Current Treatment Options in Psychiatry

, Volume 3, Issue 4, pp 394–410 | Cite as

A Review of the Diagnosis and Management of Hoarding Disorder

  • Kiara R. TimpanoEmail author
  • Jordana Muroff
  • Gail Steketee
Anxiety, Obsessive Compulsive and Related Disorders (B Brennan and D Dougherty, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Anxiety, Obsessive Compulsive and Related Disorders

Opinion statement

Hoarding disorder (HD) is a severe psychiatric and public health problem characterized by extreme challenges with discarding possessions and severe acquisition resulting in excessive clutter that impairs daily functioning and may cause substantial health and safety risks. Over the past 20 years, research on HD has grown substantially and lead to its recent designation in the DSM-5 as a discrete disorder. The key features of the cognitive behavioral etiological model of hoarding include core vulnerabilities, information processing deficits, cognitions and meaning of possessions, and emotionally driven reinforcement patterns. This model has served as the theoretical foundation for efficacious, specialized cognitive behavioral treatment (CBT) for hoarding and validated hoarding assessment measures. The individual manualized CBT treatment has been adapted for delivery through various modalities (e.g., group, web-based, self-help), populations (e.g., geriatric), and providers (e.g., clinicians, peer support, case managers). While CBT is associated with significant reductions in hoarding severity, clinical levels of hoarding symptoms persist for greater than half of treatment completers; thus, more efficacious treatments need to be developed. Further research is necessary to elucidate components of the CBT model and their interaction, in order to inform treatment targets. Although research on pharmacological treatments for HD is in the nascent stages and extant results are somewhat mixed, future studies may assess medication as a standalone treatment or combined with CBT. Family-focused hoarding interventions may also be important given that persons with hoarding behaviors may have limited insight and motivation and its negative effects on the family. Current data indicate a cost-effective and coordinated response that combines community-based and individualized interventions for hoarding may be optimal in order to (1) reach the broadest group of clients with hoarding (e.g., beyond those who voluntarily seek treatment), (2) maximize incentives and motivation through housing, health services, and safety laws, (3) enhance communication and coordination between diverse teams of providers, (4) provide sustainable comprehensive services in a stepped care approach, and (5) reduce stigma.


Hoarding disorder CBT/cognitive behavior therapy Clinical trials Community-based intervention Hoarding assessment 


Compliance with Ethical Standards

Conflict of Interest

Kiara Timpano, Jordana Muroff, and Gail Steketee declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  • Kiara R. Timpano
    • 1
    Email author
  • Jordana Muroff
    • 2
  • Gail Steketee
    • 2
  1. 1.Department of PsychologyUniversity of MiamiCoral GablesUSA
  2. 2.School of Social WorkBoston UniversityBostonUSA

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