Treatment options for compulsive hoarding

Compulsive hoarding is very difficult to treat.  In this section we look at the different treatment options.

  • Medication
  • Cognitive Behaviour Therapy (CBT)
  • Intervention
  • Support groups
  • Self-help

Medication

The first line of treatment is SSRI (Selective Seratonin Reuptake Inhibitors) medications such as paroxetine (Seroxat or Paxil), fluoxetin (Prozac) or venlafaxine (Effexor), taken at a high dose for at least three months.  SSRIs are commonly used to treat depression and other related illnesses.

There is generally a poor response rate to SSRIs compulsive hoarders without OCD. It has been shown that the higher a patient scores on a scale of hoarding symptoms the less likely they are to respond to SRI treatment. Compulsive hoarding often has co-morbidity with depression, so treating the depression with SSRIs is often helpful.

Also used is clomipramine (Anafranil) which is a tricyclic antidepressant.  Although it has more side effects it is more effective than the SSRIS against OCD.

Another line of attack is with venlafaxine (Effexor) which is a serotonin norepinephrine reuptake inhibitor (SRRI).  It is an very commonly used anti-depressant. 

It there are any co-existing illnesses such as ADHD, drug treatment for these can be added into the mix.

Cognitive Behaviour Therapy (CBT)

While CBT is effective treating OCD, trials using using the traditional CBT methods used for OCD for those with compulsive hoarding consistently report a poor response. Usually courses of CBT are administered as six sessions.

An alternative approach is intensive CBT with a skilled therapist over a prolonged period.   The CBT would need to include specialised components to address motivation problems, organising skills and exposure plus cognitive methods for reducing acquiring.  This type of therapy requires more than 25 sessions over six months to a year and would include monthly home visits. Group CBT has also been shown to be effective in the USA. 

Understandably this sort of therapy has budget and funding implications.

Find a CBT therapist in the UK.

Intervention

This is a sensitive issue. 

Families often try to help clinical compulsive hoarders by having a 'clear out' when the hoarder is away from their home.  The hoarder returns and is deeply traumatised, angry and betrayed. Often family relationships break down. 

People say 'I'll get the council in to clear up'.  Sure, that's an option but is VERY expensive and and can cost tens of thousands of pounds to clear a house.  Local authorities will only clear a house that presents a environmental health and safety hazard after a period of negotiation.  Any costs incurred will be passed on to the home owner.  If the householder doesn't have the means to pay, a charge will be put against the property which will be reclaimed when it is finally sold. 

A compulsive hoarder's problem will not be solved by someone else throwing away or organising their possessions.  The clinical compulsive hoarder will simply re-hoard even faster and fill up their home again, often within a few months.

That said though, there comes a point when a family as a whole, often children for their parents, may need to take a decision to intervene for the sake of the health and safety of any other members of the family living in the home.

Any intervention into a clinical compulsive hoarders home should be carefully planned and be with the co-operation of the hoarder.  It will probably be a short-term fix unless there is other on-going treatments and support and is never an easy choice.  These are incredibly difficult decisions for anyone to make and should never undertaken lightly.

There is no straightforward and simple solution.  We wish we had more answers.

Self help

If you have acknowledged that you are a hoarder and either can’t get individual treatment or get to that meeting, it is still possible to look for a ‘buddy’, a fellow sufferer who can sympathise with issues being faced and who can be someone to be a study buddy doing the tasks laid out in the available books.

Support groups

A new development in the treatment of hoarding is the growth of the self-help support groups, both as a group meeting and in internet groups.  Members are encouraged to set goals and supported by other members.  Open discussion is welcomed, which helps the sufferers move on from the embarrassment and shame and start to clear their houses.  

Find out more about self-help support groups for compulsive hoarding in the UK.


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