Therapy and Co-Existing Conditions (depression, anxiety and physical/medical conditions)

The question of which type of Therapy works best for Hoarding Disorder is still being studied. Early success has been found with modified Cognitive Behavioral Therapy (CBT). If you're curious about the various types there are to choose from, this article explains a lot about them: Different Types of Therapy [Psychotherapy : Which is Best For You?]

There are more than FIFTY types of therapeutic approaches. However, only a few of them are common. There are also some that act as broad categories and contain subtypes. In the above referenced article, there is a short list of the types you are most likely to encounter - and then the longer list of other types and subtypes. Remember, though, that most therapists blend therapeutic approaches and customize an integrated approach for each client.

Diagnosis and Treatment for Hoarding Disorder
From: Mayo Clinic's Hoarding Disorder Diagnosis and Treatment

Diagnosis

People often don't seek treatment for hoarding disorder, but rather for other issues, such as depression or anxiety. To help diagnose hoarding disorder, a mental health professional performs a psychological evaluation. In addition to questions about emotional well-being, you may be asked about a habit of acquiring and saving items, leading to a discussion of hoarding.

Your mental health professional may ask your permission to talk with relatives and friends. Pictures and videos of your living spaces and storage areas affected by clutter are often helpful. You also may be asked questions to find out if you have symptoms of other mental health disorders.

For diagnosis, your mental health professional may use the criteria for hoarding disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Treatment of hoarding disorder can be challenging because many people don't recognize the negative impact of hoarding on their lives or don't believe they need treatment. This is especially true if the possessions or animals offer comfort. If these possessions or animals are taken away, people will often react with frustration and anger and quickly collect more to help fulfill emotional needs.

The main treatment for hoarding disorder is cognitive behavioral therapy (CBT). Medications may be added, particularly if you also have anxiety or depression.

Psychotherapy

Psychotherapy, also called talk therapy, is the primary treatment. Cognitive behavioral therapy is the most common form of psychotherapy used to treat hoarding disorder. Try to find a therapist or other mental health professional with experience in treating hoarding disorder.

As part of cognitive behavioral therapy, you may:


 * Learn to identify and challenge thoughts and beliefs related to acquiring and saving items
 * Learn to resist the urge to acquire more items
 * Learn to organize and categorize possessions to help you decide which ones to discard
 * Improve your decision-making and coping skills
 * Declutter your home during in-home visits by a therapist or professional organizer
 * Learn to reduce isolation and increase social involvement with more meaningful activities
 * Learn ways to enhance motivation for change
 * Attend family or group therapy
 * Have periodic visits or ongoing treatment to help you keep up healthy habits

Treatment often involves routine assistance from family, friends and agencies to help remove clutter. This is particularly the case for the elderly or those struggling with medical conditions that may make it difficult to maintain effort and motivation.

Mission Australia Room To Grow Pilot Program
From: Room To Grow Infographic

Full Report at: Mission Australia Publications

From July 2015 to June 2016, Mission Australia (MA) implemented and evaluated an intervention for hoarding disorder and domestic squalor across the central and eastern Sydney region. Named Room to Grow, this pilot program aimed to address the physical, cognitive and psychological factors contributing to situations of severe domestic squalor and hoarding disorder, thereby reducing the risk of tenancy loss and homelessness.

The Room to Grow service model embedded psychological and neuropsychological interventions within an intensive case management program. Interventions included:
 * adapted cognitive behavioural therapy (CBT) run by clinical psychologists;
 * cognitive remediation sessions provided by a neuropsychologist;
 * home visits and intensive case management provided by case managers; and
 * peer support group run collectively by case managers and program participants

Key Recommendations


 * 1) Social interaction should be central to program design – there is strong therapeutic value to social support throughout service delivery and supportive relationships between participants.
 * 2) Adapted CBT is highly beneficial for those experiencing hoarding disorder – hoarding disorder is a mental health issue and requires psychological support.
 * 3) Participants must be centrally involved in all decision-making – enforced cleans are likely to lead to traumatisation and other negative outcomes, even with prior warning and consultation.
 * 4) Home visits are essential – it is important for participants to be supported to organise and discard possessions in their own homes.
 * 5) Ongoing support through peer support networks is beneficial – continuing support after ‘formal’ interventions sustains the behaviour change learnt throughout program.

Co-Existing Conditions / Co-Morbidity
From: Comorbidity in hoarding disorder

Hoarding Disorder is a stand-alone disorder - however, it often is coupled with others including (but not limited to) ADD, OCD, Depression...

One study found: "High comorbidity [co-occurring] rates were observed for major depressive disorder (MDD) as well as acquisition-related impulse control disorders (compulsive buying, kleptomania, and acquiring free things). Fewer than 20% of HD participants met criteria for OCD, and the rate of OCD in HD was higher for men than women. Rates of MDD and acquisition-related impulse control disorders were higher among HD than OCD participants. No specific anxiety disorder was more frequent in HD, but social phobia was more frequent among men with HD than among men with OCD. Inattentive ADHD was diagnosed in 28% of HD participants and was significantly more frequent than among OCD participants (3%)."

From: The economic and social burden of compulsive hoarding

In addition, there is overlap with medical conditions which exasperate the difficulty. Some of the most commonly-reported medical conditions among hoarding participants in one study were arthritis, hypertension, chronic stomach/gallbladder trouble, lupus/thyroid disorder/autoimmune disease, chronic fatigue syndrome, fibromyalgia, and diabetes/high blood sugar.

Medications
From: Mayo Clinic's Hoarding Disorder Diagnosis and Treatment

There are currently no medications approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Typically, medications are used to treat other disorders such as anxiety and depression that often occur along with hoarding disorder. The medications most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Research continues on the most effective ways to use medications in the treatment of hoarding disorder.

It's Not About The Stuff - 5 Reasons Why People Hoard
Grief, Loss, Abuse, Neglect??? Here's a link to the full article: It's Not About the Stuff

And here's an excerpt:

"It's not about the stuff at all. The "stuff" is just a manifestation of stopped-up feelings. Like feeling not worthy, not loveable, not good enough, inadequate, inferior. No one cares about me but my stuff is always there for me. It won't leave me. It won't reject me."

"People hoard to fill emotional voids. It’s not about the stuff – it’s about what’s going on with them on a personal level."

Grief/Loss is one of five reasons discussed in this document. The other four are Loneliness, Impoverished, Memory and Rescue Mentality, Commonly from Abuse/Neglect. One that isn't mentioned in this article is Trauma - and that's another cause that could be explored...

Links
return to category:Hoarding and Decluttering
 * Different Types of Therapy [Psychotherapy : Which is Best For You?]
 * Mayo Clinic's Hoarding Disorder Diagnosis and Treatment
 * Room To Grow Infographic
 * Mission Australia Publications
 * Comorbidity in hoarding disorder
 * The economic and social burden of compulsive hoarding