Compulsive hoarding: Unclutter lives and homes by breaking anxiety’s grip

Several studies of SSRI use in OCD patients have shown modest improvements in compulsive hoarders:

• In a descriptive study of patients with compulsive hoarding, 1 of 18 (6%) patients had a “marked” response to at least one SSRI trial. The others showed a partial response,¹⁷ with YBOCS scores decreasing by at least 25% in approximately 50% of this group.
  
• When 17 OCD patients with hoarding symptoms were treated with paroxetine, CBT, or placebo, 18% responded to active treatment. Response was defined as a 40% reduction on YBOCS scores and “very much” or “much” improved on the Clinical Global Impression Scale (CGI).¹⁴
  

Based on these findings and our clinical experience, an effective approach to treating compulsive hoarding with medications—as with other OCD patients—is to start with SSRIs²⁸ (Algorithm). If adequate SSRI trials fail to improve a patient’s hoarding/saving symptoms, adjunctive medications can be added.

Atypical antipsychotics may be effective for OCD symptoms that do not respond adequately to SSRIs.²⁹ Conventional antipsychotics are also effective adjuncts to SSRIs—particularly for patients with coexisting tic or psychotic disorders³⁰—but consider the potential for extrapyramidal side effects and tardive dyskinesia.

We find that stimulants help some compulsive hoarders, particularly those with comorbid ADHD, other attentional problems, low motivation, or lethargy. Mood stabilizers are necessary to treat comorbid bipolar disorder, cyclothymia, and impulsivity.

Related resources

• Saxena S, Maidment K. Treatment of compulsive hoarding. J Clin Psychol 2004;60(11):1143-54.
  
• UCLA OCD Intensive Treatment Program. For information on research studies contact Karron Maidment (310) 794-7305 or visit www.mentalhealth.ucla.edu/projects/anxiety/ocdintensivetreatment.htm.
  
• Compulsive hoarding project. Institute of Living Anxiety Disorders Center, Hartford Hospital. https://instituteofliving.org/adc/compulsive_hoarding.htm
  
• Obsessive Compulsive Foundation compulsive hoarding Web site. https://www.ocfoundation.org/1005/index.html
  
• Neziroglu F, Bubrick J, Yaryura-Tobias JA. Overcoming compulsive hoarding. Oakland, CA: New Harbinger Publications, 2004.
  

Drug brand names

• Citalopram • Celexa
  
• Clomipramine • Anafranil
  
• Escitalopram • Lexapro
  
• Fluoxetine • Prozac
  
• Fluvoxamine • Luvox
  
• Olanzapine • Zyprexa
  
• Paroxetine • Paxil
  
• Quetiapine • Seroquel
  
• Risperidone • Risperdal
  
• Sertraline • Zoloft
  
• Venlafaxine • Effexor
  

Disclosures

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.