Overcoming Compulsive Hoarding
by Fugen Neziroglu, Ph.D., Jerome Bubrick, Ph.D.
and Jose Yaryura-Tobias, M.D.

Reviewed by Renae M. Reinardy, Psy.D.

Behavior Therapy Center of Greater Washington
Silver Spring, MD

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Compulsive hoarding is a fascinating and understudied behavior that involves the acquisition of and failure to discard possessions that appear to have no or limited value. To be considered clinically significant, hoarding must result in impairment in functioning or cause significant distress. Hoarding is believed to be relatively common in clinical and nonclinical populations and seems to occur along a continuum. Individuals with compulsive hoarding are distinguished from other savers by the quantity of objects saved, the dysfunction caused by clutter, and their strong attachment to objects that most people would consider useless.

Little information exists on the treatment outcomes of people with hoarding problems. In comparison to other obsessive compulsive behaviors, compulsive hoarding is believed to be a more difficult condition to treat (Frost & Steketee, 2000). Hoarding is a complex phenomenon that has been found to predict poor treatment response. Hoarding is a well-established pattern of behavior that usually has occurred for many years by the time the person seeks treatment.

Overcoming Compulsive Hoarding by Fugen Neziroglu, Ph.D., Jerome Bubrick, Ph.D., and Jose Yaryura-Tobias, M.D. is a much-anticipated book for compulsive hoarders. It is for their families, and clinicians who are interested in learning more about the treatment of this disorder. I was pleased to be asked to review this book and believe that it can be useful for individuals with mild to moderate difficulties with hoarding. This is an easily understood book that offers practical suggestions in an interactive format.

Overcoming Compulsive Hoarding provides readers with general information on compulsive hoarding, cognitive behavioral therapy, and is a step by step structured guide to decluttering living space, preventing new clutter, keeping cleaned areas free from clutter, and preventing relapse. In my experience working with hoarders, one of the main difficulties frequently encountered in the treatment is the hoarders' struggle to declutter on their own. This book serves as a self help guide that will likely be a helpful adjunct to therapy and a way to make progress when the person who hoards is not in therapy. However, I believe that readers should understand that hoarding is often a challenging behavior to change and not to give up if they do not succeed on their own in trying to gain more control over this behavior.

The information provided in the book assists the reader by first discussing the key symptoms of compulsive hoarding and providing stories of two hoarders to demonstrate differences in how hoarding can be manifested. The reader is provided with an exercise to better understand his or her own hoarding symptoms. The authors go on to describe the differences between hoarding and collecting behaviors, the different types of hoarding behavior, and conditions associated with compulsive hoarding. Through this information and exercises provided, the reader is better able to answer one of the important question posed in the book, "Are you a hoarder?"

The authors also briefly describe the important biological and sociological aspects of hoarding in a way that is easily understood and free from unnecessary jargon. I found the section titled "A Sociological Look at Hoarding" particularly interesting in how it challenged readers to rethink how they view possessions and the societal view that happiness is achieved through the acquisition of possessions. The consequences frequently experienced by compulsive hoarders are also discussed to highlight the difficulties experienced by hoarders and their families. Later in the book, the authors expand on the consequences of hoarding and emphasize the importance of treatment, either for the person who hoards, or for family members of a hoarder. In addition, they provide some helpful advice on how to persuade a resistant hoarder to seek treatment. I believe that this is an important issue that should be further explored in other literature on hoarding.

Several reasons why people save their possessions are discussed and exercises are provided to assist the reader in identifying their own saving style. The traits commonly found in hoarding are highlighted in this book and include the fear of losing information, indecisiveness, the fear of making a mistake, the inability to prioritize tasks, fear of loss, fear of memory loss, and lack of organization.

After the reader has some basic knowledge about hoarding, the authors do a good job of describing the treatment options that have been scientifically studied to treat this behavior. The components of Cognitive-Behavioral Therapy are discussed in an understandable way and techniques, such as, Exposure and Response Prevention (E&RP) are described. Emphasis is put on cognitive restructuring and readers are provided with the message that "how we think affects the way we feel, which affects what we do." Motivational aspects are also discussed and exercises are provided to help the reader become more aware of their self-talk and the pros and cons of changing their behavior.

Treatment strategies that require action on the part of the reader make up a good portion of the book. I believe that the strategies and techniques discussed are useful and often essential in overcoming aspects of hoarding. Readers are guided through identifying their automatic thoughts, recognizing the feelings associated with these thoughts, and situations that elicit automatic thoughts. Readers are educated about cognitive distortions and are guided through an "experiment" designed to challenge maladaptive/unhelpful thoughts. This process helps the reader to arrive at a rational response that encourages a positive outlook and challenges the automatic thought. This exercise is nicely outlined in a user friendly format and incorporates the use of flash cards that can be used throughout the self-help treatment process described in the book.

The book also provides readers with a systematic guide titled "Cleaning up the Clutter." Preparation and suspending the acquisition of new items assists the reader in setting up a successful plan of attack on their hoarding. Several suggestions are made that will assist the reader in tackling Their hoarding problems in manageable, organized steps. Reinforcement is also an important part of the process and the authors suggest some strategies that may help individuals stay motivated during the difficult task of decluttering. The authors introduce some helpful strategies to help with the excavation process originally outlined by Frost and Steketee. While some of the suggestions may be difficult to comply with, it is clear how they would be helpful in decreasing churning and avoidance behaviors.

The authors did a wonderful job of emphasizing the importance of maintenance by reminding readers that "the actual cleaning process is only half of the work; the other half is maintaining the progress you've made." Suggestions were made on selecting target areas and how to make decisions on specific items such as clothing, magazines, newspapers, paper and plastic bags, and multiple items.

Once the decluttering and cleaning process is complete, readers are guided through the organizational process with the items they have kept in their "save" boxes. This stage is also set up in a structured format. This is the part of the book that readers may have difficulty waiting for since individuals may be tempted to organize before the decluttering and cleaning process is complete.

Daily, weekly, and monthly cleaning goals are suggested to help maintain gains and prevent clutter from reaccumulating. Readers are cautioned to keep working on the strategies outlined in the book to prevent relapse and address tendencies that may result in the return of clutter. Acquisition is also briefly addressed and how E&RP can be helpful in decreasing compulsive acquisition.

While this book is written in a user-friendly manner, compulsive hoarding is often a complex problem that requires much self-motivation, energy, and time. The authors make the point that the reader will be most successful by working through the book in a methodical way. This book would be a valuable tool for hoarders who have mild to moderate symptoms, without serious comorbid disorders, and who are ready to take action on their hoarding problem. In addition, this book is also a helpful guide for therapists to facilitate change in clients who hoard, and for family members to better understand how they can be of help in decluttering and maintaining a comfortable home.

Overall, this book is a welcome addition to the literature on compulsive hoarding. As compulsive hoarding becomes better understood and clinicians, researchers, and individuals who hoard share the factors thought to contribute to this behavior, the better equipped we will be to manage this disorder. As with all self-help books, it is important to work toward empirically validating the effectiveness of self-help therapies that hoarders self-administer or that therapists use as an adjunct to therapy.

The authors are experts in obsessive compulsive spectrum disorders and Drs. Neziroglu and Yaryura-Tobias have been important contributors through their numerous publications on obsessive-compulsive disorder and related disorders. The authors' knowledge and clinical experience are demonstrated through helpful information and strategies shared throughout the book.

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