The Etiology of Compulsive Hoarding

Running head: COMPULSIVE HOARDING 1

The Etiology of Compulsive Hoarding

Chad J. Ressler

Liberty University

COMPULSIVE HOARDING 2

Abstract

Compulsive hoarding, as a disorder, was not included in the DSM-IV-TR. However, bodies of

research on the differences between OCD and hoarding, such as resistance to treatment and the

ego-syntonic and ego-dystonic natures of the disorders resulted in the inclusion of hoarding as a

separate diagnostic entity in the DSM-V. Popularized by the A&E show Hoarders, this disorder

was thrust into the spotlight. Research and treatment of hoarding disorder is still in its nascent

stages, but already researchers and clinicians have formed and tested several hypotheses that

have greatly advanced the knowledge of hoarding disorder. To understand the etiology of this

disorder eludes researchers despite many theories being advanced. Properly understanding the

etiology of hoarding disorder will lead to more effective treatment approaches. This paper will

examine hoarding disorder as listed in the DSM-V as well as to put forth the assertion that

attachment theory may provide clues to the etiology of hoarding disorder.


The Etiology of Compulsive Hoarding

Decades ago, compulsive hoarding was thrust into the national spotlight with the death of

two brothers, Homer and Langley Colleyer, in March 1947. Having a home filled with 120 tons

of debris, Langley died when debris collapsed onto him as he was delivering a meal to his

paralyzed brother; subsequently, Homer died of starvation (Grisham & Barlow, 2005). Recently,

the issue of compulsive hoarding has become popularized by the A&E television show

Hoarders. Clinicians such as Robin Zasio, David Tolin, and Mark Pfeffer combine with expert

clean up specialists such as Matt Paxton and Corey Chalmers to treat and de-clutter the homes of

compulsive hoarders around the nation. Though a television show, the experiences of the

individuals as well as the ramifications of the disorder are quite real and quite significant.

Compulsive hoarding follows a chronic course in an individual’s life and often results not

only in significant impairment and danger for the hoarder, but the effects ripple into

communities. Grisham and Barlow (2005) noted that in a survey of local health departments

“hoarding complaints were reported by 64% of the health officers and sometimes resulted in

significant cost to the community” (p. 45). As such, a fuller understanding of the nature and

causes of compulsive hoarding is necessary. Though research on and empirical studies of

compulsive hoarding are in their nascent stages, several conclusions have been made and future

directions for research garnered. Specific cognitive-behavioral treatment plans have been

established, and success has been met when treating those with hoarding disorder. What is

lacking, however, is a solid etiology of hoarding disorder. Though many theories have been

advance to explain the occurrence of hoarding disorder, it is perhaps attachment theory that will

provide some answers. This paper will seek to explain compulsive hoarding through the


epistemology of attachment theory and proposes that the cause of hoarding disorder is the result

of not developing secure attachments early in life.

Diagnostic Criteria of Hoarding Disorder

Hoarding disorder is defined as “the acquisition of, and inability to discard, possessions

of limited value, to a degree that precludes appropriate use of living spaces and creates

significant distress or impairment in functioning” (Grisham & Barlow, 2005, p. 46). The

prevalence of hoarding disorder is estimated to be roughly 2-6% in the U.S. and Europe affecting

males and females (APA, 2013). The recent inclusion of hoarding disorder in the DSM-V

closely follows the above definition with its diagnostic criteria. The diagnostic criteria for

Hoarding Disorder 300.3 (F42) are as follows:

A) Persistent difficulty discarding or parting with possessions, regardless of their actual

value.

B) This difficulty is due to a perceived need to save the items and to distress associated

with discarding them.

C) The difficulty discarding possessions results in the accumulation of possessions that

congest and clutter active living areas and substantially compromises their intended

use. If living areas are uncluttered, it is only because of the interventions of third

parties (e.g., family members, cleaners, authorities).

D) The hoarding causes clinically significant distress or impairment in social,

occupational, or other important areas of functioning (including maintaining a safe

environment for self and others).

E) The hoarding is not attributable to another medical condition (e.g. brain injury,

cerebrovascular disease, Prader-Willi syndrome).


F) The hoarding is not better explained by the symptoms of another mental disorder

(e.g., obsessions in obsessive compulsive disorder, decreased energy in major

depressive disorder, delusions in schizophrenia or another psychotic disorder,

cognitive deficits in major neurocognitive disorder, restricted interests in autism

spectrum disorder) (APA, 2013, p. 247).

One key feature of hoarding disorder, which is included as a specifier when diagnosing,

is that of excessive acquisition. Gilliam and Tolin (2010) note that self-reports of hoarding

indicate that 85% of hoarders report excessive acquisition, yet family reports push the percentage

to 95%. Levels of insight are additional specifiers when diagnosing hoarding disorder. Good or

fair insight, poor insight, and absent insight or delusional beliefs comprise this section of

specifiers (APA, 2013). Maladaptive behavioral processes are believed to contribute to the

hoarder’s difficulty perceiving the hoard as pathological. Tolin (2011) suggests that hoarders

suffer deficits in their ability to both recognize and become motivated to change. Hoarders are

often unaware that their behavior has reached a level of pathology, sometimes even rationalizing

their hoarding behavior.

While Grisham and Barlow (2005) note that it is in line with evolutionary adaptive

behavior to acquire and store goods to ensure survival, this normal collecting behavior does not

produce the effects seen in hoarding disorder. Normal collecting behavior does not result in

significant distress when having to discard (Criterion B), nor does it manifest the extreme clutter

that is characteristic of hoarding disorder (Criterion C) (APA, 2013). It also logically follows

that normal collecting behavior would seek after items that hold some value, however, those with

hoarding disorder will not discard, nor part with items regardless of value (Criterion A). As

such, following from criteria A, B, and C is the clinically significant distress caused by the hoard


which often results in unsafe and unsanitary environments (Criterion D) (APA, 2013). The

DSM-V notes that other common features of hoarding disorder include: “indecisiveness,

perfectionism, avoidance, procrastination, difficulty planning and organizing tasks, and

distractibility” (APA, 2013, p. 249). These ancillary features of hoarding disorder are in line

with research that suggests four main deficits that contribute to hoarding: “information

processing, beliefs about and emotional attachments to possessions, and emotional stress and

avoidance behaviors that develop as a result” (Grisham & Barlow, 2005, p. 47).

Diagnostic Process

Diagnosing hoarding can be notoriously difficult because one cannot observe in a clinical

interview that an individual is a compulsive hoarder. Unless self-reported, often a diagnosis is a

result of the individual being treated due to the involvement of a third party (e.g., police, family

member, or social service worker). However, once confronted with the prospect of a hoarding

diagnosis, David Tolin (2011) states that “hoarding symptoms should be assessed thoroughly,

using validated and specific measures” (p. 524). Though a recent diagnostic entity, assessment

measures have been developed to assist in diagnosing hoarding disorder. Two tools for

diagnosing the disorder include the Saving Inventory—Revised and the Saving Cognitions

Inventory (Grisham & Barlow, 2005). The SI—R contains 23 items with subscales examining

discarding, excessive clutter, and compulsive acquisition, while the SCI has 24 items that

measure hoarding beliefs and emotional reactions (Grisham & Barlow, 2005). Both scales have

good reliability and discriminate and convergent validity. Other tools for assessing hoarding

disorder would include the Yale-Brown Obsessive Compulsive Scale (YBOCS) and the

Obsessive Compulsive Inventory (OCI). While useful, these scales are not able to assess certain


specific aspects of hoarding as well as to discriminate between normal collecting and compulsive

hoarding (Grisham & Barlow, 2005).

Causes of Hoarding Disorder

The exact cause of hoarding disorder is unknown. Researchers have proposed various

etiologies of hoarding disorder; however, more research is needed on this disorder before any

firm conclusions can be made. Jumping to any one conclusion risks committing fallacies in

scientific thinking; specifically, the fallacy of confusing various kinds of causes (Geisler &

Brooks, 1990). The efficient cause of hoarding disorder is what needs discovered. The efficient

cause is that which produces the effect. With efficient causes there can be both a primary cause

and a secondary cause (Geisler & Brooks, 1990). A secondary cause is “a subsidiary efficient

cause used by the primary cause to produce the effect. There is a primary cause for every event,

but there may not be a secondary cause” (Geisler & Brooks, 1990, p. 174). It is necessary then

to examine those causes which may provide an answer as to the efficient cause of hoarding

disorder.

Biological

Hoarding can be the result of genetic and biological causes. Medial prefrontal and

orbitofrontal cortex damage is but one known cause of the onset of new hoarding symptoms in

those without a prior disposition to hoard (Ayers, Saxena, Golshan, & Wetherell, 2009).

Hoarding behavior can also be the result of the condition known as Prader-Willi syndrome. This

genetic disorder is present in 1 in 15,000 live births. Individuals with this disorder are small in

stature and possess small extremeties as well as hypopigmentation and hypogonadism (Storch,

Rahman, Park, Reid, Murphy, & Lewin, 2011). Those with Prader-Willi syndrome have a

constant need for food and it is estimated that they consume three to six times more food than


normal. It is this constant need for food that can often lead to food hoarding behavior (Storch et

al., 2011). Tolin (2011) adds that Chromosome 14 has been linked to hoarding as well as noting

that “the majority of hoarders described a first degree relative as a “packrat”, compared with a

minority of OCD patients without hoarding symptoms” (p. 520).

Psychosocial

Various psychosocial theories have been advanced to explain the cause, not the onset, of

hoarding symptoms. Two main causes that need exploration are stressful life events and

attachment related issues. The reason for this is that this paper asserts that attachment related

issues are the primary efficient cause of hoarding disorder while stressful life events are the

secondary cause. However, often stressful life events are assumed to be the cause due to the fact

that “inaccurate initial recall of hoarding onset may have led to the idea that hoarding onset

occurred only after extreme life events, when in fact it may have been present all along” (Ayers,

Saxena, Golshan, & Wetherell, 2010, p. 147).

Stressful Life Events. A study conducted by Tolin, Meunier, Frost, and Steketee (2010)

examined the relationship of stressful life events to compulsive hoarding. While the authors of

the study noted that there was a link between SLEs and compulsive hoarding, the link remained

unclear. The study they conducted sought to examine age of onset and course of compulsive

hoarding, the incidence of SLEs among those with compulsive hoarding, as well as to determine

temporal associations (Tolin, et al., 2010). Among other predictions was that SLEs would be

more common among those with compulsive hoarding. The researchers were able to sample 751

individuals who self-reported compulsive hoarding; the diagnosis and severity were assessed

using the Hoarding Rating Scale—Self-Report. Onset was found to be between the ages of 11-20

with 70% of the sample reporting an onset before age 21, and for 548 individuals, or 73%,


hoarding was chronic (Tolin, et al., 2010). The researchers used five categories of SLE’s in this

study: loss of job or functioning, change in relationships, loss or damage to possessions,

interpersonal violence, and other (Tolin et al., 2010, p. 834). For purposes of this paper, the

researches findings showed a high incidence of SLE’s among hoarders with 76% reporting

having experienced interpersonal violence. Disruption of relationships was also noted as a

contributor to symptom onset or increase suggesting a link between attachment and hoarding.

The researchers did note some limitations with this study with the major limitation being

the heavy reliance on self-report measures as well as retrospective reports of SLE’s. As was

indicated previously, self-reports can suffer from recall problems which could cause researchers

to commit a post hoc, ergo propter hoc fallacy. A biased sample is another limitation of this

study. The sample was drawn from individuals who were seeking treatment, thus indicating that

the sample used was from the more severe end of the hoarding spectrum rather than surveying a

more representative mix of hoarders who may have suffered from a milder form (Tolin, et al.,

2010).

A study of geriatric patients found that of 18 participants only 2 reported what could be

considered an SLE (relocation and divorce) during an abrupt increase in symptoms with one

participant going from none to moderate (Ayers, Saxena, Golshan, &Wetherell, 2010). The

problem with their sample, however, was that it was too small to make any generalizations.

Moreover, the sample was taken strictly from elderly patients, suffering from the same if not

more exacerbated self-report and recall problems as the aforementioned study. However,

similarities between the two studies should be noted. Age of onset for seven of the participants

was between 11-20 years of age with one reporting symptom onset at age 4. Participants also


reported that severity increased over the life span. In nearly every subject hoarding symptoms

originated in childhood and adolescence and increased with age (Ayer, et al., 2010).

Attachment Issues. Barlow and Grisham (2005) write, “correlations of attachment with

measures of hoarding suggest a positive association between anxious/ambivalent attachment and

hoarding, attachment to possessions, and saving cognitions” (p. 48). A unique study conducted

by Kellet, Greenhalgh, Beail, and Ridgway (2010) used an interpretative phenomenological

analysis to assess the experience of compulsive hoarders. Interpretative phenomenological

analysis is “particularly concerned with the exploration of unique individual experiences, rather

than seeking to make general or universal statements (Kellet, et al., 2010, p. 144). A sample of

11 individuals (3 male, 8 females) participated in this experiment which sought to examine the

lived experiences of hoarders (Kellet, et al., 2010). Interviews lasted between 1 and 1.5 hours

with tapes transcribed verbatim. Results of the study indicated that, again, hoarding behaviors

developed during childhood with individuals reporting complex relationships with the

possessions, including emotional attachment. Researchers noted an important subtheme that

emerged, that of individuals anthropomorphizing possessions and a “sense of fusion between the

hoarder and their possessions” (Kellet, et al., 2010, p. 146). One major drawback of this study

was that the authors noted that some of the individuals may not have met the definition of

compulsive hoarding and no clinical interviews or established tools for assessing hoarding were

used. However, the authors were able to visit 10 of 11 homes in the study (Kellet, et al., 2010).

As has been established, the onset of compulsive hoarding starts in childhood. It is

logical then to assume that stressful life events, while not a primary efficient cause, are a

subsidiary efficient cause. The reason for this is that children will first form their attachment

style and then filter all experiences through this cognitive schema. A stressful life event simply


reinforces their already insecure attachment style leading to exacerbation of their symptoms

whether it be onset of hoarding or an increase in the severity of hoarding.

Attachment is a trait as well as a relationship construct as has been pointed out by Hazan

and Shaver (1994). An insecure attachment style describes the quality of the relationship;

however, the experiences and features of that relationship are then represented in the mind and

behavior of the infant (Hazan & Shaver, 1994). If the infant cannot form a secure attachment

style to the primary caregiver then it is possible that a fantasy surrogate will be formed in order

to form a secure base. Hazan and Shaver (1994) write, “humans normally become attached to

multiple individuals and even to inanimate objects” (p. 71). It is thus logically possible that the

hoarder has formed a secure attachment with his or her possessions which may explain why

hoarding disorder is so resistant to both pharamacological treatment and psychotherapy.

Though his work was geared toward an epistemology of sexual addiction, the work of

Richard Leedes (1999) may be able to be extrapolated to explain the behavior of compulsive

hoarders. Leedes (1999) proposed that individuals will demonstrate differing responses to

separation and proximity seeking depending on their attachment style. When a person is unable

to form attachment relationships in reality, they will turn to fantasy in order to form a secure

base. Interestingly, in the aforementioned study by Ayers, Saxena, Golshan, and Wetherell

(2010), only 22% of their participants were married while 2005 Census data showed that 75.5%

of men and 54% of women were married. Infants form an Internal Working Model (IWM)

which allows them to predict the “responsiveness of a caregiver by past availability” (Leedes,

1999, p. 300). The primary caregiver then serves as the model from which all other interpersonal

relationships and evaluations of self-worth will be evaluated. Lest the author risk the charge of

committing the logical fallacy of hasty generalization, it should be noted that this is not to say


that attachment styles cannot or will not change, however, they are extremely resistant to change.

IWM’s that continue to be reinforced in infancy, childhood, and adolescence are extremely

difficult, though not impossible, to change (Hazan & Shaver, 1994). Leedes (1999) writes:

I propose that some insecure children become attached to a sexualized objectification

during a separate developmental phase, i.e., eroticization, at about 3-5 years old. It is

fundamental that the ethological purpose of the attachment system is to find a releasing

stimulus in the environment which creates warmth, bonding, and security (p. 300).

Though Leedes (1999) was examining attachment in relation to sexualized

objectification, it follows that since humans can form attachments with inanimate objects that

compulsive hoarders become attached to possessions at around 3-5 years old. This primary

efficient cause, while sufficient to produce hoarding in and of itself, can be combined with a

subsidiary cause, a stressful life event, to either induce or worsen symptoms.

Differential Diagnosis

When assessing for a differential diagnosis, it should be noted that the DSM-V reports

that as many as 75% of individuals with hoarding disorder also have a comorbid mood or anxiety

disorder (APA, 2013). Gilliam and Tolin (2010) noted that the percentage of those with hoarding

disorder and a comorbid Axis I and Axis II disorder to be 92%. More importantly, 20% of

individuals with hoarding disorder also meet the criteria for OCD (APA, 2013). Thus, several

factors need to be examined prior to diagnosing hoarding disorder.

Obsessive-Compulsive Disorder

Once a sub-type of OCD, hoarding disorder has now been listed as a separate diagnostic

entity, though individuals with OCD can present with hoarding symptoms. When examining an

individual for hoarding disorder, one should look for the presence of other OCD symptoms as


82% of those with hoarding disorder will not meet criteria for other forms of OCD (Tolin, 2011).

OCD patients who hoard possess an ego-dystonic quality of obsessions and compulsions in that

they recognize their illogicity. However, the behavior of the compulsive hoarder has an ego-

syntonic quality in that they rarely see that their thoughts and actions are illogical (Gilliam &

Tolin, 2010).

Medical Conditions

Hoarding disorder is not to be diagnosed if the presence of Prader-Willi syndrome is

suspected, nor should it be diagnosed if the hoarding is determined to be the result of traumatic

brain injury, surgical treatment damage, or cerebrovascular disease (APA, 2013). Organic brain

illness such as focal lesions of the telencepahalon and those suffering from dementia would also

be excluded from a diagnosis of hoarding disorder (Tolin, 2011). The presence of hoarding

behavior in these individuals must not be present prior to the onset of hoarding symptoms (APA,

2013).

Other Conditions

Hoarding disorder should also not be diagnosed if it results from the fatigue, lack of

motivation and energy, and psychomotor retardation of a major depressive disorder. Also, if

hoarding disorder is the direct result of an autism spectrum disorder or intellectual disability it

should not be diagnosed. Those with Alzheimer’s disease or other degenerative disorders should

not be given the diagnosis of hoarding disorder (APA, 2013).

Treatment of Hoarding Disorder

Steketee, Frost, and Kyrios (2003) write, “increasing empirical and anecdotal evidence

argues that hoarders report greater levels of emotional attachment to their possessions compared

to non-hoarders…these attachments are associated with beliefs about the meaning and


importance of possessions in the lives of hoarders” (p. 464). Tolin (2011) asserts that CBT

should be primary in the treatment of hoarding disorder. However, as has been noted, hoarding

disorder is notoriously resistant to treatment. Perhaps Rational Emotive Behavior Therapy

(REBT), developed by Albert Ellis, would serve best in the treatment of hoarding disorder. Ellis

maintained that if one could make a significant philosophical change and modify musturbatory

attitude, then that individual could change their self-defeating behavior and emotion (Murdock,

2009). If one assumes that attachment related issues are the cause of hoarding disorder, then

REBT style disputations may serve to effectively challenge the client’s thinking. Whether

inculcated in an individual through family or their own thinking process, many individuals

harbor irrational beliefs that result in unhealthy emotions and behaviors (Ellis & Ellis, 2011).

One main irrational belief is that an individual must have love and approval from significant

others. The hoarder, having formed an insecure attachment style, cannot unconditionally accept

him or herself because their IWM has reinforced that they are unworthy of love or approval.

One must then logically dispute this idea, and teach the client unconditional self-acceptance.

Another irrational belief that one would want to dispute with a hoarder is the belief that if

something once strongly affected one’s life that it should continue to affect it (Ellis & Ellis,

2011). This is opposed to rationality, whereby one should not be overly attached to past

circumstances, but rather accept the events.

For those suffering for hoarding disorder the goals and methods of treatment should be no

different. The goals of REBT are “ (a) identifying irrational beliefs and seeing how they cause

and maintain unhappiness and disturbance, (b) disputing them, and (c) rethinking and

reverbalizing beliefs into rational, self-helping, and life-enhancing forms” (Ellis & Ellis, 2011, p.

20). As Steketee, Frost, and Kyrios (2003) note, evidence does suggest that those suffering from


hoarding disorder do have difficulty in forming and maintaining relationships with others. In an

effort to achieve the goals of REBT with the hoarder, the “as-if” technique may prove beneficial.

The hoarder would be instructed to act as if they did not have trouble forming relationships with

others. They would be asked to try and initiate contact with someone they are acquainted with,

but perhaps do not know well. Homework assignments for this could increase in difficulty to

where they are to try and arrange to meet and spend time with this other person.

Biblical Worldview of Hoarding Disorder

Filtering hoarding disorder through a Christian epistemology can be an arduous task as

the exact cause of the disorder remains unknown. However, assuming the conclusion that

attachment related issues are the cause of hoarding disorder, one must then look to human beings

created in the image of God. REBT is designed to teach a person unconditional self and other

acceptance which is commensurate with how we are to view ourselves and others as made in the

image of God. Wayne Grudem (1999) writes, “the Hebrew word for “image” (tselem) and the

Hebrew word for “likeness” (demut) refer to something that is similar but not identical to the

thing it represents or is an “image” of” (p. 189). As such, we are to find our joy in knowing God

and recognizing that our chief end in life is to glorify Him (Grudem, 1999). Those with hoarding

disorder were not able to form a secure base with their primary caregiver resulting in an IWM

that tells them they are unworthy of love or responsiveness. This irrational belief can be

challenged by turning to the inerrant word of God which states in Lamentations 3:22-23, “The

Lord’s loving kindnesses indeed never cease, for His compassions never fail. They are new every

morning; Great is Your faithfulness” (NASB).

Jeremiah was a great prophet of God, but suffered greatly in his role as one of God’s

messengers. Drawing from the example of Jeremiah one can see many things that apply to


individuals’ lives today. Jeremiah was suffering emotional pain, and it is often said that

emotional pain is far worse than physical pain. Emotional pain can be dominating as one feels

things like anger, anxiety, depression, and self-hate. For those who have experienced this kind

of emotional pain, it is very difficult not to let it dominate.

Most of the time, people assume that what happens to them determines whether they live

a good life or not. As Backus and Chapian (2000) write, “It is not, however, events either past or

present which make us feel the way we feel, but our interpretation of those events…Our feelings

are caused by what we tell ourselves about our circumstances…” (p. 17). So, the problem is that

it is not what happens that causes the kind of emotionally dominating pain suffered by those with

hoarding disorder, but it is what they tell themselves about what happened. In Jeremiah’s case

he had many terrible things happen to him and he began to tell himself that what happened to

him deprived him of peace, that he had forgotten what prosperity is, and that all he had hoped

from the Lord was gone. He began to tell himself misbeliefs about his circumstances, and these

misbeliefs come directly from the evil one.

As we approach the treatment of hoarding disorder from a biblical perspective, one must

facilitate an atmosphere of empathy passing no judgment on the hoarder. Most likely, they have

experienced this in some form or another from family or peers and this will only serve to alienate

them. A level of trust needs to be cultivated within the context of the therapeutic relationship

whereby the client will see the therapist as a competent, loyal guide with respect to cognitive

restructuring. Logical disputation will be much more effective when the client trusts the

therapist, and homework assignment compliance would be assumed to high. Lastly, as all

human beings are made in the image of God, therapist must unconditionally accept the hoarder

thereby reinforcing the notion that the hoarder can unconditionally accept themself.


Conclusion

Hoarding disorder is a chronic and debilitating condition that not only affects the hoarder,

but results in substantial losses to friends, family, and, in some cases, the community. With its

inclusion in the DSM-V, hoarding disorder will continue to be robustly researched in order to

determine its causes. Biological and psychosocial factors have been advanced, and stressful life

events provide a good roadmap in understanding the disorder. However, SLE’s are only a

subsidiary efficient cause. The role that insecure attachment style plays in the development of

hoarding disorder perhaps provides answers as to its etiology. An individual who is unable to

form a secure bond with a primary caregiver must turn to something else, human or not, in order

to feel secure. Human beings are highly adaptable and can turn those attachment needs to

inanimate objects in order to provide themselves with such a basic need as security. Treatment

for hoarding disorder is still being refined, and this disorder has proven to be highly resistant to

even cognitive-behavioral therapy. While specific CBT techniques have been developed to deal

with hoarding disorder, initial results are mixed. By understanding its etiology, counselors will

have a better understanding of the tools they need to properly treat individuals who suffer from

this. REBT provides a very strong, well-established, and empirically verified therapeutic

technique to deal with compulsive hoarding. If attachment related issues are at the core of

hoarding disorder, then specific REBT techniques can more properly be utilized in disputing the

basis for the individual’s irrational beliefs. Fostering a sense of unconditional self-acceptance in

those who suffer from hoarding disorder as well as teaching them how to form and maintain

relationships with others may be the keys to helping individuals with hoarding disorder.

Researchers and counselors have a challenge on their hands in dealing with hoarding disorder,

but the body of research already produced shows promising results.


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The Etiology of Compulsive Hoarding