Cognitive Therapy and Research

, Volume 34, Issue 1, pp 69–81 | Cite as

Family Informants’ Perceptions of Insight in Compulsive Hoarding

  • David F. Tolin
  • Kristin E. Fitch
  • Randy O. Frost
  • Gail Steketee
Original Article


Existing psychological and pharmacological interventions for obsessive-compulsive disorder have not been particularly successful for compulsive hoarding, perhaps due in part to poor insight on the part of sufferers. Individuals with compulsive hoarding problems commonly display lack of awareness of the severity of their behavior, sometimes denying that they have a problem and often resisting intervention attempts and failing to follow through with therapeutic assignments. Using an internet-based survey, family and friends of individuals with reported hoarding problems (family/friend informants, N = 584) provided ratings of the hoarder’s level of insight. They also made several ratings of the severity of the person’s hoarding behavior, then rated the same items again with regard to how they thought the hoarder would respond to the items. Family/friend informants described the hoarder on average as having fair to poor insight. More than half were described as having “poor insight” or “lacks insight/delusional,” substantially worse insight than found in samples of OCD clinic patients using the same measure. Family/friend informants’ ratings of hoarding severity were significantly greater than were their estimates of the hoarder’s ratings. Hoarders described as showing less distress about the hoarding were described as showing poorer insight. These results suggest that compulsive hoarding is characterized by poor insight into the severity of the problem. Treatment development might need to emphasize strategies to bolster awareness, insight, and motivation.


Anosognosia Overvalued ideation Clutter Saving Delusions Obsessive-compulsive disorder 



This study was funded by National Institute of Mental Health grants R01 MH074934 (Tolin), R01 MH068008 and MH068007 (Frost and Steketee), and R21 MH068539 (Steketee). Oxford University Press supplied copies of a book to be used in a raffle for participants. Results of this study were presented at the Annual Meeting of the Association of Behavioral and Cognitive Therapies, November 2007, Philadelphia. The authors thank Dr. Nicholas Maltby for his technical assistance.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • David F. Tolin
    • 1
    • 2
  • Kristin E. Fitch
    • 1
  • Randy O. Frost
    • 3
  • Gail Steketee
    • 4
  1. 1.Anxiety Disorders CenterThe Institute of LivingHartfordUSA
  2. 2.Yale University School of MedicineNew HavenUSA
  3. 3.Smith CollegeNorthamptonUSA
  4. 4.Boston University School of Social WorkBostonUSA

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