Skip to main content

Advertisement

SpringerLink
Log in

Treatment for Hoarding Behaviors: A Review of the Evidence

  • Original Paper
  • Published:
Clinical Social Work Journal Aims and scope Submit manuscript

Abstract

This article reviews the empirical literature on treating clients with hoarding behaviors, including psychosocial treatments, mainly cognitive behavioral, and pharmacotherapy. Standard treatments used for obsessive compulsive disorder (OCD) such as medication and/or behavior therapy have been associated with poor treatment response for those with hoarding. Recent prospective pharmacotherapy research suggests that serotonergic medication may be helpful to OCD patients with or without hoarding. A multi-component cognitive behavioral treatment (CBT) designed specifically for hoarding has shown promising results especially in trials of individual therapy with periodic home visits. Social work researchers have played a prominent role in the development and testing of this CBT intervention and development of instruments to assess hoarding treatment outcomes. This CBT intervention has demonstrated modest success when delivered individually in an open trial and a waitlist-controlled trial, and in quasi-experimental studies of group treatment modalities, including in-person and web-based groups as well as bibliotherapy-based support groups. Overall, evidence supports the use of specialized CBT methods to improve hoarding symptoms. Future testing may include controlled trials with more diverse samples.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Cohen’s d conversion from partial eta squared (η 2p ). Note that this conversion is robust only when k = 2 and N > 100 and therefore must be viewed cautiously in this context.

References

  • Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71, 1049–1057.

    Article  PubMed  Google Scholar 

  • Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help-seeking. American Psychologist, 58, 5–14.

    Article  PubMed  Google Scholar 

  • Alonso, P., Menchon, J. M., Pifarre, J., Mataix-Cols, D., Torres, L., Salgado, P., et al. (2001). Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy. Journal of Clinical Psychiatry, 62, 535–540.

    Article  PubMed  Google Scholar 

  • Black, D. W., Monahan, P., Gable, J., Blum, N., Clancy, G., & Baker, P. (1998). Hoarding and treatment response in 38 nondepressed subjects with obsessive-compulsive disorder. Journal of Clinical Psychiatry, 59, 420–425.

    Article  PubMed  Google Scholar 

  • Bratiotis, C., & Flowers, K. L. (2010). Community-based compulsive hoarding interventions for elders who hoard. Journal of Geriatric Care Management, 20(2), 15–20.

    Google Scholar 

  • Busseri, M. A., & Tyler, J. D. (2003). Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form. Psychological Assessment, 15, 193–197.

    Article  PubMed  Google Scholar 

  • Cermele, J. A., Melendez-Pallitto, L., & Pandina, G. J. (2001). Intervention in compulsive hoarding. A case study. Behavior Modification, 25, 214–232.

    Article  PubMed  Google Scholar 

  • Cullen, B., Brown, C. H., Riddle, M. A., Grados, M., Bienvenu, O. J., Hoehn-Saric, R., et al. (2007). Factor analysis of the Yale-Brown Obsessive Compulsive Scale in a family study of obsessive-compulsive disorder. Depression and Anxiety, 24, 130–138.

    Article  PubMed  Google Scholar 

  • Erzegovesi, S., Cavallini, M. C., Cavedini, P., Diaferia, G., Locatelli, M., & Bellodi, L. (2001). Clinical predictors of drug response in obsessive-compulsive disorder. Journal of Clinical Psychopharmacology, 21, 488–492.

    Article  PubMed  Google Scholar 

  • Frost, R. O., & Gross, R. C. (1993). The hoarding of possessions. Behaviour Research and Therapy, 31, 367–381. doi:0005-7967(93)90094-B.

    Article  PubMed  Google Scholar 

  • Frost, R. O., & Hartl, T. L. (1996). A cognitive-behavioral model of compulsive hoarding. Behaviour Research and Therapy, 34, 341–350.

    Article  PubMed  Google Scholar 

  • Frost, R. O., & Steketee, G. (1998). Hoarding: Clinical aspects and treatment strategies. In M. A. Jenike, L. Baer, & W. E. Minichiello (Eds.), Obsessive compulsive disorder: Practical management (3rd ed., pp. 533–554). St. Louis, MO: Mosby Press.

    Google Scholar 

  • Frost, R. O., & Tolin, D. F. I. (2008). Compulsive hoarding. In S. Taylor, J. S. Abramowitz, & D. McKay (Eds.), Clinical handbook of obsessive-compulsive disorder and related problems. Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Frost, R. O., Krause, M. S., & Steketee, G. (1996). Hoarding and obsessive-compulsive symptoms. Behavior Modification, 20, 116–132.

    Article  PubMed  Google Scholar 

  • Frost, R. O., Steketee, G., & Williams, L. (2000a). Hoarding: a community health problem. Health & Social Care in the Community, 8, 229–234.

    Article  Google Scholar 

  • Frost, R. O., Steketee, G., Williams, L. F., & Warren, R. (2000b). Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls. Behaviour Research and Therapy, 38, 1071–1081.

    Article  PubMed  Google Scholar 

  • Frost, R. O., Meagher, B. M., & Riskind, J. H. (2001). Obsessive-compulsive features in pathological lottery and scratch-ticket gamblers. Journal of Gambling Studies, 17, 5–19.

    Article  PubMed  Google Scholar 

  • Frost, R. O., Steketee, G., & Williams, L. (2002). Compulsive buying, compulsive hoarding, and obsessive-compulsive disorder. Behavior Therapy, 33, 201–214.

    Article  Google Scholar 

  • Frost, R. O., Steketee, G., & Grisham, J. (2004). Measurement of compulsive hoarding: Saving inventory-revised. Behaviour Research and Therapy, 42, 1163–1182.

    Article  PubMed  Google Scholar 

  • Frost, R. O., Steketee, G., Tolin, D., & Brown, T. (2006). Co-morbidity and diagnostic issues in compulsive hoarding. Paper presented at the Annual Meeting of the Anxiety Disorders Association of America., Atlanta, GA.

  • Frost, R., Steketee, G., Tolin, D., & Renaud, D. (2008). Development and validation of the Clutter Image Rating. Journal of Psychopathology and Behavioral Assessment, 30, 193–203.

    Article  Google Scholar 

  • Gilliam, C., Hannan, S. E., Norberg, M. M., Morrison, S., Villavicencio, A., & Dufresne, D. (2009). Group cognitive behavioral therapy for compulsive hoarding: An effectiveness study. Paper presented at the Association of Behavioral and Cognitive Therapies, New York, NY.

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale-Brown obsessive compulsive scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.

    PubMed  Google Scholar 

  • Greenberg, D. (1987). Compulsive Hoarding. American Journal of Psychotherapy, XLI, 409-416.

  • Greist, J. H., Marks, I. M., Baer, L., Kobak, K. A., Wenzel, K. W., Hirsch, M. J., et al. (2002). Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Journal of Clinical Psychiatry, 63, 138–145.

    Article  PubMed  Google Scholar 

  • Grisham, J. R., Frost, R. O., Steketee, G., Kim, H. J., & Hood, S. (2006). Age of onset of compulsive hoarding. Journal of Anxiety Disorders, 20, 675–686.

    Article  PubMed  Google Scholar 

  • Guy, W. (1976). ECDEU Assessment manual for psychopharmacology. Rockville, MD: US: Department of Health and Human Services publication (ADM).

    Google Scholar 

  • Hartl, T. L., & Frost, R. O. (1999). Cognitive-behavioral treatment of compulsive hoarding: a multiple baseline experimental case study. Behaviour Research and Therapy, 37, 451–461.

    Article  PubMed  Google Scholar 

  • Himle, J. A., Fischer, D. J., Muroff, J. R., Van Etten, M. L., Lokers, L. M., Abelson, J. L., et al. (2006). Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 44, 1821–1829.

    Article  PubMed  Google Scholar 

  • Horvath, A., & Greenberg, L. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.

    Article  Google Scholar 

  • Iervolino, A. C., Perroud, N., Fullana, M. A., Guipponi, M., Cherkas, L., Collier, D. A., et al. (2009). Prevalence and heritability of compulsive hoarding: a twin study. American Journal of Psychiatry, 166, 1156–1161.

    Article  PubMed  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.

    Article  PubMed  Google Scholar 

  • Kozak, M. J., & Foa, E. B. (1997). Mastery of obsessive-compulsive disorder: A cognitive-behavioral approach. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Masi, G., Millepiedi, S., Perugi, G., Pfanner, C., Berloffa, S., Pari, C., et al. (2009). Pharmacotherapy in paediatric obsessive-compulsive disorder: A naturalistic, retrospective study. CNS Drugs, 23, 241–252.

    Article  PubMed  Google Scholar 

  • Mataix-Cols, D., Rauch, S. L., Manzo, P. A., Jenike, M. A., & Baer, L. (1999). Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 156, 1409–1416.

    PubMed  Google Scholar 

  • Mataix-Cols, D., Marks, I. M., Greist, J. H., Kobak, K. A., & Baer, L. (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from controlled trial. Psychotherapy and Psychosomatics, 71, 255–262.

    Article  PubMed  Google Scholar 

  • Mataix-Cols, D., Frost, R. O., Pertusa, A., Clark, L. A., Saxena, S., Leckman, J. F., et al. (2010). Hoarding disorder: A new diagnosis for DSM-V? Depression and Anxiety, 27, 556–572. doi:10.1002/da.20693.

    Article  PubMed  Google Scholar 

  • Matsunaga, H., Nagata, T., Hayashida, K., Ohya, K., Kiriike, N., & Stein, D. J. (2009). A long-term trial of the effectiveness and safety of atypical antipsychotic agents in augmenting SSRI-refractory obsessive-compulsive disorder. Journal of Clinical Psychiatry, 70, 863–868. doi:10.4088/JCP.08m04369.

    Article  PubMed  Google Scholar 

  • Meunier, S. A., Tolin, D. F., Frost, R. O., Steketee, G., & Brady, R. E. (2006). Prevalence of hoarding symptoms across the anxiety disorders. Paper presented at the Annual Meeting of the Anxiety Disorders Association of America, Miami, FL.

  • Mueller, A., Mitchell, J. E., Crosby, R. D., Glaesmer, H., & de Zwaan, M. (2009). The prevalence of compulsive hoarding and its association with compulsive buying in a German population-based sample. Behaviour Research and Therapy, 47, 705–709. doi:10.1016/j.brat.2009.04.005.

    Article  PubMed  Google Scholar 

  • Muroff, J., Steketee, G., & Frost, R. (2009a). Cognitive Behavioral Treatment Delivered via Webcam. Paper presented at the Annual Meeting of the Association for Behavioral and Cognitive Therapies, New York, NY.

  • Muroff, J., Steketee, G., Rasmussen, J., Gibson, A., Bratiotis, C., & Sorrentino, C. (2009b). Group cognitive and behavioral treatment for compulsive hoarding: a preliminary trial. Depression and Anxiety, 26(7), 634–640. doi:10.1002/da.20591.

    Article  PubMed  Google Scholar 

  • Muroff, J., Steketee, G., & Bratiotis, C. (2010a). Enhancing group cognitive behavioral treatment for hoarding: A pilot study. Paper presented at the World Congress of Cognitive and Behavioral Therapies. Boston, MA.

  • Muroff, J., Steketee, G., Himle, J., & Frost, R. (2010b). Delivery of Internet Treatment for Compulsive Hoarding (D.I.T.C.H.). Behaviour Research and Therapy, 48, 79–85.

    Article  PubMed  Google Scholar 

  • Pekareva-Kochergina, A., & Frost, R. O. (2009). The Effects of a Biblio-Based Self-Help Program for Compulsive Hoarding. Paper presented at the Annual Meeting of the Association of Behavioral and Cognitive Therapies, New York.

  • Pertusa, A., Frost, R., Fullana, M., Samuels, J., Steketee, G., Tolin, D., et al. (2010). Refining the diagnostic boundaries of compulsive hoarding: a critical review. Clinical Psychology Review, 30, 371–386.

    Article  PubMed  Google Scholar 

  • Rufer, M., Fricke, S., Moritz, S., Kloss, M., & Hand, I. (2006). Symptom dimensions in obsessive-compulsive disorder: Prediction of cognitive-behavior therapy outcome. Acta Psychiatrica Scandinavica, 113, 440–446.

    Article  PubMed  Google Scholar 

  • Salomoni, G., Grassi, M., Mosini, P., Riva, P., Cavedini, P., & Bellodi, L. (2009). Artificial neural network model for the prediction of obsessive-compulsive disorder treatment response. Journal of Clinical Psychopharmacology, 29, 343–349. doi:10.1097/JCP.0b013e3181aba68f.

    Article  PubMed  Google Scholar 

  • Samuels, J., Bienvenu, O. J., Riddle, M. A., Cullen, B. A., Grados, M. A., Liang, K. Y., et al. (2002). Hoarding in obsessive compulsive disorder: results from a case-control study. Behaviour Research and Therapy, 40, 517–528.

    Article  PubMed  Google Scholar 

  • Samuels, J., Bienvenu, O. J., Grados, M. A., Cullen, B., Riddle, M. A., Liang, K. Y., et al. (2008). Prevalence and Correlates of Hoarding Behavior in a Community-Based Sample. Behaviour Research and Therapy, 46, 836–844.

    Article  PubMed  Google Scholar 

  • Saxena, S. (2008). Recent advances in compulsive hoarding. Current Psychiatry Reports, 10, 297–303.

    Article  PubMed  Google Scholar 

  • Saxena, S., Brody, A. L., Maidment, K. M., & Baxter, L. R., Jr. (2007). Paroxetine treatment of compulsive hoarding. Journal of Psychiatric Research, 41, 481–487. doi:10.1016/j.jpsychires.2006.05.001.

    Article  PubMed  Google Scholar 

  • Shafran, R., & Tallis, F. (1996). Obsessive-compulsive hoarding: a cognitive-behavioural approach. Behavioural and Cognitive Psychotherapy, 24, 209–221.

    Article  Google Scholar 

  • Shetti, C. N., Reddy, Y. C., Kandavel, T., Kashyap, K., Singisetti, S., Hiremath, A. S., et al. (2005). Clinical predictors of drug nonresponse in obsessive-compulsive disorder. Journal of Clinical Psychiatry, 66, 1517–1523.

    Article  PubMed  Google Scholar 

  • Stein, D. J., Andersen, E. W., & Overo, K. F. (2007). Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo. Revista Brasileira de Psiquiatria, 29, 303–307.

    Article  PubMed  Google Scholar 

  • Stein, D. J., Carey, P. D., Lochner, C., Seedat, S., Fineberg, N., & Andersen, E. W. (2008). Escitalopram in obsessive-compulsive disorder: response of symptom dimensions to pharmacotherapy. CNS Spectrums, 13, 492–498.

    PubMed  Google Scholar 

  • Steketee, G., & Frost, R. (2003). Compulsive hoarding: current status of the research. Clinical Psychology Review, 23(7), 905–927.

    Article  PubMed  Google Scholar 

  • Steketee, G., & Frost, R. (2007a). Compulsive Hoarding and Acquiring: Workbook. New York, NY: Oxford University Press.

    Google Scholar 

  • Steketee, G., & Frost, R. O. (2007b). Compulsive hoarding and acquiring: A Therapist Guide. New York, NY: Oxford University Press.

    Google Scholar 

  • Steketee, G., Frost, R., Wincze, J., Greene, A., & Douglass, H. (2000). Group and individual treatment of compulsive hoarding: A pilot study. British Association for Behavioural and Cognitive Psychotherapies, 23, 259–268.

    Article  Google Scholar 

  • Steketee, G., Frost, R. O., & Kyrios, M. (2003). Cognitive aspects of compulsive hoarding. Cognitive Therapy and Research, 27, 463–479.

    Article  Google Scholar 

  • Steketee, G., Frost, R. O., Tolin, D. F., Rasmussen, J., & Brown, T. A. (2010). Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder. Depression and Anxiety, 27, 476–484.

    Article  PubMed  Google Scholar 

  • Tolin, D., Frost, R. O., & Steketee, G. (2006). Buried in treasures: Help for compulsive hoarding. New York: Oxford.

    Google Scholar 

  • Tolin, D. F., Frost, R. O., & Steketee, G. (2007). An open trial of cognitive-behavioral therapy for compulsive hoarding. Behaviour Research and Therapy, 45, 1461–1470.

    Article  PubMed  Google Scholar 

  • Tolin, D. F., Frost, R. O., Steketee, G., Gray, K. D., & Fitch, K. E. (2008). The economic and social burden of compulsive hoarding. Psychiatry Research, 160, 200–211.

    Article  PubMed  Google Scholar 

  • Tolin, D. F., Kiehl, K. A., Worhunsky, P., Book, G. A., & Maltby, N. (2009). An exploratory study of the neural mechanisms of decision making in compulsive hoarding. Psychological Medicine, 39, 325–336.

    Article  PubMed  Google Scholar 

  • Tolin, D., Frost, R., & Steketee, G. (2010). A brief interview for assessing compulsive hoarding: The Hoarding Rating Scale. Psychiatry Research, 178, 147–152.

    Article  PubMed  Google Scholar 

  • Turner, K., Steketee, G., & Nauth, L. (2010). Treating elders with compulsive hoarding: A pilot program. Cognitive and Behavioral Practice, 17, 449–457.

    Article  Google Scholar 

  • Winsberg, M. E., Cassic, K. S., & Koran, L. M. (1999). Hoarding in obsessive-compulsive disorder: A report of 20 cases. Journal of Clinical Psychiatry, 60, 591–597.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215, USA

    Jordana Muroff, Christiana Bratiotis & Gail Steketee

Authors
  1. Jordana Muroff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christiana Bratiotis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gail Steketee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jordana Muroff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muroff, J., Bratiotis, C. & Steketee, G. Treatment for Hoarding Behaviors: A Review of the Evidence. Clin Soc Work J 39, 406–423 (2011). https://doi.org/10.1007/s10615-010-0311-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10615-010-0311-4

Keywords

Search

Navigation