Attachment theory and hoarding disorder: A review and theoretical integration

Hoarding disorder (HD) is a severe and persistent mental illness characterized by extreme difficulty parting with possessions and considerable clutter that can result in dangerous living conditions. HD poses a considerable public health burden; however, treatment for HD remains relatively limited, as many individuals do not respond to treatment and/or do not maintain treatment gains, suggesting there are important factors not being adequately addressed. In particular, one area that is not well-understood nor well-integrated into cognitive behavioral models is the pathological attachment individuals with HD hold to their possessions. The current review delineates existing work regarding attachment in HD and integrates findings regarding attachment into existing cognitive behavioral models of HD. We use attachment theory as a foundation by which to examine HD and better understand the dysfunctional relationships seen in those who hoard. We propose that both maladaptive cognitions and dysfunctional attachments to people and possessions jointly underlie saving behaviors characteristic of the disorder. The hypotheses put forth in this theory may help to advance our knowledge of HD, identify potential factors that can be targeted in intervention and prevention efforts, and provide important future directions for empirical work.