simply overwhelmed by the gravity of the task of sorting through mountains of “stuff.” Their avoidance becomes its own source of anxiety and dread.

The therapist will help the person who struggles with these issues by listening carefully to them. The therapist will help the patient learn how his or her own automatic thoughts tend to follow certain patterns and to how to label them according to this insight. For example, many people who hoard anticipate a catastrophic outcome if a valuable document is discarded. A trained therapist can help the person who hoards look more rationally at this outcome. Are there other ways to reproduce the item? Where would you look for a copy of the item? Would scanning pictures of documents serve as an alternative to preserve something meaningful? The idea is to help the person who hoards turn their beliefs into more rational ones. The therapist is not arguing or trying to talk the person out of their beliefs, but rather helping them recognize distorted thinking. Once the person can recognize that their belief is distorted, they can work to substitute a more rational one. This takes a lot of work!

Usually, hoarding behavior continues for years. No “automatic switch” will suddenly clarify that a belief is not a helpful one and a new one belongs in its place. Behavioral change, including discarding, organizing, or donating the items is also a slow process which should be approached delicately. The behavioral exercises to remove the clutter should reinforce the efforts to change the mindset. The therapist may help the client safely remove items considered less precious first. They may start at one section of the home that is most threatening to health and safety. These behavioral changes (discarding rather than saving) will usually provoke a great deal of anxiety. That is to be expected. It is recommended that the person with Hoarding Disorder allow themselves to feel this anxiety and learn they can get through it.

It is essential that a therapist shows compassion for the person struggling with hoarding, and validates the difficulty of changing one’s mindset and behaviors. This is best accomplished by helping to minimize the shame associated with hoarding and exploring its psychological underpinnings. Hoarding can be viewed from an evolutionary lens; to some extent many humans have a natural tendency to cling to resources that promote our survival.

A compassionate approach can guide the patient to speak to themselves as they would to a friend suffering with the same problem, rather than degrading or blaming themselves. It can also encourage someone who hoards to imagine what life would be like without this behavior and help establish reasonable steps to get there.

CBT does NOT look to the root of the intrusive thoughts and behavior. Research has shown, however, that combining CBT with compassionate insight may be the best approach to yield success.

Finding a therapist

Therapy has been proven to yield major improvements in the lives of those with Hoarding Disorder. While some therapists have experience working with adults with HD, it is best for a patient seeking those services to ask specifically if the therapist in question is trained to provide them.

There are different kinds of professionals who can provide effective therapy:

• Clinical psychologists (PhD)
• Licensed social workers (LSW)
• Licensed professional counselors (LPC)
• Licensed clinical professional counselors (LCPC)
• Licensed Marriage and Family Therapists (LMFT)

The decision to start therapy

Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Asking one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

Medications are not considered helpful in treating Hoarding Disorder if that is the sole diagnosis. Many people with Hoarding Disorder may also have an underlying disorder that is responsive to medication. By treating the underlying disorder, it may be easier to improve the symptoms of hoarding disorder.