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State of the Science: Hoarding Disorder and Its Treatment

David F Tolin1, Blaise L Worden2, Hannah C Levy2

  • 1The Institute of Living; Yale University School of Medicine.

Behavior Therapy
|June 20, 2025
PubMed

Insights

Hoarding disorder (HD) is a new diagnosis involving difficulty discarding possessions. Cognitive-behavioral therapy for hoarding disorder (CBT-HD) shows some efficacy, but more research is needed on its cultural effectiveness.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Mental Health

Background:

  • Hoarding disorder (HD) is a distinct diagnosis characterized by excessive acquisition, difficulty discarding, and living space clutter.
  • Several theoretical models attempt to explain HD, including cognitive-behavioral, biopsychosocial, attachment, and addiction perspectives.

Purpose of the Study:

  • To provide a state-of-the-science review of hoarding disorder.
  • To examine current theoretical models and interventions for HD.
  • To discuss future research and clinical directions.

Main Methods:

  • Literature review of theoretical models of hoarding disorder.
  • Review of interventions for hoarding disorder, with a focus on cognitive-behavioral therapy for hoarding disorder (CBT-HD).

Main Results:

  • Cognitive-behavioral therapy for hoarding disorder (CBT-HD) is the only intervention with conclusive evidence of efficacy for HD.
  • Clinical results for CBT-HD have been modest.
  • The cross-cultural efficacy of CBT-HD and the impact of cultural modifications remain unclear.

Conclusions:

  • Hoarding disorder is a complex condition with multiple theoretical underpinnings.
  • CBT-HD is a promising, though not fully established, treatment for HD.
  • Further research is needed to understand and optimize HD treatment across diverse cultural contexts.

Keywords:
addictionattachmentcognitive-behavioral therapyneuroimagingobsessive-compulsive and related disorders

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