Treatment of hoarding disorder

Hoarding disorder (HD) is a chronic and debilitating psychological disorder with wide ranging negative effects on individuals, their families, and the community. In this chapter we review the current evidence for the use of pharmacological and psychological interventions in HD. Our review showed that cognitive-behavioral interventions are efficacious. However, many gaps and issues exist. In particular, research has not evaluated the efficacy of pharmacological treatments in comparison to control treatments. Furthermore, psychological treatment outcomes are modest and treatment effectiveness is further reduced by high dropout rates. Recent studies evaluating modifications to cognitive-behavioral interventions such as incorporating cognitive rehabilitation and exposure/ sorting therapy, contingency management, community services such as a local fire officer, and the inclusion of student-facilitated in-home sessions show that improvements to outcomes are possible and provide an impetus for large scale clinical trials. We conclude the chapter with a discussion of the challenges that affect treatment outcomes for HD and provide suggestions for future directions in research.