A description of what hoarding is, what assessments are available, and treatment as well as self-help.

2. HOARDING DISORDER
Lita Furby, a pioneer researcher in the field of ownership and possessions, studied explanations for the things
people own. She found three major themes among people of all ages:
1. Possessions allow the owner to do or accomplish something. (personal power or efficacy). Possessions have
instrumental value; they are tools to perform tasks; to control our environment.
2. Possessions provide a sense of security; reminiscent of Winnicott’s transitional objects.
3. Possessions become part of an individual’s sense of self. Objects can increase one’s sense of status or power
and expand one’s potential. They can also preserve personal history. (Frost, R. O., & Steketee, G., 2011).
“When I’m trying to decide what I want to keep, this outdated coupon seems as important as my grandmother’s
picture.”

3. • The key features of a collection seem to be that it involves more than one thing but related somehow
and they must be acquired and organized in a certain way. However, a large amount of pens dumped in
a desk drawer are not actually a collection because there’s no organization and they are used.
• Virtually all hoarding clients make the claim they have a use for their possessions, but so do people
who do not have hoarding problems. The difference is the volume/variety of things they find useful.
• Hoarding is not about the number of items but by how the acquisition and management of those
possessions affects their owner. When hoarding causes distress or impairs one’s ability to perform
basic functions, it has crossed the line into pathology. (Frost, R. O., & Steketee, G., 2011).
“It was my BIG SECRET. I always had to make up something to keep my friends from coming over.”
HOARDING DISORDER

4. HOARDING DISORDER
“I had such a terrible week that I just wanted to come home and gather my treasures
around me.”
• Terror Management Theory: Grows out of an existential predicament that people, like all
animals are mortal. Knowledge about this death can produce paralyzing fear. To cope with this
potential terror, a collection offers the potential for immorality.
• Compensation Theory: People who question their self-worth need evidence to reassure
themselves of their value and importance. Physical objects provide clear and tangible
verification of mastery of the world. The feedback boosts self-esteem and contributes to a
positive self-image. (Frost, R. O., & Steketee, G., 2011).

5. HOARDING DISORDERAttachment Theory:
• Attachment Injury occurs which is a phenomenon where betrayal of trust results from a significant other at a time
of deep need.
• Out of disorganized early attachment experiences with compromised chaotic parenting…hoarding behavior
might be an unconscious effort in order to feel safe and creating a binding environment…by making a bridge
between object and subject…for psychological survival to compensate the early chaotic and traumatic
parenting or other traumatic events…to obtain unconditional love.
• Their object becomes a medium to love oneself as happens in case of a mother nurturing their child.
Expanded Narcissism:
• The same way we use objects to beautify ourselves…these objects now become part of the self; boundaries are
broken; and the object melts with the subject.
• Hoarders become extremely emotionally attached to their objects and report feelings of excessive anxiety,
difficulty in self control and a sense of having been violated when others touch their possessions without their
permission. (Kumar Singh, L., & Srivastava, K. 2017).
“If she ever owned it, its hers: if she wished she owned it, its hers; if in the future she might own it, its hers; if it
belongs to anyone she loves and who loves her, its hers.”

6. HOARDING DISORDER
A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them
C. The difficulty discarding possessions results in accumulation of possessions that congest and clutter active
living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because
of the interventions of third parties (e.g., family members, cleaners, authorities)
D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important
areas of functioning (including maintaining a safe environment for self and others)
E. The hoarding is not better explained by the symptoms of another medical disorder (e.g., brain injury,
cerebrovascular disease[blood vessels affecting the brain], prader-willi syndrome[genetic disorder by
intellectual disability, obesity, shortened height, behavior problems.])
F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in OCD,
decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder,
restricted interests in autism spectrum disorder). (American Psychiatric Association, 2013).
“I attach meaning to things that don’t need it.”

7. Specify if:
With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of
items that are not needed or for which there is no available space. (80-90% of individuals have this feature,
females tend to display more, particularly excessive buying than males do.
Specify if:
With good or fair insight: the individual recognizes that hoarding related beliefs and behaviors (pertaining to
difficulty discarding items, clutter, or excessive acquisition) are problematic.
With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining
to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the
contrary.
With absent insight/delusional beliefs: the individual is completely convinced that hoarding-related beliefs
and behaviors ( pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic
despite evidence to the contrary. (American Psychiatric Association, 2013).
HOARDING DISORDER
“If I throw too much away, there’ll be nothing left of me.”

8. HOARDING DISORDER
Once symptoms begin, the course of hoarding is often chronic, with few individuals reporting waxing and
waning course. The severity of hoarding also increases with age.
Approximately 75% of individuals with hoarding have a comorbid mood or anxiety disorder. Most common
are major depressive disorder, social anxiety disorder, and generalized anxiety disorder. 20% also have
symptoms that meet diagnostic criteria for OCD. These comorbidities may be the reason help is sought; these
individuals are unlikely to report hoarding disorders.
One feature of hoarding that sets it apart from disorders such as OCD is the pleasure. The experience of
shopping or acquiring is so overwhelmingly rewarding that it can be intensely gratifying.
ANY ATTEMPTS TO DISCARD OR CLEAR THE POSSESSIONS BY THIRD PARTIES RESULT IN HIGH
LEVELS OF DISTRESS. (American Psychiatric Association, 2013).
“Without these things, I am nothing.”

9. CLASSIC PROFILE OF HOARDING DISORDER
HTTPS://WWW.YOUTUBE.COM/WATCH?V=WQYSWUE5ATC
“Tag sales. That’s my thing. Its what gives me joy. I get real high from finding a
bargain. Every Saturday morning, I’m supposed to work, but I go tag-selling instead.
They dock my pay, but I don’t care. This is what I love to do. I’m in a much better
mood when I get to work.”

10. TREATMENTDiagnostic Interviews
• Diagnostic Interview for Anxiety, Mood, and Obsessive Compulsive and Related Neuropsychiatric
Disorders (DIAMOND; Tolin, Gilliam, Wootton, et al., 2018).
• Research version of the Structured Clinical Interview for DSM-5 (SCID-5) (First, Williams, Karg, &
Spitzer, 2015).
• Structured Interview for Hoarding Disorder (Nordsletten et al., 2013).
Assessments
• Hoarding Rating Scale (HRS) (Tolin, Frost, & Steketee, 2010; Tolin, Gilliam, Davis, et al., 2018).
Saving Inventory-Revised (SI-R) (Frost, Steketee, & Grisham, 2004).
• The Clutter Image Rating Scale (Frost, Steketee, Tolin, & Renaud, 2008).
• The Saving Cognitions Inventory (Steketee, Frost, & Kyrios, 2003).
(Wootton et al., 2019).
“All my life, I took care of people. I felt needed but not loved or appreciated. The animals have filled a void
inside me. I’m only one who can love and care for these animals. I am saving them from a life on the
streets.”

11. TREATMENTEvidenced Based Treatment Models
• Steketee, G. & Frost, R. O. (2014). Compulsive hoarding and acquiring: Therapist guide. (2nd ed.). New York:
Oxford University Press.
• Tolin, D. F., Worden, B., Wootton, B. M., & Gilliam, C. (2017). CBT for hoarding disorder: A group therapy
program therapist’s guide. Wiley.
Self-Help Treatment Books
• Tolin, D. F., Frost, R. O., & Steketee, G. (2007). Buried in treasures: Help for compulsive acquiring, saving,
and hoarding. New York: Oxford University Press.
Still, Cognitive-Behavior Therapy (CBT) is the most evidenced based treatment but requires more sessions than
other disorders do for treatment.
Hoarders may also benefit from: Home Visits, Contingency Management, Remote Based Interventions, & Peer-
Led Support Groups.
Even after treatment, most individuals will remain symptomatic with significant clutter and functional impairment.
(Wootton et al., 2019).
“I see too many options [for things]. I can’t control it. My brain needs to be rewired!”

12. REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders:
DSM-5. Washington (D.C.).
Frost, R. O., & Steketee, G. (2011). Stuff: compulsive hoarding and the meaning of things. Boston:
Mariner Books.
Frost, R.O. [International OCD Foundation]. (2012, April 26). Classic profile of hoarding disorder.
Retrieved from https://www.youtube.com/watch?v=wQYSWuE5ATc
Kumar Singh, L., & Srivastava, K. (2017). Hoarding: Quest for survival object relation perspective.
Indian Journal of Health & Wellbeing, 8(7), 740–743
Wootton, B. M., Worden, B. L., Norberg, M. M., Grisham, J. R., & Steketee, G. (2019). A clinician’s
quick guide to evidence‐based approaches: Hoarding disorder. Clinical Psychologist, 23(1),
85–87