Compulsive Hoarding: Current Research and Theory

  • Jessica R. Grisham
  • David H. Barlow

Compulsive hoarding has emerged as a treatment refractory and impairing psychological disorder. Although promising research over the past decade has substantially furthered an understanding of hoarding, the etiology, diagnostic status, and associated features of this phenomenon are not yet completely understood. This article reviews current research on hoarding, including comorbidity and diagnostic issues, theoretical models, and treatment approaches. A cognitive–behavioral model of compulsive hoarding (R. O. Frost and G. Steketee, 1998) is presented, including the proposed information-processing deficits, beliefs and cognitions, and excessive emotional attachment to possessions. In addition, existing treatment approaches that target the cognitive and behavioral components of acquisition, difficulty organizing, and avoidance of discarding are described. Future directions for compulsive hoarding research are suggested to improve diagnostic clarity, refine therapeutic techniques, and enhance treatment response.


hoarding collecting saving clutter obsessive–compulsive spectrum 


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  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th edn.). Washington, DC: Author.Google Scholar
  2. Baer, L. (1994). Factor analysis of symptom subtypes of obsessive–compulsive disorder and their relation to personality and tic disorders. Journal of Clinical Psychiatry, 55, 18–23.Google Scholar
  3. Ball, S. G., Baer, L., & Otto, M. W. (1996). Symptom subtypes of obsessive–compulsive disorder in behavioral treatment studies: A quantitative review. Behaviour Research and Therapy, 34, 47–51.Google Scholar
  4. 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.Google Scholar
  5. Calamari, J. E., Wiegartz, P. S., & Janeck, A. S. (1999). Obsessive–compulsive disorder subgroups: A symptom-based clustering approach. Behaviour Research and Therapy, 37, 113–125.Google Scholar
  6. Christenson, D. D., & Greist, J. H. (2001). The challenge of obsessive–compulsive disorder hoarding. Primary Psychiatry, 8, 79–86.Google Scholar
  7. Duffany, S. R., Hartl, T. L., Allen, G. J., & Frost, R. O. (2002). Relationships among compulsive hoarding, trauma, and attention deficit hyperactivity disorder. Unpublished manuscript.Google Scholar
  8. Eslinger, P. J., & Damasio, A. R. (1985). Severe disturbance of higher cognition after frontal lobe ablation: Patient EVR. Neurology, 35, 1731–1741.Google Scholar
  9. Faber, H. (1947, April 9). Body of Collyer is found near where brother died. New York Times, pp. A1, A22.Google Scholar
  10. Finkel, S., Costa, E., Silva, J., Cohen, G., Miller, S., & Sartorius, N. (1997). Behavioral and psychological signs and symptoms of dementia: A consensus statement on current knowledge and implications for research and treatment. International Journal of Geriatric Psychiatry, 12, 1060–1061.Google Scholar
  11. Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N. (1998). The validation of a new obsessive–compulsive disorder scale: The Obsessive–Compulsive Inventory. Psychological Assessment, 10, 206–214.Google Scholar
  12. Frankenberg, F. R. (1984). Hoarding in anorexia nervosa. British Journal of Medical Psychology, 57, 57–60.Google Scholar
  13. Freud, S. (1908). Collected papers (Vol. 2). London: Hogarth.Google Scholar
  14. Fromm, E. (1947). Man for himself: An inquiry into the psychology of ethics. New York: Rinehart.Google Scholar
  15. Frost, R. O., & Gross, R. C. (1993). The hoarding of possessions. Behaviour Research and Therapy, 31, 367–381.Google Scholar
  16. Frost, R. O., & Hartl, T. (1996). A cognitive–behavioral model of compulsive hoarding. Behaviour Research and Therapy, 34, 341–350.Google Scholar
  17. Frost, R. O., Kim, H., Morris, C., Bloss, C., Murray-Close, M., & Steketee, G. (1998). Hoarding, compulsive buying, and reasons for saving. Behaviour Research and Therapy, 36, 657–664.Google Scholar
  18. Frost, R. O., Krause, M., & Steketee, G. (1996). Hoarding and obsessive–compulsive symptoms. Behavior Modification, 20, 116–132.Google Scholar
  19. 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.Google Scholar
  20. Frost, R. O., & Shows, D. (1993). The nature and measurement of compulsive indecisiveness. Behaviour Research and Therapy, 31, 683–692.Google Scholar
  21. 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 edn., pp. 533–554) St. Louis, MO: Mosby Yearbook Medical.Google Scholar
  22. Frost, R. O., & Steketee, G. (2002). Cognitive and behavioral treatment of compulsive hoarding. Unpublished manuscript.Google Scholar
  23. Frost, R. O., Steketee, G., & Grisham, J. (in press). Measurement of compulsive hoarding: Saving Inventory Revised. Behaviour Research and Therapy.Google Scholar
  24. Frost, R. O., Steketee, G., & Williams, L. (2000). Hoarding: A community health problem. Health and Social Care in the Community, 8, 229–234.Google Scholar
  25. Frost, R. O., Steketee, G., & Williams, L. F. (2002). Compulsive buying, compulsive hoarding, and obsessive–compulsive disorder. Behavior Therapy, 33, 201–214.Google Scholar
  26. Frost, R. O., Steketee, G., Williams, L. F., & Warren, R. (2000). Mood, personality disorder symptoms, and disability in obsessive–compulsive hoarders: A comparison with clinical and nonclinical controls. Behaviour Research and Therapy, 38, 1071–1081.Google Scholar
  27. Frost, R. O., Steketee, G., Youngren, V. R., & Mallya, G. K. (1999). The threat of the housing inspector: A case of hoarding. Harvard Review of Psychiatry, 6, 270–278.Google Scholar
  28. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). Yale–Brown Obsessive–Compulsive Scale: Part I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.Google Scholar
  29. Greenberg, D., Witzum, E., & Levy, A. (1990). Hoarding as a psychiatric symptom. Journal of Clinical Psychiatry, 51, 417–421.Google Scholar
  30. Grisham, J. R., Brown, T. A., Liverant, G., & Campbell, L. A. (2004). The distinctiveness of hoarding from other dimensions of obsessive–compulsive disorder. Unpublished manuscript.Google Scholar
  31. Grisham, J. R., Frost, R. O., Steketee, G., Kim, H.-J., & Hood, S. (2003). Age of onset and course of compulsive hoarding. Unpublished manuscript.Google Scholar
  32. Hahm, D. S., Kang, Y., Cheong, S. S., & Na, D. L. (2001). A compulsive collecting behavior following an A-com aneurysmal rupture. Neurology, 56, 398–400.Google Scholar
  33. Harlow, J. M. (1868). Recovery from the passage of an iron bar through the head. Publications of the Massachusetts Medical Society, 2, 327–347.Google Scholar
  34. 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.Google Scholar
  35. Hartl, T. L., Savage, C. R., Frost, R. O., Allen, G. J., Deckersbach, T., Steketee, G., et al. (2002). Actual and perceived memory deficits among individuals with hoarding symptoms. Under editorial review.Google Scholar
  36. Hwang, J., Tsai, S., Yang, C., Liu, K., & Ling, J. (1998). Hoarding behavior in dementia: A preliminary report. American Journal of Geriatric Psychiatry, 6, 285–289.Google Scholar
  37. James, W. (1918). The principles of psychology (Vol. 2). New York: Dover.Google Scholar
  38. Leckman, J. F., Grice, D. E., Boardman, J., Zhang, H., Vitale, A., Bondi, C., et al. (1997). Symptoms of obsessive–compulsive disorder. American Journal of Psychiatry, 154, 911–917.Google Scholar
  39. Luchins, D., Goldman, M. B., Lieb, M., & Hanrahan, P. (1992). Repetitive behaviors in chronically institutionalized schizophrenic patients. Schizophrenia Research, 8, 119–123.Google Scholar
  40. Mataix-Cols, D., Baer, L., Rauch, S., & Jenike, M. (2000). Relation to factor analyzed symptom dimensions of obsessive–compulsive disorder to personality disorders. Acta Psychiatrica Scandinavica, 102, 199–202.Google Scholar
  41. Mataix-Cols, D., Rauch, S., Manzo, P., Jenike, M., & 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.Google Scholar
  42. McElroy, S. L., Keck, P. E., & Phillips, K. A. (1995). Kleptomania, compulsive buying, and binge-eating disorder. Journal of Clinical Psychiatry, 56(Suppl. 4), 14–26.Google Scholar
  43. Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing: Preparing people for change. (2nd ed.). New York: Guilford Press.Google Scholar
  44. Samuels, J., Bienvenu, O. J., III, Riddle, M. A., Cullen, B. A. M., 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.Google Scholar
  45. Saxena, S., Maidment, K. M., Vapnik, T., Golden, G., Rishwain, T., Rosen, R., et al. (2002). Obsessive–compulsive hoarding: Symptom severity and response to multimodal treatment. Journal of Clinical Psychiatry, 63, 21–27.Google Scholar
  46. Sobin, C., Blundell, M. L., Weiller, F., Gavigan, C., Haiman, C., & Karayiorgou, M. (2000). Evidence of a schizotypy subtype in OCD. Journal of Psychiatric Research, 34, 15–24.Google Scholar
  47. Steketee, G., Frost, R. O., & Kim, H.-J. (2001). Hoarding by elderly people. Health and Social Work, 26, 176–184.Google Scholar
  48. Steketee, G., Frost, R. O., & Kyrios, M. (2003). Beliefs about possessions among compulsive hoarders. Cognitive Therapy and Research.Google Scholar
  49. Steketee, G., Frost, R. O., Wincze, J., Greene, K., & Douglass, H. (2000). Group and individual treatment of compulsive hoarding: A pilot study. Behavioural and Cognitive Psychotherapy, 28, 259–268.Google Scholar
  50. Summerfeldt, L. J., Richter, M. A., Antony, M. M., & Swinson, R. P. (1999). Symptoms structure in obsessive–compulsive disorder: A confirmatory factor-analytic study. Behaviour Research and Therapy, 37, 297–311.Google Scholar
  51. White, L. E., Krause, E. M. S., Williams, A., Frost, R., Steketee, G., & Kyrios, M. (2000). Attachment deficits in compulsive hoarding: Implications for theory and treatment. Poster presented at the Annual Convention of the American Association of Behavior Therapy, New Orleans, LA.Google Scholar
  52. Wincze, J., Steketee, G., & Frost, R. (2002). Categorization in obsessive–compulsive hoarding. Unpublished manuscript.Google Scholar
  53. 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.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Center for Anxiety and Related DisordersBoston UniversityBoston

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