Current Psychiatry Reports

, 21:91 | Cite as

Recent Advances in Research on Hoarding

  • Eliza J. Davidson
  • Mary E. Dozier
  • James O. E. Pittman
  • Tina L. Mayes
  • Brian H. Blanco
  • John D. Gault
  • Lauren J. Schwarz
  • Catherine R. AyersEmail author
Anxiety Disorders (A Pelissolo, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Anxiety Disorders


Purpose of Review

The purpose of the following paper is to review recent literature trends and findings in hoarding disorder (HD). Our goal is to highlight recent research on etiology, associated features, and empirically based treatments.

Recent Findings

Recent literature has added support for cognitive differences as a risk factor for HD; however, there is evidence that individuals with HD may overestimate their level of cognitive impairment. Several associated features have been highlighted in recent studies, including emotion regulation, intolerance of uncertainty and distress intolerance, and attachment. Finally, several psychotherapeutic treatments for hoarding have been recently validated, including group-based therapy and treatments using the cognitive-behavioral model.


Although recent research demonstrates that hoarding can be effectively treated with available psychotherapeutic modalities, the effectiveness of current treatments is not as robust as that for other psychiatric disorders and more work is needed in treatment precision.


Hoarding disorder Cognitive functioning Distress intolerance Attachment 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts 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.


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

  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  2. 2.
    Frost RO, Hartl TL. A cognitive-behavioral model of compulsive hoarding. Behav Res Ther. 1996;34:341–50. Scholar
  3. 3.
    Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman JF, … Wilhelm S. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety, 2010;27, 556–572. CrossRefPubMedGoogle Scholar
  4. 4.
    • Cath DC, Nizar K, Boomsma D, Mathews CA. Age-specific prevalence of hoarding and obsessive compulsive disorder: a population-based study. Am J Geriatr Psychiatry. 2017;25(3):245–55. This study found that hoarding prevalence increases over the lifespan, and the increased rate of hoarding disorder in older adults may be driven by greater difficulties with discarding. CrossRefPubMedGoogle Scholar
  5. 5.
    Ayers CR. Age-specific prevalence of hoarding and obsessive compulsive disorder: a population-based study. Am J of Geriatr Psychiatry. 2017;25:256–7. Scholar
  6. 6.
    Ong C, Pang S, Sagayadevan V, Chong SA, Subramaniam M. Functioning and quality of life in hoarding: a systematic review. J Anxiety Disord. 2015;32:17–30. Scholar
  7. 7.
    Snowdon J, Shah A, Halliday G. Severe domestic squalor: a review. Int Psychogeriatr. 2007;9:37. Scholar
  8. 8.
    Ayers CR, Saxena S, Golshan S, Wetherell JL. Age at onset and clinical features of late life compulsive hoarding. Int J of Geriatr Psychiatry. 2010;25:142–9. Scholar
  9. 9.
    Frost RO, Steketee G, Williams L. Hoarding: a community health problem. Health Soc Care Community. 2000;8:229–34. Scholar
  10. 10.
    Frost RO, Steketee G, Tolin DF. Comorbidity in hoarding disorder. Depress Anxiety. 2011;28:876–84. Scholar
  11. 11.
    Draguns JG, Tanaka-Matsumi J. Assessment of psychopathology across and within cultures: issues and findings. Behav Res Ther. 2003;41(7):755–76. Scholar
  12. 12.
    Timpano KR, Çek D, Fu ZF, Tang T, Wang JP, Chasson GS. A consideration of hoarding disorder symptoms in China. Compr Psychiatry. 2015;57:36–45. Scholar
  13. 13.
    Fernández de la Cruz L, Nordsletten AE, Mataix-Cols D. Ethnocultural aspects of hoarding disorder. Curr Psychiatry Rev. 2016;12(2):115–23. Scholar
  14. 14.
    Wang Z, Wang Y, Zhao Q, Jiang K. Is the DSM-5 hoarding disorder diagnosis valid in China? Shanghai Arch Psychiatry. 2016;28(2):103–5. Scholar
  15. 15.
    Subramaniam M, Abdin E, Vaingankar JA, Picco L, Chong SA. Hoarding in an Asian population: prevalence, correlates, disability and quality of life. Ann Acad Med Singapore. 2014;43(11):535–43.PubMedGoogle Scholar
  16. 16.
    Mataix-Cols D, Billotti D, De La Cruz LF, Nordsletten AE. The London field trial for hoarding disorder. Psychol Med. 2013;43(4):837–47. Scholar
  17. 17.
    Bulli F, Melli G, Carraresi C, Stopani E, Pertusa A, Frost RO. Hoarding behaviour in an Italian non-clinical sample. Behav Cogn Psychother. 2014;42(3):297–311. Scholar
  18. 18.
    Ong C, Sagayadevan V, Lee SP, Ong R, Chong SA, Frost RO, et al. Hoarding among outpatients seeking treatment at a psychiatric hospital in Singapore. J Obsessive Compuls Relat Disord. 2016;8:56–63. Scholar
  19. 19.
    Tortella-Feliu M, Fullana MA, Caseras X, Andión Ó, Torrubia R, Mataix-Cols D. Spanish version of the Savings Inventory–revised: adaptation, psychometric properties, and relationship to personality variables. Behav Modif. 2006;30(5):693–712. Scholar
  20. 20.
    Fontenelle IS, Rangé BP, Prazeres AM, Borges MC, Versiani M, Fontenelle LF. The Brazilian Portuguese version of the saving inventory–revised: internal consistency, test-retest reliability, and validity of a questionnaire to assess hoarding. Psychol Rep. 2010;106(1):279–96. Scholar
  21. 21.
    Yorulmaz O, Demirhan N. Cognitive correlates of hoarding symptoms: an exploratory study with a non-Western community sample. J Obsessive Compuls Relat Disord. 2015;7:16–23. Scholar
  22. 22.
    Melli G, Chiorri C, Smurra R, Frost RO. Psychometric properties of the paper-and- pencil and online versions of the Italian saving inventory—revised in nonclinical samples. Int J Cogn Ther. 2013;6(1):40–56. Scholar
  23. 23.
    Morris SH, Jaffee SR, Goodwin GP, Franklin ME. Hoarding in children and adolescents: a review. Child Psychiatry Hum Dev. 2016;47(5):740–50. Scholar
  24. 24.
    Burton CL, Crosbie J, Dupuis A, Mathews CA, Soreni N, Schachar R, et al. Clinical correlates of hoarding with and without comorbid obsessive-compulsive symptoms in a community pediatric sample. J Am Acad Child Adolesc Psychiatry. 2016;55(2):114–21. Scholar
  25. 25.
    Ivanov VZ, Mataix-Cols D, Serlachius E, Lichtenstein P, Anckarsäter H, Chang Z, et al. Prevalence, comorbidity and heritability of hoarding symptoms in adolescence: a population based twin study in 15-year olds. PLoS ONE. 2013;8(7):e69140. Scholar
  26. 26.
    Woerner M, Selles RR, De Nadai AS, Salloum A, Storch EA. Hoarding in college students: exploring relationships with the obsessive compulsive spectrum and ADHD. J Obsessive Compuls Relat Disord. 2017;12:95. Scholar
  27. 27.
    La B-A, Wood JJ, Kendall PC, McBride NM, Cepeda SL, Small BJ, et al. Presentation and correlates of hoarding behaviors in children with autism spectrum disorders and comorbid anxiety or obsessive-compulsive symptoms. J Autism Dev Disord. 2018;48(12):4167–78. Scholar
  28. 28.
    Storch EA, Nadeau JM, Johnco C, Timpano K, McBride N, Jane MP, et al. Hoarding in youth with autism spectrum disorders and anxiety: incidence, clinical correlates, and behavioral treatment response. J Autism Dev Disord. 2016;46(5):1602–12. Scholar
  29. 29.
    Dozier ME, Wetherell JL, Twamley EW, Schiehser DM, Ayers CR. The relationship between age and neurocognitive and daily functioning in adults with hoarding disorder: age and functioning in adults with HD. Int J Geriatr Psychiatry. 2016;31(12):1329–36. Scholar
  30. 30.
    Roane DM, Landers A, Sherratt J, Wilson GS. Hoarding in the elderly: a critical review of the recent literature. Int Psychogeriatr. 2017;29(7):1077–84. Scholar
  31. 31.
    Sumner JM, Noack CG, Filoteo JV, Maddox WT, Saxena S. Neurocognitive performance in unmedicated patients with hoarding disorder. Neuropsychology. 2016;30(2):157–68. Scholar
  32. 32.
    •• Pushkarskaya H, Tolin DF, Henick D, Levy I, Pittenger C. Unbending mind: individuals with hoarding disorder do not modify decision strategy in response to feedback under risk. Psychiatry Res. 2018;259:506–13. During a behavioral gambling task in which the probabilities of risk and rewards were known, hoarding participants utilized an inflexible and ecologically ineffective decision-making strategy relative to control participants, who adapted their strategy according to relative risk/reward ratios. CrossRefPubMedGoogle Scholar
  33. 33.
    Mathews CA, Perez VB, Roach BJ, Fekri S, Vigil O, Kupferman E, et al. Error-related brain activity dissociates hoarding disorder from obsessive-compulsive disorder. Psychol Med. 2016;46(02):367–79. Scholar
  34. 34.
    Mathews CA, Perez VB, Delucchi KL, Mathalon DH. Error-related negativity in individuals with obsessive–compulsive symptoms: toward an understanding of hoarding behaviors. Biol Psychol. 2012;89(2):487–94. Scholar
  35. 35.
    •• Zakrzewski JJ, Datta S, Scherling C, Nizar K, Vigil O, Rosen H, et al. Deficits in physiological and self-conscious emotional response to errors in hoarding disorder. Psychiatry Res. 2018;268:157–64. While completing a modified Stop-Change task, those with HD committed significantly more errors, were less accurate in monitoring their errors, and during error trials, demonstrated a deficit in self-conscious emotional expression and physiological reactivity, despite self-reporting higher levels of experienced emotions. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Timpano KR, Shaw AM, Cougle JR, Fitch KE. A multifaceted assessment of emotional tolerance and intensity in hoarding. Behav Ther. 2014;45(5):690–9. Scholar
  37. 37.
    Woody SR, Kellman-McFarlane K, Welsted A. Review of cognitive performance in hoarding disorder. Clin Psychol Rev. 2014;34(4):324–36. Scholar
  38. 38.
    Moshier SJ, Wootton BM, Bragdon LB, Tolin DF, Davis E, DiMauro J, et al. The relationship between self-reported and objective neuropsychological impairments in patients with hoarding disorder. J Obsessive Compuls Relat Disord. 2016;9:9–15. Scholar
  39. 39.
    Hallion LS, Diefenbach GJ, Tolin DF. Poor memory confidence mediates the association between inattention symptoms and hoarding severity and impairment. J Obsessive Compuls Relat Disord. 2015;7:43–8. Scholar
  40. 40.
    Tolin DF, Hallion LS, Wootton BM, Levy HC, Billingsley AL, Das A, et al. Subjective cognitive function in hoarding disorder. Psychiatry Res. 2018;265:215–20. Scholar
  41. 41.
    Yamada S, Nakao T, Ikari K, Kuwano M, Murayama K, Tomiyama H, et al. A unique increase in prefrontal gray matter volume in hoarding disorder compared to obsessive-compulsive disorder. PLoS ONE. 2018;13(7):e0200814. Scholar
  42. 42.
    Hough CM, Luks TL, Lai K, Vigil O, Guillory S, Nongpiur A, et al. Comparison of brain activation patterns during executive function tasks in hoarding disorder and non-hoarding OCD. Psychiatry Res Neuroimaging. 2016;255:50–9. Scholar
  43. 43.
    Seeley WW, Menon V, Schatzberg AF, Keller J, Glover GH, Kenna H, et al. Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci. 2007;27(9):2349–56. Scholar
  44. 44.
    Ivanov V, Nordsletten A, Mataix-Cols D, Serlachius E, Lichtenstein P, Lundström S, et al. Heritability of hoarding symptoms across adolescence and young adulthood: a longitudinal twin study. PLoS ONE. 2017;12(6). Scholar
  45. 45.
    Mathews CA, Delucchi K, Cath DC, Willemsen G, Boomsma DI. Partitioning the etiology of hoarding and obsessive–compulsive symptoms. Psychol Med. 2014;44(13):2867–76. Scholar
  46. 46.
    Zilhão N, Smit D, Boomsma D, Cath D. Cross-disorder genetic analysis of tic disorders, obsessive compulsive, and hoarding symptoms. Front Psychiatry. 2016;7:120. Scholar
  47. 47.
    Iervolino AC, Perroud N, Fullana MA, Guipponi M, Cherkas L, Collier DA, et al. Prevalence and heritability of compulsive hoarding: a twin study. Am J Psychiatry. 2009;166(10):1156–61. Scholar
  48. 48.
    Nordsletten AE, Reichenberg A, Hatch SL, Fernandez de la Cruz L, Pertusa A, Hotopf M, et al. Epidemiology of hoarding disorder. Br J Psychiatry. 2013;203(6):445–52. Scholar
  49. 49.
    Taylor JK, Theiler S, Nedeljkovic M, Moulding R. A qualitative analysis of emotion and emotion regulation in hoarding disorder. J Clin Psychol. 2018;75(3). Scholar
  50. 50.
    • Crone C, Norberg MM. Scared and surrounded by clutter: the influence of emotional reactivity. J Affect Disord. 2018;235:285–92. This study found that environmental state (i.e., a cluttered room versus an uncluttered room) influences discarding decisions differently depending on emotional reactivity. CrossRefPubMedGoogle Scholar
  51. 51.
    Raines AM, Boffa JW, Allan NP, Short NA, Schmidt NB. Hoarding and eating pathology: the mediating role of emotion regulation. Compr Psychiatry. 2015;57:29–35. Scholar
  52. 52.
    Raines AM, Chavarria J, Allan NP, Short NA, Schmidt NB. Hoarding behaviors and alcohol use: the mediating role of emotion dysregulation. Subst Use Misuse. 2017;52:1684–91. Scholar
  53. 53.
    Mathes BM, Oglesby ME, Short NA, Portero AK, Raines AM, Schmidt NB. An examination of the role of intolerance of distress and uncertainty in hoarding symptoms. Compr Psychiatry. 2017;72:121–9. Scholar
  54. 54.
    Grisham JR, Roberts L, Cerea S, Isemann S, Svehla J, Norberg MM. The role of distress tolerance, anxiety sensitivity, and intolerance of uncertainty in predicting hoarding symptoms in a clinical sample. Psychiatry Res. 2018;267:94–101. Scholar
  55. 55.
    Castriotta N, Dozier ME, Taylor CT, Mayes T, Ayers CR. Intolerance of uncertainty in hoarding disorder. J Obsessive Compuls Relat Disord. 2018;21:97–101. Scholar
  56. 56.
    Wheaton MG, Abramowitz JS, Jacoby RJ, Zwerling J, Rodriguez CI. An investigation of the role of intolerance of uncertainty in hoarding symptoms. J Affect Disord. 2016;193:208–14. Scholar
  57. 57.
    Burgess AM, Graves LM, Frost RO. My possessions need me: anthropomorphism and hoarding. Scand J Psychol. 2018;59(3):340–8. Scholar
  58. 58.
    Crone C, Kwok C, Chau V, Norberg MM. Applying attachment theory to indecisiveness in hoarding disorder. Psychiatry Res. 2019;273:318–24. Scholar
  59. 59.
    Danet M, Secouet D. Insecure attachment as a factor in hoarding behaviors in a non-clinical sample of women. Psychiatry Res. 2018;270:286–92. Scholar
  60. 60.
    Dozier ME, Taylor CT, Castriotta N, Mayes TL, Ayers CR. A preliminary investigation of the measurement of object interconnectedness in hoarding disorder. Cogn Ther Res. 2017;41(5):799–805. Scholar
  61. 61.
    Norberg MM, Crone C, Kwok C, Grisham JR. Anxious attachment and excessive acquisition: the mediating roles of anthropomorphism and distress intolerance. J Behav Addict. 2018;7(1):171–80. Scholar
  62. 62.
    Kwok C, Grisham JR, Norberg MM. Object attachment: humanness increases sentimental and instrumental values. J Behav Addict. 2018;7(4):1132–42. Scholar
  63. 63.
    Bratiotis C, Davidow J, Glossner K, Steketee G. Requests for help with hoarding: who needs what from whom? Pract Innov. 2016:82–8. Scholar
  64. 64.
    Rodriguez C, Levinson A, Patel S, Rottier K, Zwerling J, Essock S, et al. Acceptability of treatments and services for individuals with hoarding behaviors. J Obsessive Compuls Relat Disord. 2016:1–8. Scholar
  65. 65.
    • Bodryzlova Y, O’Connor K. Factors affecting the referral rate of the hoarding disorder at primary mental health care in Quebec. Community Ment Health J. 2018;54(6):773–81. Among HD individuals in Quebec, help seeking was related to older age, female gender, availability of services, and affiliation to a university medical center. Overall, communication and availability of clinical management tools for HD were lacking. CrossRefPubMedGoogle Scholar
  66. 66.
    Tolin DF, Frost RO, Steketee G, Muroff J. Cognitive behavioral therapy for hoarding disorder: a meta-analysis. Depress Anxiety. 2015;32(3):158–66. Scholar
  67. 67.
    •• Williams M, Viscusi JA. Hoarding disorder and a systematic review of treatment with cognitive behavioral therapy. Cogn Behav Ther. 2016;45(2):93–110. This systematic review compared treatment outcomes from CBT trials targeting OCD versus HD and determined that treatment research for HD is currently too limited to establish which approach is superior; however, they did conclude that individuals with hoarding symptoms are more treatment resistant than are individuals with OCD. CrossRefPubMedGoogle Scholar
  68. 68.
    Bodryzlova Y, Audet JS, Bergeron K, O’Connor K. Group cognitive-behavioural therapy for hoarding disorder: systematic review and meta-analysis. Health Soc Care Community. 2019;27(3):517–30. Scholar
  69. 69.
    Mathews CA, Uhm S, Chan J, Gause M, Franklin J, Plumadore J, et al. Treating hoarding disorder in a real-world setting: results from the mental health association of San Francisco. Psychiatry Res. 2016;30(237):331–8. Scholar
  70. 70.
    Moulding R, Nedeljkovic M, Kyrios M, Osborne D, Mogan C. Short-term cognitive behavioural group treatment for hoarding disorder: a naturalistic treatment outcome study. Clin Psychol Psychother. 2017;24(1):235–44. Scholar
  71. 71.
    O’Connor K, Bodryzlova Y, Audet JS, Koszegi N, Bergeron K, Guitard A. Group cognitive–behavioural treatment with long-term follow-up and targeting self-identity for hoarding disorder: an open trial. Clin Psychol Psychother. 2018;25(5):701–9. Scholar
  72. 72.
    Worden BL, Bowe WM, Tolin DF. An open trial of cognitive behavioral therapy with contingency management for hoarding disorder. J Obsessive Compuls Relat Disord. 2017;12:78–86. Scholar
  73. 73.
    Ivanov VZ, Enander J, Mataix-Cols D, Serlachius E, Månsson KN, Andersson G, et al. Enhancing group cognitive-behavioral therapy for hoarding disorder with between-session Internet-based clinician support: a feasibility study. J Clin Psychol. 2018 Jul;74(7):1092–105. Scholar
  74. 74.
    Ayers CR, Dozier ME, Twamley EW, Saxena S, Granholm E, Mayes TL, et al. Cognitive rehabilitation and exposure/sorting therapy (CREST) for hoarding disorder in older adults: a randomized clinical trial. J Clin Psychiatry. 2018;79(2). Scholar
  75. 75.
    DiMauro J, Genova M, Tolin DF, Kurtz MM. Cognitive remediation for neuropsychological impairment in hoarding disorder: a pilot study. J Obsessive Compuls Relat Disord. 2014;3(2):132–8. Scholar
  76. 76.
    Brakoulias V, Milicevic D. Assessment and treatment of hoarding disorder. Australas Psychiatry. 2015;23(4):358–60. Scholar
  77. 77.
    Saxena S, Sumner J. Venlafaxine extended-release treatment of hoarding disorder. Int Clin Psychopharmacol. 2014;29(5):266. Scholar
  78. 78.
    Mathews CA. Hoarding disorder: more than just a problem of too much stuff. J Clin Psychiatry. 2014;75(8):893. Scholar
  79. 79.
    Grassi G, Micheli L, Mannelli LD, Compagno E, Righi L, Ghelardini C, et al. Atomoxetine for hoarding disorder: a pre-clinical and clinical investigation. J Psychiatr Res. 2016;83:240–8. Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Eliza J. Davidson
    • 1
    • 2
  • Mary E. Dozier
    • 1
    • 2
    • 3
  • James O. E. Pittman
    • 4
    • 5
  • Tina L. Mayes
    • 4
    • 5
  • Brian H. Blanco
    • 1
    • 5
  • John D. Gault
    • 1
    • 5
  • Lauren J. Schwarz
    • 1
  • Catherine R. Ayers
    • 4
    • 5
    Email author
  1. 1.Research ServiceVA San Diego Healthcare SystemSan DiegoUSA
  2. 2.San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical PsychologySan DiegoUSA
  3. 3.Psychology ServiceSouth Texas Veterans Health Care SystemSan AntonioUSA
  4. 4.Mental Healthcare LineVA San Diego Healthcare SystemSan DiegoUSA
  5. 5.Department of PsychiatryUniversity of California, San Diego School of MedicineSan DiegoUSA

Personalised recommendations