OCD spectrum · Treatment guide
Hoarding Disorder
Persistent difficulty discarding possessions, with accumulation that compromises living space.
In this guide
Overview
Hoarding is its own DSM-5 diagnosis, distinct from OCD. Treatment combines motivational work, in-home sorting practice, and cognitive work on beliefs about possessions. Progress is slow and relapse-prone.
First-line treatments
- CBT — Cognitive Behavioral Therapy
Hoarding-specific CBT (Steketee & Frost) — motivation, sorting practice, discarding exposure.
- MI — Motivational Interviewing
Ambivalence about discarding is central — MI is integrated throughout treatment.
Also consider
- ACT
Values clarification re: the home and relationships; defusion from beliefs about objects.
Cautions
- Coordinate with family, social services, or housing when safety (fire, sanitation, eviction) is at stake.
- Forced clean-outs without skill-building cause re-accumulation and damage the therapeutic alliance.