Hoarding: From Pop Culture Sideshow to Getting Help

Guide and workbook from IOL staff offers new approach to treatment

Movies and television have long featured people suffering from common mental health conditions. Hoarding disorder is no different. It has been highlighted on programs including The Dr. Oz Show, The Oprah Winfrey Show and the A&E series Hoarders.

Although these representations may focus on extreme examples of people suffering from hoarding disorder, they often attempt to confront the misconception that hoarders are lazy or sloppy by showing that hoarding disorder is a legitimate mental illness that requires treatment. Fortunately, there is now evidence that people with hoarding disorder can be helped.

A new, two-volume book on the condition, authored by David Tolin, PhD, ABPP, director of the Anxiety Disorders Center at the Institute of Living; Blaise Worden, PhD, and Christina Gilliam, PhD, both staff psychologists at the Institute of Living’s Anxiety Disorders Center; along with former IOL postdoctoral fellow Bethany Wootton, offers an evidence-based treatment approach and practical steps to help people living with hoarding disorder.

CBT for Hoarding Disorder: A Group Therapy Program offers a comprehensive cognitive behavioral therapy approach for people struggling with hoarding disorder, which includes a guidebook for therapists and a workbook for patients.

The book was released in September 2017.

“Hoarding disorder is a relatively new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that is characterized by difficulty letting go of possessions or discarding possessions, resulting in clutter that impacts a person’s ability to function or be safe in their home,” said Dr. Tolin. “The best estimate we have is that about three percent of adults in the United States suffer from hoarding disorder.”

Until recently, a person with hoarding disorder was treated the same way as a person with obsessive compulsive disorder (OCD). That approach proved disappointing because hoarding and OCD are different. For example, people with hoarding disorder often do not have obsessive thoughts and compulsive behaviors that are typically associated with OCD.

“We’ve developed a new model of understanding hoarding that largely focuses on problems of emotion regulation and difficulty with effective decision making,” Tolin said. “As a result, we have conducted research using cognitive behavioral therapy, which is a form of counseling that involves teaching people how to apply new patterns of behavior and to challenge maladaptive ways of thinking. We have tested it in the group therapy setting and found that it is effective in a controlled trial.”

CBT for Hoarding Disorder is expected to make an impact on clinical practice right away because it is an approachable source of best practices.

“Clinicians in our field often use treatment manuals as a guide for implementation of effective treatments,” said Dr. Worden. “Since research efforts on hoarding disorder are relatively new in the field, there are very few protocols or manuals to guide mental health providers as they treat hoarding disorder. In our research and that of our colleagues, we have found our cognitive-behavioral hoarding treatment to be among the most effective of treatments available, and we are happy to share it with mental health providers and the scientific community as a whole.”

The Institute of Living’s Anxiety Disorders Center has long been a pioneer in understanding and treating this condition.

“We are one of the few sites in the nation that does both treatment and research on hoarding and related issues, and we have been doing so for almost two decades,” said Dr. Worden. “I’m proud to be a part of it.”