CBT for Compulsive Hoarding
I've never forgotten the look Sam* gave me when I began to bag up his things: it was a mixture of the ferocious protectiveness of a mother mixed with panic and sorrow, almost like he was watching me kill his beloved dog. But all I was doing was stuffing some moldering old newspapers into a trash bag. Sam had been told that if he didn't de-clutter he would be evicted from the halfway house where he lived. That intense, pained look gave me was my first inkling of the unusual and intense emotional attachments that hoarders have to their belongings.
Hoarders are sometimes drawn to acquire certain varieties of cherished objects. Sam was eighty-five years old and what some have called an information hoarder. He accumulated mostly old newspapers, magazines and books he found in the free book bin at Powell's Books. Like most who hoard, Sam was convinced the information would be crucial for him to have one day, or it would jog his memory about something important. Other scrap objects that he collected he simply felt were irreplaceable and he had a strong sentimental attachment to them.
Hoarding is very different from being a collector of objectively valuable or interesting objects. Compulsive hoarding--although not yet an official DSM-IV mental disorder--is generally defined as the excessive acquisition of and saving of items that are worthless, hazardous or unsanitary, which impairs basic activities of living. Sadly, animals are what some hoarders are drawn to acquire. Hoarding can be present by itself or it can be an associated symptom of another disorder, most often Obsessive Compulsive Disorder (OCD), Obsessive Compulsive Personality Disorder (OCPD), Attention-deficit /hyperactivity disorder (ADHD) or depression.
Because hoarding shares traits with Obsessive Compulsive, the psychotherapy treatment approach of choice for it is the same: exposure-based Cognitive Behavioral Therapy (CBT) that emphasizes gradual exposure and tolerance building to the distressing emotions associated with not hoarding. The APTC is one of few clinics in the Portland area that provides this evidence-based treatment for compulsive hoarding.
Sam never got the chance to get effective CBT treatment for his hoarding before he passed away of age-related illness. I sometimes reflect with sadness on how much happier, less isolated, and less filled with resentment, suspicion and depression his later years could have been if Sam had had that chance to get treatment for this difficult and debilitating condition.