Abstract and Keywords
Compulsive hoarding is a common and potentially disabling disorder. The primary treatments for compulsive hoarding are pharmacotherapy and cognitive-behavioral therapy (CBT). This chapter first provides a brief overview of the clinical presentation of compulsive hoarding, as well as its epidemiology, course, and comorbidity. It also briefly reviews the nosological conceptualization of compulsive hoarding and its relationship to obsessive-compulsive disorder (OCD). It then reviews retrospective studies of the effects of hoarding symptoms on response to serotonin reuptake inhibitor (SRI) medications in patients with OCD, as well as recent prospective studies of pharmacotherapy specifically for patients with hoarding disorder. Taken together, the results of these studies indicate that the “conventional wisdom” that compulsive hoarding does not respond well to SRI treatment is wrong. SRIs appear to be as effective for hoarding disorder as they are for nonhoarding OCD. Symptom improvement from pharmacotherapy of compulsive hoarding appears to be at least as great as that resulting from CBT. However, the combination of pharmacotherapy and CBT for compulsive hoarding is likely to be more effective than either treatment alone. Recommendations are provided for clinical assessment and pharmacotherapy of patients with compulsive hoarding. Finally, the chapter discusses future directions and options for pharmacotherapeutic trials for compulsive hoarding, which should target the functional brain abnormalities and information-processing deficits that appear to underlie the compulsive hoarding syndrome.
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