Compulsive hoarding is a disabling disorder that may affect as many as 2 million people in the United States, and many more around the world. Compulsive hoarding is often found in combination with other diseases such as dementia, Alzheimer’s, schizophrenia and obsessive-compulsive disorder (OCD). But how and where can compulsive hoarders get effective treatment?
The two most common forms of treatment for compulsive hoarding are medication and psychotherapy.
Medication as Treatment for Compulsive Hoarding
The medication most often used to treat compulsive hoarding is a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)-such as paroxetine (Paxil or Seroxat) or fluoxetin (Prozac)-that increase the level of serotonin activity in the brain.
Research studies show that some people with compulsive hoarding disorder respond well to these medications. Many others do not, however, compulsive hoarders without obsessive-compulsive disorder (OCD). Many compulsive hoarders are also depressed, so treating their depression with SSRIs is often helpful, but the higher a person scores on a scale of hoarding symptoms the less likely they are to respond to SSRI treatment.
Other drugs that are sometimes used to treat compulsive hoarding include venlafaxine (Effexor), a serotonin norepinephrine reuptake inhibitor (SRRI) and common antidepressant, and clomipramine (Anafranil), which is a trycyclic antidepressant. Clomipramine has more side effects than the SSRIs, but it is generally more effective against OCD.
Psychotherapy as Treatment for Compulsive Hoarding
Cognitive-behavioral therapy is the most common type of psychotherapy used to treat compulsive hoarding. Through therapy, compulsive hoarders can explore why they feel compelled to acquire and hoard an excessive number of possessions and why they allow their compulsion to dominate their lives.
Therapy can also help compulsive hoarders improve their decision-making skills, learn to organize and manage their possessions, and enable them to find the will to give away or discard some of the things they have gathered around them. For many people, psychotherapy is more effective than medication for treating their compulsive hoarding.
Some therapists make on-site visits to the homes of compulsive hoarders who have come to them for treatment, sometimes in the company of a professional organizer, to offer the hoarder support and guidance in deciding how to begin freeing themselves from the tyranny of their possessions. Therapists may also teach their clients relaxation techniques that can help compulsive hoarders manage the anxiety brought on by decluttering their homes, and may recommend a hoarding support group in some cases.
Compulsive hoarders who want to try therapy as a treatment should be sure to find a therapist who has extensive experience in helping people with the disorder. Your local mental health agency can help you find a suitable therapist, and the International OCD Foundation maintains a list of therapists across the United States who specialize in treating compulsive hoarding.
Barriers to Treatment of Compulsive Hoarding
The most significant barrier to effective treatment for compulsive hoarding is that many hoarders don't see anything wrong with their lifestyle and don't believe they need treatment. In such cases, some families try an intervention in which the hoarders friends and relatives clean out the house and discard the accumulated clutter. All too often, however, the hoarder immediately begins gathering a new assortment of valueless possessions to replace the old.
Some compulsive hoarders also have dementia, which can be treated in other ways, but people with dementia are not good candidates for psychotherapy. Effective therapy requires a level of awareness and insight that is not possible for someone with dementia to sustain.