Treatment of hoarding disorder in adults
- David Mataix-Cols, PhD
David Mataix-Cols, PhD
- Professor of Child and Adolescent Psychiatric Science
- Karolinska Institutet
- Lorena Fernández de la Cruz, PhD
Lorena Fernández de la Cruz, PhD
- Assistant Professor
- Karolinska Institutet
- Pino Alonso, MD, PhD
Pino Alonso, MD, PhD
- Assistant Professor
- University of Barcelona
Individuals with hoarding disorder experience persistent difficulty discarding or parting with possessions, regardless of their value. They typically experience distress when thinking about discarding things and perceive a need to save them. Possessions thus congest and clutter their living areas, compromising use of these spaces, interfere with the individual’s daily life, and cause clinically significant distress.
Hoarding disorder was newly included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , replacing the conceptualization of extreme hoarding in DSM-IV as a form of obsessive-compulsive disorder (OCD) . As a more recently specified mental disorder, there is less research available on hoarding disorder and its treatment compared with many disorders. The point prevalence of clinically significant hoarding has been estimated to be at least 1.5 percent among adults .
The treatment of hoarding disorder in adults is reviewed here. The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of hoarding disorder are reviewed separately. OCD in adults is also reviewed separately. (See "Hoarding disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Pharmacotherapy for obsessive-compulsive disorder in adults" and "Psychotherapy for obsessive-compulsive disorder in adults".)
APPROACH TO TREATMENT
●Patients who have poor, absent, or delusional insight may not seek help for hoarding. It can be challenging to engage with these patients so that they will accept treatment. Involving relatives or other significant persons can be helpful.
●Risks due to hoarding (eg, risks of fire or tripping/falling as a result of excessive accumulation of possessions) should be assessed and, if appropriate, addressed at the beginning of treatment. Community services such as housing, public health, or social work professionals may be needed to help maintain the health and safety of the individuals who hoard. If vulnerable individuals are living in the home (eg, children or disabled persons) and deemed to be at risk, appropriate agencies should be involved as part of the overall care plan.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- APPROACH TO TREATMENT
- General principles
- Initial treatment
- Response to first-line treatment
- Treatment resistance
- PSYCHOSOCIAL INTERVENTIONS
- Cognitive-behavioral therapy
- - Conceptual model
- - Intervention components
- - Administration
- - Efficacy
- Cognitive remediation
- Serotonin-reuptake inhibitors (SRIs)
- Augmentation of SRIs
- SUMMARY AND RECOMMENDATIONS