Identifying and Treating Hoarding Disorder

Licensed Master Social Worker (LMSW), Laura Lokers, has specialized training in Cognitive Behavioral Therapy and has extensive experience in identifying and treating hoarding disorders.

Part 1: Identifying Hoarding Behavior


There are three main characteristics of hoarding

  1. Acquiring too many things
  2. Having difficulty getting rid of those things
  3. Organizational difficulties


Two parts of the brain affected by hoarding disorder

  1. One is the anterior cingulate cortex (involved in decision making).
  2. Two is the insula (involved in spatial awareness—our ability to interact with things and accurately process that information).


Trauma may increase the risk of a pre-existing condition, but does trauma cause hoarding? No, there’s no evidence of that. -Laura Lokers


What’s the difference between hoarding and clutter?

Clutter is accidental; it just happens, and at some point, a decision is made to clean up. With hoarding, it’s very deliberate collecting. Clutter usually doesn’t impede your ability to function, whereas hoarding typically does.


Part 2: Treating Hoarding Disorder


First Steps in Treating Hoarding Disorder

  1. Cut off paper flow. If the paper is not there, then there’s no decision to make. The number is 1-888-5-OPT-OUT. This is a government agency; this goes to the credit bureau. This puts you on the can’t list-the “you can’t sell out my information list.” This will reduce your junk mail by 80%.
  2. Create a mail station. This can be a table with a garbage/recycling bin underneath; there, you have a mail station. Put this no more than 15 feet from the entrance of your house and when you cross the threshold, you have three minutes to sort through the mail. 1. keep 2. follow up or 3.trash/recycle.
  3. Get on donation lists like the Purple Heart. They come to your house and pick up your stuff to give to people in need. And if they’re in your neighborhood to pick up something, they may call you to see if you have anything. And you always say yes—even if it’s just one sweater. Always say yes and find something to give.” –Laura Lokers


Treatment is about creating habits and teaching how to make quick and imperfect decisions.
“If you got in the habit of throwing away ten pieces of paper a day or putting away ten pieces of clothing or dishes or whatever, you could probably keep up with your home pretty easily.” –Laura Lokers.


OHIO protects from churning

OHIO stands for:Only Handle It Once

Once something is in your hand, make a decision about it. Don’t set the thing down and come back. It may seem easier to do that, but it isn’t. Deciding later will be harder. Maybe it seems like too much time to decide, but the reality is, the time spent re-visiting the same item over and over is taking much more time.


Part 3: Challenges in Treating Hoarding Disorder


Treating hoarding can be difficult

Hoarding disorder does not fall into anxiety, mood, or OCD disorders. 80% of people with hoarding disorder show zero signs of OCD. The treatments for these disorders don’t work effectively when used to treat hoarding disorder. The treatment that IS found to be effective in the short-term and long-term requires slow discarding and teaching skills for how to deal with stuff.


Most people with hoarding disorder believe they are helping a lot of people. Many people who hoard have many things in their home intended for other people.


Hoarding disorder changes the perception of space compared to things in that space. For instance, you might walk in and say, “Wow you have 300 sweaters.” And they will say, “What are you talking about? There’s like 50 in here,” and they believe that.

Treating hoarding disorder is challenging, but Lokers has seen successful treatments all throughout her career.


Watch Full Video: Identifying and Treating Hoarding Behavior

  • Part 1: Identifying and Defining Hoarding
  • Part 2: Treating Hoarding Disorder
  • Part 3: Challenges in Treating Hoarding Behavior



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