Understanding and treating hoarding disorder: A review of cognitive-behavioral models and treatment

• Hoarding disorder (HD) involves difficulty discarding possessions, causing clutter.
• Cognitive-behavioral models suggest multiple factors contribute to HD symptoms.
• Cognitive behavioral therapy (CBT) for HD targets factors implicated in the model.
• CBT shows promise as an effective intervention for HD.

The hallmark feature of hoarding disorder (HD) is difficulty discarding possessions resulting in the accumulation of large amounts of clutter. Although hoarding symptoms have been noted for decades, HD did not constitute a formal diagnosis until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013). Research on psychological models of HD has revealed a substantial amount about the nature of hoarding problems and how they can be treated, as described in this review. The first section of this article reviews the factors implicated in the cognitive-behavioral model of HD, including dysfunctional beliefs about possessions, excessive emotional attachments to objects, and problematic patterns of behavioral avoidance, as well as skill deficits and information processing problems. Next, the components of cognitive-behavioral psychotherapy for HD, which are derived from this model, are presented. Evidence for the efficacy of this treatment (and each of its components) are then reviewed. Finally, factors that may interfere with treatment, as well as directions for future research, are discussed.