The compulsion to hoard belongings has been likened to addiction; yet there are some important differences between the two. In a previous post, some of those differences were discussed. Most importantly, however, are the differences in treatment approach. I am frequently asked by loved ones, “Can’t I just go in and clean the house?” It can be difficult to understand why this is not in the best interest of the individual struggling with hoarding difficulties. Herein lies the reason:

Treatment of the disorders

Addiction is typically treated by detoxification (i.e., the initial stage of purging the drug from the body while reducing withdrawal symptoms) and rehabilitation (i.e., may involve medication and/or behavioral therapy). Behavioral therapy helps individuals maintain motivation, develop coping skills to resist cravings, develop more adaptive behaviors in response to antecedents (behavior triggers), develop problem-solving skills, avoid drugs, and prevent relapse in addition to improving communication skills and relationships.

Cognitive-behavioral therapy has been demonstrated to be effective in the treatment of compulsive hoarding which involves helping individuals to change the way they think about and make decisions about their possessions in order to control their behavior and their emotional attachment to possessions. This process involves a thorough behavior assessment (to learn each individual’s contributing factors), psychoeducation (to improve insight and knowledge of the disorder), exposure/response prevention (E/RP) (for those who actively acquire, this involves exposing them to situations in which they have the opportunity to acquire, while having them refrain from acquiring – – this may be difficult for them initially, but with repeated E/RP, they habituate, or get used to, the situation and their distress decreases), cognitive restructuring (helping them to identify the flaws/distortions in their thought processes and change them to more adaptive/accurate/positive thoughts), and excavation exposure (exposing them to having to engage in the process of de-cluttering by sorting through their items while utilizing and practicing improved decision-making skills).

Why not remove individuals who compulsively hoard from the situation and clean for them?

Is drug abuse as simple as taking drugs away from an individual and forcing them to detox? No, of course not. Why? The individuals would be very likely to do anything they had to do to find drugs and return to their drug use because not only must the individuals manage the strong neurobiological dependence that has developed, which will influence drug-craving and drug-seeking, but they have also not developed the skills necessary to cope with cravings, environmental “triggers”, and improve problem-solving, or address other psychopathology and stressors, which are common. This also would not address the persons’ motivation to change; without a desire to end addiction, treatment will inevitably fail.

Compulsive hoarding is no different. Why then can’t we simply remove individuals who hoard from their home and clean the home for them? First of all, doing so has the potential to cause significant distress and interpersonal conflict. Because of the great value placed upon many of these hoarded possessions, disposing them without the individuals’ consent typically causes them to feel violated and distraught. Moreover, it is not at all likely to produce long-term change; the individuals will be likely to quickly re-acquire and clutter the home and will be more resistant to help or intervention. Cleaning for them does not give them the opportunity to practice and learn important decision making skills, learn the function that hoarding has served in their lives, and learn strategies to cope with their intense emotions. Exposure allows them to learn that the emotions that they have been avoiding (by failing to make decisions about items or discarding) are tolerable and that the intensity of distress and anxiety decreases (habituates) as they continue to expose themselves to proceeding through the process of decision-making and de-cluttering. Therefore, they must do it themselves in order to be able to achieve long-term success and maintain the cleanliness of the home.

Take-home messages

1)Hoarding is not an addiction; it does not involve tolerance or physiological dependence and if the behavior was to cease, there would be no physical withdrawal symptoms.

2)Hoarding is primarily driven by the strong urge to reduce or avoid anxiety or distress, whereas drug addiction is primarily driven by a desire for a “high.”

3)Treatment of addiction and compulsive hoarding share commonalities, but differ significantly.

4)Individuals who compulsively hoard must engage in the process of sorting through their possessions themselves in order to be able to achieve long-term behavior change.

5)There remains much more to be learned about these behaviors and their functioning.

Dr. Deibler

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