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Symptoms of hoarding include procrastination, avoidance, indecisiveness, perfectionism and difficulty in tasks relating to organization. The initial phases of hoarding may be misinterpreted as the individual simply being a “pack rat", however, over time the collections become overwhelming, unhealthy, dangerous and possibly life threatening. It is not clear what causes hoarding behavior, however, the first symptoms are an increase in clutter and the inability to discard unsafe/non-useful items. The hoarding behaviors typically start off with a few collections of sentimental items that provide comfort to the individual. Items begin to accumulate to the point of entire rooms being inaccessible.
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As time goes on the individual has become so consumed with items, their homes are nearly inhabitable, unsafe and overrun with insects and/or rodents. The individual is extremely attached to their items and are in denial about the situation. They also have false misconceptions by thinking, that others are wrong for not seeing the value in their items. Overcoming hoarding is often difficult, as these individuals typically do not view the behavior as inappropriate. A vast majority of hoarders have difficulty recognizing they have a problem or that their hoarding behaviors have a negative impact on their lives, therefore, they do not believe they need treatment. Hoarding treatment can be an intense and time consuming process, often requiring several months to several years for completion. Therapy is effective in the majority of those who agree to become involved in the complete treatment process. There are two types of treatment recommended for hoarders, psychotherapy and medication.
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Cognitive Behavior Therapy
The most common form of psychotherapy used in treating hoarding, is cognitive behavior therapy. Throughout the cognitive behavior therapy process the individual will learn ways to improve their decision making skills, learn organization skills to help with prioritizing their possessions for determining which to discard and delve into what may compel them to hoard. At some point during the therapy process, a therapist and/or professional organizer will make home visits to assist with de-cluttering the home. The hoarder may not recognize there is a problem, however, they are very embarrassed for others to come into their home, making this one of the most difficult process of the therapy. The individual will be taught throughout the de-cluttering process how to determine which items are beneficial in keeping and which should be thrown out. Treatment of hoarding requires extensive participation of the individual, in order for treatment to be successful.
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Selective serotonin reuptake inhibitors (SSRI’s), a type of antidepressant, are the most common used medications for hoarding treatments. The medications are typically used in combination with the cognitive behavior therapy. Though hoarding has not to date, been classified as a definitive category of obsessive compulsive disorder (OCD), the symptoms of hoarding are associated with those of OCD. SSRI’s such as Paxil have been shown to be effective in treatment of OCD and is being used in combination with therapy, for the treatment of hoarding. The primary treatment for overcoming hoarding, is therapy, however, the medications are beneficial in treating the symptoms of depression that are often associated with the hoarding.