By Dr Ananya Mandal, MD
As of now since compulsive hoarding was not considered a separate disease entity, it does not have an established protocols of treatment.
With inclusion in the Diagnostic and Statistical Manual of Mental disorders V (DSM V) this may be remedied.
Up until now compulsive hoarding is treated as a part of obsessive compulsive disorder.
Who treats compulsive hoarding?
Compulsive hoarding is treated by a team of psychiatrists, psychologists and therapists experienced in treating OCD and other compulsive conditions.
Initial management includes diagnosis of the condition and also evaluation for other mental ailments that may be associated with the condition like social phobias, specific phobias, anxiety, depressive disorders and post-traumatic stress disorders (PTSD) etc.
Types of treatment for hoarding
Treatment of compulsive hoarding includes medication, cognitive behaviour therapy and so forth. (1-4)
Drugs with potent effects on the brain chemical serotonin seem most effective.
Initial therapy is begun with first line of treatment with SSRI (Selective Seratonin Reuptake Inhibitors).
These include drugs like paroxetine, fluoxetine, venlafaxine etc. These are basically antidepressants.
They are prescribed in high doses for at least three months. In compulsive hoarders without OCD response may be poor.
Other drugs include clomipramine which is a tricyclic antidepressant.
Cognitive Behaviour Therapy (CBT)
CBT is useful in OCD. Usually courses of CBT are administered as six sessions.
A prolonged therapy may be needed for compulsive hoarding compared to OCD.
The therapy addresses problems of motivation, organising, reduction of excessive acquisition etc.
This may require more than 25 sessions over six months to a year along with monthly home visits.
CBT may also be provided as group therapy. The therapist does not throw anything away, but may help guide and encourage the person to do so.
As part of CBT the sufferers are encouraged to keep a daily log of what they have purchased, to keep tabs incoming clutter.
A combination of medication and CBT appears to be the most effective treatment regimen for most people with the compulsive hoarding syndrome.
By the end of the therapy sessions the sufferer may not have cleared all their clutter but may have acquired the understanding of their problem.
They may be helped with a plan to remove and keep away excess stuff and prevent hoarding again.
Exposure and response prevention (ERP)
Education and ERP are major components of CBT.
Patients learn to understand their hoarding in terms of problems with anxiety, avoidance, inadequate decision making and information processing.
Patients are told that ERP will involve discarding items rather than merely organizing them.
This makes them decide on discarding rather than postponing. This decreases the anxiety associated with decision making.
The therapy teaches patients that nothing terrible happens when they discard items that they feel are valuable.
ERP is followed by increasing awareness of the consequences of hoarding and benefits of discarding unnecessary items.
Hoarding behavior is also replaced by better and more adaptive behaviors. Patients are kept active and engaged in more profitable occupations to keep their mind off hoarding.
This is a drastic step. It involves clearing out of the stuff that has been hoarded.
Most sufferers return deeply traumatised and angry. If the disease is not addressed before such intervention the hoarding behavior may come back in a few months.
Intensive multimodal treatment
Recent research suggests that the combination of medications and CBT is superior to either alone for compulsive disorders.
Support groups and self help
Another form of treatment available is for the sufferer to attend support groups and try self- help.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
What is hoarding?