7 Mental Health Treatment Options For Addressing Hoarding OCD
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Living with hoarding OCD can feel like a constant battle. Wanting to have a clean and organized home but not being able to resist keeping and collecting things can be difficult. The growing clutter can cause a person to feel anxious and overwhelmed and can affect mental health, relationships, and overall well-being. That said, there are effective treatments available for addressing these and related symptoms. Read on to learn more about hoarding OCD and what treatment options are available.
Are hoarding disorder and hoarding OCD the same thing?
First, it can be helpful to understand a bit about terminology around hoarding. Hoarding disorder and hoarding OCD have similarities but are separate disorders. Both are listed in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under the category of “obsessive-compulsive and related disorders,” but hoarding disorder is its own illness while hoarding OCD is shown as a subtype of obsessive-compulsive disorder (OCD). See below to understand the key differences between the two.
Understanding hoarding disorder
According to the DSM-5, hoarding disorder has these key identifying characteristics:
- Individuals have trouble letting go of material possessions, regardless of their actual value.
- People with the condition feel distress at the thought of discarding their items.
- Hoarding behaviors cause someone to accumulate objects to the point where they cannot use their living spaces for their intended use.
Someone with hoarding disorder typically develops a very strong emotional attachment to objects and experiences significant distress at the thought of letting items go. Hoarded items are often disorganized and can end up taking over entire rooms or living spaces. They often include items like cardboard boxes, household supplies, and books. Some people may even hoard animals. They often don’t see their hoarding as a problem.
Approximately 2.5% of the general population meets the criteria for hoarding disorder. Men and women are impacted at similar rates with statistics currently unavailable for other genders, and hoarding behaviors tend to worsen as a person ages.
Understanding hoarding OCD, or hoarding obsessive-compulsive disorder
Compulsive hoarding symptoms associated with hoarding OCD usually occur because someone feels an intense need to keep certain belongings due to intrusive, distressing thoughts about their possessions. They may have thoughts like, “If I throw this away, something bad will happen.” An object isn’t kept necessarily because someone values it, but because keeping it helps relieve their anxiety. A person with OCD hoarding may realize that their behavior is irrational but not know how to stop.
Other mental health conditions associated with hoarding OCD (obsessive-compulsive disorder) and hoarding disorder
In some cases, hoarding conditions are related to or co-occur with other mental disorders, such as depression or schizophrenia. Depression impacts around half of the people with hoarding conditions, and individuals with this type of illness are also more likely to experience anxiety disorders or attention-deficit/hyperactivity disorder (ADHD).
In addition, people who hoard tend to experience cognitive struggles in other areas of their life as well, even if these don't represent an additional diagnosable disorder. Some examples include being unable to maintain their attention for long or having a poor working memory.
Common causes of hoarding disorder and hoarding OCD
Researchers are still trying to determine the exact causes of hoarding-related disorders, but they suspect that these may develop due to a combination of genetics, family history, and personality traits.
Traumatic experiences may also be linked to hoarding problems. Losing a loved one, going through an intense breakup, being abused, or experiencing social isolation can also contribute to the development of hoarding tendencies.
Exploring 7 treatment options for hoarding disorder OCD and hoarding disorder
If you’re experiencing signs of hoarding disorder or hoarding OCD, it’s generally recommended that you seek professional treatment, as symptoms are unlikely to resolve on their own. While it can take time and support, there are various treatments available that may help you address your symptoms, reduce the number of objects in your home, and improve your quality of life. Treatments for a person with hoarding disorder and a person with hoarding OCD are often similar; below are some of the most common options.
1. Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) can help individuals learn to identify thoughts related to hoarding behaviors and practice shifting them in order to change their resulting behaviors. With CBT, clients may discover how to change their mindset about hoarding, limit how many objects they bring into their home, and stay focused on organizing the items they do have.
2. Motivational interviewing
Motivational interviewing (MI) is often used during CBT sessions to help clients increase their motivation and reduce their defensiveness. During MI, therapists use open-ended questions, reflections, and affirmations to discuss a client’s behavior without making them feel like they’re being attacked or criticized.
3. Skills training
In skills training, someone with hoarding OCD can develop the practical skills necessary to break the cycle of their behavior. These may include:
- Decision-making skills
- Organizational skills
- Emotional regulation skills
4. Exposure and response prevention therapy for hoarding disorder OCD
Exposure and response prevention (ERP) therapy is a type of CBT used specifically for OCD treatment. During ERP, someone with hoarding OCD will work through a series of steps that help them learn how to manage their symptoms.
The process may look something like this:
- Identify specific objects they are experiencing obsessions and resulting compulsions about.
- Work with the therapist to create a hierarchy of triggering situations.
- Participate in exposure during therapy, such as seeing pictures or videos that trigger a response. This is when therapists prepare a patient to resist compulsions.
- Begin exposure outside of therapy, building up from low-anxiety situations to high-anxiety situations.
- Create a plan to help prevent relapse.
5. Hoarding disorder support groups
Support groups provide a place to connect with others experiencing similar struggles and gain a source of accountability. A support group can also provide a nonjudgmental environment where someone with hoarding OCD can talk about their experiences with people who understand. During meetings, participants can also gain new coping tools from their peers and the facilitator and learn how other people have found success in treating their hoarding OCD.
The International OCD Foundation offers more than 200 support groups around the world, and other organizations may also offer such groups online and in person.
6. Community-based support
Because hoarding can pose a health and safety risk for the community, such as increasing pests in an apartment and limiting access routes for first responders, some cities have launched task forces to offer support to people experiencing hoarding behaviors. These coalitions vary by community, but they may involve agencies such as fire, police, public health, social work, and/or animal control departments. According to the International OCD Foundation, at least 75 communities in the United States currently have such a task force.
7. Medication as a part of treatment
Medication can sometimes help address hoarding OCD, typically in conjunction with psychotherapy. Some of the most common medications used for OCD include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Other medications may also be prescribed to treat co-occurring mental health conditions such as ADHD or anxiety. Don’t start, stop, or change any medication without consulting with your doctor or psychiatrist.
Other changes that may support mental health
Professional mental health support is usually necessary to treat hoarding disorder or hoarding OCD. In addition, certain lifestyle choices may help reduce symptoms and improve treatment outcomes. Examples include:
- Accept help. You may not want anyone to help because you’re embarrassed about the state of your home, but it can be nearly impossible to address years of hoarding on your own. If you’re uncomfortable with family and friends seeing your home, you might connect with local resources or professional organizers.
- Eat healthy meals. If your kitchen is filled with clutter, it can be difficult to cook proper meals and get the nutrition you need. If you’re unable to use your kitchen as a result of hoarding behaviors, starting in that area with a professional organizer and/or therapist and seeking meal support from loved ones in the meantime may be advisable.
- Establish daily tidying routines. You might set aside 10–15 minutes a day for tidying and decluttering, instead of waiting until the mess becomes overwhelming and too big to tackle. A therapist may be able to help you create a manageable cleaning routine that does not trigger symptoms.
- Prioritize your sleep. Being sleep-deprived can increase anxiety and cause difficulty making decisions. Following good sleep hygiene practices can be helpful.
Addressing common barriers to treatment
People with hoarding OCD often face several barriers that can prevent them from seeking treatment. These can include challenges like:
- Not recognizing their behavior as a problem
- Feeling too much shame to let anyone know what’s going on
- Feeling too attached to objects to let them go
- Isolating themselves, so they may not have loved ones to help
While having a professional come into the home can be helpful to address hoarding, some people may be uncomfortable with the idea of letting someone in. Online therapy through platforms like BetterHelp can sometimes act as a middle-ground solution, allowing a mental health professional to provide support without having their physical presence in the home.
Several studies have examined the impact of online therapy in reducing hoarding behaviors. A small study published by the Journal of Clinical Psychology looked at how patients did when online therapy support was offered in the form of group CBT. No one dropped out of treatment early, patients significantly reduced the inventory of items they were saving, and their treatment gains remained after three months.
How to help someone if you believe they may be hoarding
If someone you love is displaying hoarding tendencies, it may be tempting to help them by cleaning out their home or throwing things away. However, this can cause a great deal of distress and doesn’t resolve the mental health challenges that are causing the behaviors.
If you want to help, one of the best things you can do is typically to gently encourage your loved one to seek professional support. Hoarding is usually tied to a mental health condition, and it often takes treatment from a therapist to see real progress and learn how to manage everyday tasks without being overshadowed by hoarding behaviors.
Takeaway
What is the root cause of hoarding?
As is the case with most mental health conditions, experts believe that various contributing elements may play a part in a person who experiences a hoarding-related disorder. Some risk factors may include genetics, living alone, having grown up deprived of material possessions, or having been raised in a home where caregivers displayed hoarding behaviors.
What childhood trauma causes hoarding?
Many types of trauma can contribute to a person hoarding possessions or displaying other compulsive behaviors in adulthood. One early traumatic experience that can be linked to hoarding behaviors later in life is poverty.
Do hoarders know they have a problem?
A person with hoarding disorder may not see their difficulties discarding objects, resulting trouble with personal hygiene, rodent or insect infestations, or related challenges with everyday living being indicative of a problem, which can represent a barrier to treatment. A person with hoarding OCD, in contrast, often recognizes their difficulty discarding objects and their very strong emotions related to their possessions as irrational, which may make treatment that involves challenging underlying beliefs somewhat easier to seek.
How do you treat hoarding OCD?
Treatment for hoarding OCD usually involves talking therapy, sometimes in combination with medication. Talk therapy may help guide how a person takes responsibility for their actions, help the individual address any poor relationships with family members as a result of all their clutter due to symptoms, and provide non-judgmental, compassionate support for reducing symptoms.
What medication is used for OCD hoarding?
Medication is sometimes used to treat OCD as a person gradually learns how to reduce their symptoms through talk therapy. SSRIs and SNRIs are commonly prescribed for this purpose. However, remember that you should never start, stop, or change any medication without consulting with your psychiatrist.
What therapy is best for hoarding?
Cognitive behavioral therapy and motivational interviewing are two approaches to talk therapy that are commonly used to treat symptoms in a person who begins hoarding and whose symptoms are causing significant distress and making them feel extremely ashamed. A therapist can offer compassionate and nonjudgmental support, helping the person identify and address the underlying causes of their symptoms.
How to break a hoarding habit?
Seeking treatment early for hoarding tendencies or symptoms of a hoarding-related disorder can be crucial. A mental health professional can provide talk therapy and may also recommend medication and lifestyle changes. In conjunction with mental health treatment, it can be helpful to work with a house cleaner and organizer who specializes in hoarding and to connect with animal welfare agencies if there has been animal hoarding involved.
What percentage of hoarders recover?
Studies on the most effective treatment for people who show symptoms of hoarding things (like magazines, books, clothes, leaflets, and other forms of clutter) are ongoing. Research shared by the American Psychiatric Association suggests that individuals with hoarding symptoms who engage in talk therapy may experience a 40% reduction in these symptoms, which can be a positive step toward improving the quality of the person’s life.
What is the new treatment for hoarding disorder?
New treatments are being researched for hoarding disorder. Still, talk therapy and medication are the most well-researched treatments available today. Speak to a doctor, therapist, or psychiatrist for more information on what interventions might be right for you or a loved one.
How to help someone who hoards?
Attempting to clean up their house and throw away items may do more harm than good for a person who is experiencing symptoms of a hoarding disorder. Instead, the recommended course of action is typically to gently encourage and help them seek mental health support.
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