Hoarding Related Research
San Francisco Bay Area Internet Guide for Extreme Hoarding Behavior
Clutterers Syndrome or Pack Rat Syndrome

Supported by Peninsula Community Services, Inc



JCBPR. 2013; 2(1):41-46
By Colin Jones, Satwant Singh

The Experience of Emotional Distancing in The Management of Compulsive Hoarding: A Visual Methods Approach Using The “Hoard” Acronym Tool

“Conclusion: Emotional distancing occurs during these reflective activities, with seems to play an important role when utilizing the “HOARD” acronym tool.  Three key themes emerged from the data:  the evocative power of the image,  images as monitoring tools and verifying and validating the hoarding problem.  This particular methodological approach is beneficial in generating valuable narrative for self-reflection.”


The Hoarding HUB

Understanding  Hoarding in Vancouver’s downtown eastside

"A separate arm of the project is to get a sense of the prevalence of hoarding in
the Downtown Eastside neighbourhood, which has many supportive housing buildings.

A previous study by a community group in the neighbourhood involved a survey of
landlords and building managers and suggested a very high prevalence rate - up to
four times as high as estimates for the general population"




Science Alert, January 8, 2013

Hoarders struggle to make decisions

"Compulsive hoarders struggle to throw out their many possessions because their brains lack flexibility,

new research suggests.But psychologists at Curtin University now think the problem may be down to a
chronic case of putting things in the 'too-hard' basket..."


JCBPR. 2012 1(1): 36-42

by Satwant Singh, Colin Jones

Visual Research Methods: A Novel Approach To Understanding The Experiences of Compulsive Hoarders: A Preliminary Study,
“ . . The study also concluded that visual research methods may be particularly helpful when generating qualitative evidence within this specialist field.”


UCSF Carol Mathews, MD May 31, 2012

OCD linkage study published in Biological Psychiatry


J Nerv Ment Dis. 2012 Jan;200(1):91-4. doi: 10.1097/NMD.0b013e31823f678b.

Rodriguez CI, Herman D, Alcon J, Chen S, Tannen A, Essock S, Simpson HB.

Prevalence of hoarding disorder in individuals at potential risk of eviction in New York City: a pilot study.


Journal of Aging Research 2012; 2012:205425

By Kyle Y. Whitfield, Jason S. Daniels, Keri Flesaker, and Doneka Simmons
Older Adults with Hoarding Behaviour Aging in Place:
Looking to a Collaborative Community-Based Planning Approach for Solutions

 "Results demonstrated that when a highly collaborative approach to planning is used, there
were quite direct benefits for older adults with hoarding behavior and, at the same time, there
were benefits for the members of the community collaborative. This approach to planning for
the health and social needs of this population resulted in people with hoarding behavior being
able to remain in their own homes when eviction was a potential, enhancing their safety, helping to
minimize their isolation, and creating opportunities to increase control in their own decision making......"


International Journal of Cognitive Therapy
Vol. 4, Special Section: Hoarding, pp. 225-238.2011
By M. Wheaton, J Abramowitz, L. Fabricant, N. Berman, J. Franklin,UNC

Is Hoarding a Symptom of Obsessive-Compulsive Disorder?
"The presence of hoarding symptoms in patients with obsessive-compulsive disorder (OCD)
is a commonly reported phenomenon. How these symptoms are to be understood is less clear.
The extent to which hoarding fits with other symptoms of OCD by considering its diagnostic
utility and underlying cognitive processes is evaluated. In the first study, hoarding symptoms
did not differentiate OCD patients from individuals with other anxiety disorders or unscreened
students, indicating that hoarding does not inform diagnostic decision making. In the second study,
using an independent nonclinical sample, cognitive variables related to OCD were distinct from
hoarding-specific cognitions, and not predictive of hoarding symptoms. These results add to a
growing body of evidence suggesting that hoarding is not a symptom or manifestation of OCD.
The need for careful assessment of the function of hoarding symptoms is discussed"


J Anxiety Disord. 2011 Dec;25(8):1116-22. doi: 10.1016/j.janxdis.2011.08.002. Epub 2011 Aug 10

Reid JM, Arnold E, Rosen S, Mason G, Larson MJ, Murphy TK, Storch EA.

Hoarding behaviors among nonclinical elderly adults: correlations with hoarding cognitions,
obsessive-compulsive symptoms, and measures of general psychopathology.


University of St. Thomas, Minnesota, November 29, 2011
By Ryan J. Sorensen

Hoarding Disorder (Compulsive Hoarding): A
Comprehensive Literature Review and Professional
Training to Prepare Clinicians to Treat Problematic Hoarding


UBM Medica,
Psychiatric Times, August 19, 2011

By Suzanne Otte and Gail Steketee

Psychiatric Issues in Hoarding - Strategies for Diagnosing and Treating Symptoms of Hoarding

"Historically, hoarding has been deemed a subtype of OCD, although forthcoming evidence
suggests there are more differences than similarities. Hoarding is under consideration for
inclusion in DSM-5 as a stand-alone disorder. A set of provisional criteria for hoarding disorder
has been proposed and will require further study in the future. A recent study conducted by
Frost and colleagues that examined the largest sample of participants to date confirmed that
major depressive disorder was the most frequently occurring comorbid condition (more than 50%)
and that kleptomania was a factor in 10% of the sample. This article highlights treatment options
for hoarding that are available to practitioners, including alternative approaches focusing on
self-help, support group, and Web-based delivery models."..........

Social Work Today, May/June 2011, Vol.11, No.3, P.14
By Jennifer Van Pelt,MA
Treating People Who Hoard — What Works for Clients and Families
"TV reality shows can help and hurt people who hoard. Find out why and know what really works
 best for clients and the families who care about them."

Depress Anxiety.
2010 Jul;27(7):667-74
UCSF Psychiatry Resident Research Tract
By Sheppard, Azzam, Grados, Umana, Garrido, & Mathews
ADHD prevalence and association with hoarding behaviors in childhood-onset OCD.
CONCLUSION: ADHD rates were elevated in this sample of individuals with childhood-onset OCD
compared to the general population rate of ADHD, and there was a strong association between
ADHD and clinically significant hoarding behavior. This association is consistent with recent studies
suggesting that individuals with hoarding may exhibit substantial executive functioning impairments
and/or abnormalities, including attentional problems


Psychiatric Services 2010: doe:101176/appi.ps.61.2.20
Personalized Intervention for Hoarders at Risk of Eviction
Carolyn Rodriguez, M.D., Ph.D.; Lisa Panero, M.S.W.; Audrey Tannen

Depression and Anxiety
: Volume 27, Issue 6, pp 556–572 June (2010)
By David Mataix-Cols, Ph.D.,Randy O. Frost, Ph.D.,Alberto Pertusa, M.D.,
Lee Anna Clark, Ph.D.,Sanjaya Saxena, M.D., James F. Leckman, M.D.,
Dan J. Stein, M.D.,Hisato Matsunaga, M.D.,and Sabine Wilhelm, Ph.D.

See the full article and research at the link below.
One of the conclusions and preliminary recommendations:
1. Clinically significant hoarding is prevalent and can
vary from mild to life threatening. The personal and
public health consequences of hoarding are substantial and it is generally considered difficult to
treat. These direct and indirect consequences of
hoarding are serious enough to warrant its consideration as a mental disorder
10. If it becomes a separate diagnostic category, the most appropriate ‘‘neighborhood’’ for hoarding
disorder is unclear as it has ties with several groupings of disorders, particularly OCD and
impulse control disorders. Until we learn moreabout its etiology, the decision will necessarily
require expert consensus. For the time being, giventhe historical link between hoarding and OCD/
OCPD, the fact that some hoarders are seen in OCD clinics, and the conservative approach adopted
by DSM-V, it would be reasonable to acknowledge hoarding disorder as an OCSD, if such a group is
included in DSM-V. An alternative to our recommendation would be to include it in an Appendix of
Criteria Sets Provided for Further Study.

J Anxiety Discrd. 2011 Mar;25(2):192-202. Epub 2010 Sep 15.
By Landau, Lervolino, Pertusa, Santo, Singh, & Mataix
Stressful life events and material deprivation in hoarding disorder
Results support a link between trauma, life stress and hoarding, which may help to
inform the conceptualization and treatment of hoarding disorder, but await confirmation
in a representative epidemiological sample and using a longitudinal design.


, 2011, Part 5, 687-701, DOI: 10.1007/978-1-4419-0338-9_34
by J. Grisham, A.D.Williams, R. Kadib
SpringerLinkAbstract, 2011
Hoarding as a Behavioral Addiction
"Compulsive hoarding is a psychiatric syndrome with serious personal and public health consequences.
Although the diagnostic status of hoarding is uncertain, it appears to be associated with a number of
other psychiatric disorders, including obsessive-compulsive disorder. Several important features of
hoarding, however, differentiate it from obsessive-compulsive disorder and other anxiety disorders.
Moreover, there are important phenomenological similarities between hoarding and behavioral addictions,
such as the pleasurable feelings that may be associated with collecting and saving. In this chapter, we
review diagnostic and comorbidity issues regarding hoarding, while highlighting the relationship between
hoarding and impulse control disorders. In addition, we discuss ways in which a behavioral addiction model
may be consistent with compulsive hoarding. We also outline a prominent cognitive-behavioral theoretical
model of hoarding that emphasizes the role of both information-processing deficits and excessive emotional
attachment to possessions. Finally, we describe various self-report and interview measures used to assess
hoarding, as well as current biological and psychological approaches to treatment"

Clinical Social Work Journal, 2010, DOI: 10.1007/s10615-010-0311-4
by J. Muroff, C. Bratiotis and G Steketee
SpringerLink.com ABSTRACT 
Treatment of Hoarding Behaviors: A Review of the Evidence
"Overall, evidence supports the use of specialized CBT methods to improve hoarding symptoms.
Future testing may include controlled trials with more diverse samples."

Marketing Research
Qualitative Market Research: An International Journal, Volume 13, Number 1, 2010 , pp. 8-23
A study of hoarding behavior and attachment to material possessions

Primary Psychiatry.com,
CNS Spectr. 2010;15(4):258-265. CNS Spectr. 2010;15(4)231236 
Clinical Features and Treatment Characteristics of Compulsive Hoarding in Japanese Patients
with Obsessive-Compulsive Disorder

by Hisato Matsunaga, MD, PhD, Kazuhisa Hayashida, MD, Nobuo Kiriike, MD, PhD,
Toshihiko Nagata, MD, PhD, and Dan J. Stein, MD, PhD

"Conclusion: The prevalence and clinical characteristics of compulsive hoarding in OCD subjects
was similar to those reported in Western countries, supporting its trans-cultural consistency.
The distinction between primary and secondary hoarding in OCD is clinically useful, and may
contribute to the debate about whether hoarding should be a separate diagnostic entity."

BehaV. Res Ther
.,2010 Oct;48(10):1012-20. Epub 2010 Jul 29.
When hoarding is a symptom of OCD: a case series and implications for DSM-V.

Journal of Anxiety Disorders
, 2010 Sep 15.
Stressful life events and material deprivation in hoarding disorder

Int Psychogeriatr.,2010 Sep 14:1-3.
The need to consider mood disorders, and especially chronic mania,
in cases of Diogenes syndrome (squalor syndrome)

JPsychiatry Res., 2010 Sep 3.
Quality of life and functional impairment in compulsive hoarding

Published Online
: March 24, 2010
Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder
Gail Steketee, Ph.D. , Randy O. Frost, Ph.D. , David F. Tolin, Ph.D. , Jessica Rasmussen, M.A. , Timothy A. Brown, Psy.D

Psychiatr Serv
61:205, February 2010 doi: 10.1176/appi.ps.61.2.205
Personalized Intervention for Those At Risk of Eviction
by Carolyn Rodriguez, M.D., Ph.D., Lisa Panero, M.S.W. and Audrey Tannen


Clin Psychol Rev. 2010 Jun;30(4):371-86. Epub 2010 Feb 4.
Refining the diagnostic boundaries of compulsive hoarding: a critical review

Behaviour Research and Therapy

Volume 48, Issue 1, January 2010, Pages 79-85

Delivery of internet treatment for compulsive hoarding
by Jordana Muroff, Gail Steketee, Joe Himle and Randy Frost
From abstract: "Online CBT-based self-help for hoarding appears to be a promising intervention
strategy that may extend access to treatment. Evaluating the benefits of internet self-help groups
is critical given growing popularity of and demand for web-based interventions.."
First go to http://dx.doi.org   Then enter the following into the text box provided doi:10.1016/j.brat.2009.09.006 

Behavioural and Cognitive Psychotherapy
Published online by Cambridge University Press January 12, 2010
Compulsive Hoarding : an interpretive phenomenological analysis                                                       Abstract:                                                                                                                                                                                                            
This project aimed to explore the experiences of people who compulsively hoard
and how they make sense of their own hoarding behaviours.

A total of 11 compulsive hoarders were recruited and interviewed using a simple semi-structured
interview format, designed for the purposes of the study. The resulting transcribed interviews were analyzed using
interpretive-phenomenological analysis.

: Four super-ordinate discrete, but interacting, themes were found: (1) childhood factors; (2) the participants'
relationship to their hoarded items; (3) cognitive and behavioural avoidance of discard; and (4) the impact of
hoarding on self, others and the home environment. The themes as a whole described people entrapped in
massively cluttered physical environments of their own making. Efforts at discard appeared consistently
sabotaged by cognitive/behavioural avoidance, thereby creating maintaining factors of associated personal
distress and environmental decline.

The results are discussed in the context of the extant evidence concerning hoarding, the distinct
contribution made by the current results and the identified methodological shortcomings of the research approach.

Molecular Psychiatry (2009) 14, 318–331; doi:10.1038/sj.mp.4002129; published online January 8, 2008
by S K An, D Mataix-Cols, N S Lawrence, S Wooderson, V Giampietro, A Speckens, M J Brammer, and M L Phillips
To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder.

and/or First go to http://dx.doi.org , then copy and paste in : doi:10.1038/sj.mp.4002129

Cognitive Therapy Research
, 2008, Volume 34, Number1 69-81, DOI: 1007/s10608-008-9217-7
by Tolin Frost, Steketee
SpringerLinkAbstract, 2008
Family Informants' Perceptions of Insight in Compulsive Hoarding
"Family/friend informants’ ratings of hoarding severity were significantly greater than were their estimates
of the hoarder’s ratings. Hoarders described as showing less distress about the hoarding were described
as showing poorer insight. These results suggest that compulsive hoarding is characterized by poor insight
into the severity of the problem. Treatment development might need to emphasize strategies to bolster
awareness, insight, and motivation."


Journal of Psychopathology and Behavioral Assessment,
2008, Vol31, Number 3220-227, DOI: 10.1007/s10862-008-9106-0
by L Hayward, M.E.Coles
SpringerLink.com ABSTRACT
Elucidating the Relationship of Hoarding to Obsessive Compulsive Disorder and Impulse Control Disorders
"Therefore, the current study tested the hypothesis that hoarding would be as strongly related to symptoms
of ICDs as it is to OCD and that these relationships would be medium to strong in magnitude. Results from
an undergraduate sample showed hoarding behaviors were strongly related to symptoms of OCD, moderately
related to symptoms of compulsive buying, and more modestly related to symptoms of pathological gambling,
trichotillomania, and kleptomania. Finally, findings suggest indecisiveness may be a particularly important
underlying feature in hoarding behaviors. These results support the consideration of hoarding outside the confines
of OCD."

American J. Psychiatry
165:129-1233 Oct. 2008
A Developmental and Evolutionary Perspective on Obsessive-Compulsive Disorder:
Whence and Whither Compulsive Hoarding?
James F. Leckman, M.D., and Michael H. Bloch, M.D.

Genes Brain Behav
- 01-OCT-2008 7(7): 778-85
Genetic Susceptibility to Obsessive Compulsive Hoarding 
"Among other clinical dimensions, the presence of hoarding obsessions and compulsions
has been shown to be correlated with a number of clinical and neuroimaging findings,
as well as with a different pattern of genetic inheritance." 


Despression and Anxiety
, vol 25, issue 9, Sept.2008
Wiley InterScience, February 20, 2007
Interpersonal problems and emotional intelligence in compulsive hoarding
by Jessica R. Grisham, Ph.D. , Gail Steketee, Ph.D., Randy O. Frost, Ph.D.

Behavior Research and Therapy, 2008 September 46(9)1040-1046
Sex-Specific Clinical Correlates of Hoarding in Obsessive-Compulsive Disorder
Abstract: DefaultReportPanel.Pubmed_RVDocSum&log$=freejrpmc
Full article http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2578847


Current Psychiatrity Reports, Volume 10, Number 4, August 20, 2008
by Sanjaya Saxena
Recent Advances in Compulsive Hoarding
"Compulsive hoarding is a common and often disabling neuropsychiatric disorder. This article reviews the
conceptualization, phenomenology, diagnosis, etiology, neurobiology, and treatment of compulsive hoarding.
Compulsive hoarding is part of a discrete clinical syndrome that includes difficulty discarding, urges to save,
excessive acquisition, indecisiveness, perfectionism, procrastination, disorganization, and avoidance. It was
thought to be part of obsessive-compulsive disorder or obsessive-compulsive personality disorder, but recent
evidence indicates that it should be classified as a separate disorder with its own diagnostic criteria. Compulsive
hoarding is a genetically discrete, strongly heritable phenotype. Neuroimaging and neuropsychological studies
are elucidating its neurobiology, implicating dysfunction of ventral and medial prefrontal cortical areas that
mediate decision-making, attention, and emotional regulation. Effective treatments include pharmacotherapy
and cognitive-behavioral therapy. More research will be required to determine the prevalence, etiology, and
pathophysiology of compulsive hoarding and to develop better treatments."   

Br J Clin Psychol.
2008 Mar;47(Pt 1):59-73.
Compulsive hoarding: a qualitative investigation of partner and carer perspectives.

Behav Res Ther
2008 Mar;46(3):334-44. Epub 2008 Jan 3.
Family burden of compulsive hoarding: results of an internet survey

Journal of Psychopathology and Behavioral Assessment
, 2007, Vol 30, Number 3,193-203, DOI: 10.1007/s10862-007-9068-7
by Frost, Steketee, Tolin, S Renaud 
SpringerLink.com ABSTRACT
Development and Validation of Clutter Image Rating
"Few instruments are available to assess compulsive hoarding and severity of clutter. Accuracy of assessment
is important to understanding the clinical significance of the problem. To overcome problems associated with
over- and under-reporting of hoarding symptoms, the clutter image rating (CIR) was developed. This pictorial
scale contains nine equidistant photographs of severity of clutter representing each of three main rooms of
most people’s homes: living room, kitchen, and bedroom. The psychometric properties of this measure were
examined in two studies. Internal consistency, test–retest, and interobserver reliabilities were good and
convergent validity with other questionnaire and interview measures was also good. The CIR correlated more
strongly with measures of clutter than with other hoarding and psychopathology scales. The CIR’s very brief
pictorial assessment method makes it useful in clinical and treatment contexts for measuring the clutter
dimension of compulsive hoarding. Development and Validation of the Clutter Image Rating"

Behaviour Research and Therapy 45 (2007) 1657–1662
Cognitive aspects of nonclinical obsessive compulsive hoarding 
by Luchian, McNally, and Hooley                                         
See this article for information on a very small study delineating problems
of categorization, under inclusiveness, and indecisiveness in non clinical hoarders.

Behavior Research Therapy 2007 Nov; 45(11):2754-63. Epub 2007 Aug 8
Hoarding in a compulsive buying sample 

Literature Review
April 2007
Comparison of Medication Treatment versus Cognitive Behavior Therapy of Hoarding Behaviors
in Obsessive-Compulsive Behavior. 
Extensive evidence-based medicine literature review
by C. Powers, T.Quigley,MPH, College of Health Professions, Wichita State University

Am J Psychiatry 164:3, March 2007
By Sanjaya Saxena
Editorial: Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome?
Implications for Diagnostic Classification

Behavior Research Therapy
2007 Apr; 45(4):673-86. Epub 2006 Jul 5.
Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
UCSD News Center, 2006 Oct 24
SRI Medication Found Effective in Treating Compulsive Hoarding Patients
by Debra Kain

Literature Review   April, 2005

To Support the Development of A Community Response to Hoarding
Prepared for: The Ottawa Community Response to Hoarding Coalition


Science Daily-University of Iowa Research-  2005 Jan
Brain Region Identified That Controls Collecting Behavior
By studying patients who developed abnormal hoarding behavior following brain injury, neurology researchers in the
University of Iowa Roy J. and Lucille A Carver College of Medicine have identified an area in the prefrontal cortex that
appears to control collecting behavior.


Hoarders' Scans Reveal Distinct Brain Signature.
Am J Psychiatry. 2004 June;161(6):1038-48.
"Recent positron emission tomography (PET) imaging studies by scientists at the University of California at Los Angeles
suggest that the neurobiology of America's estimated 1 million compulsive hoarders differs significantly from people
with other obsessive-compulsive disorder (OCD) symptoms as well as healthy individuals. The findings also suggest
that hoarders might respond best to medications that target particular brain systems. The study by Sanjaya Saxena, M.D.,
and colleagues detected less brain activity in the anterior cingulate gyrus of compulsive hoarders than in other OCD
patients. This brain structure helps govern decision-making, focused attention, motivation, and problem solving ? cognitive
functions that frequently are impaired in compulsive hoarders. The study also found a correlation in all of the subjects
with OCD between the severity of hoarding symptoms and lower brain activity in the anterior cingulate gyrus.
Saxena S, Brody AL, Maidment KM, Smith EC, Zohrabi N, Katz E, Baker SK, Baxter LR Jr.
Cerebral glucose metabolism in obsessive-compulsive hoarding.

UCLA PET Study on the Neurobiology of Hoarding
UCLA PET Study finds Neurobiology of Hoarders differs from other OCD patients 2004 June