Posted: May 25th, 2022

Challenges in the Treatment of Hoarding Cognitive

Characteristics did Jenny have as a child that are common in individuals who develop hoarding disorder?

Hoarding usually involves having difficulty getting rid of items and also issues on the maintenance of control over belongings. This behavior affects school and social functioning and appeared to Jenny when she was aged eight (Sorensen, 2011). Jenny also experienced problems at school as the teacher often sent notes stating that her desk is messy and she appeared to be absent minded in class. By the time she was in second grade, she had started being left behind in some subjects.

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Literature points out that hoarding has been higher among children having ADHD than in children who are relatively healthy (Sorensen, 2011). In the case of Jenny, she was diagnosed with ADHD by a neuropsychologist. Dr. Davis said that she had neurodevelopment disorder that ensured it was hard for her to sustain her attention for a sustained period of time.

Hoarding behaviors come up partly as a way of strengthening a person’s sense of control and safety following a traumatic experience or a chaotic environment in childhood that is indicative of using possessions to gain a sense of control. Jenny played with toys for most of her childhood and so developed a sense of possession over toys. Furthermore, when the parents began receiving complaints from her teachers, they used to confiscate the toys as a form of punishment.

These experiences had an effect on her core beliefs and made her prone to the disorder. The most common core beliefs reported anecdotally include feelings of being unloved, helpless and unworthy. Environmental factors, traumatic and stressful events included, emotional deprivation, family attachments and economic and cultural forces are influential in the developing core beliefs (Sorensen, 2011).

Jenny was a Daddy’s girl when she was younger but she felt lonely and sad when she became older because he was always away on business. An event in her childhood that brought with it trauma was when she was a baby and Andrew, 17, her cousin, died in an accident involving a motorcycle. Andrew and Jenny were close and she was traumatized by Andrew’s death.

Having difficulty categorizing and making decisions are shown in the existence of clutter in the homes of people who hoard compulsively. They take unnecessarily long to organize items. They experience difficulty and anxiety and have their items sort into many categories (Sorensen, 2011). Jenny struggled to make even the most basic of decisions like what to wear, what dinner to take which toys to dispose. When she was a baby, she didn’t make most of her decisions herself. A problem for her was the disposal of boxes of her jewelry and also the original toy boxes. She began by saving the small jewelry boxes plus the paper towel rolls and empty toilet paper rolls as she thought that they might be useful for future art projects, like papier mache’ animals. She didn’t have the time to make use of these items but Jenny knew that they might be of use someday – for several years. She also had a feeling that it was important for her to save all the packaging of her toys because she had arranged with the parents that she would sell the toys on Craigslist when she was no longer using them and she would keep the money. She understood that items with packaging sold highly. While this was a good idea theoretically, Jenny sold just a single game as it was troublesome for her to decide whether to put items on sale or not.

Who in Jenny’s family appeared to have hoarding tendencies? What situations appeared to trigger an episode?

Hoarding symptoms appear to be linked to family – suggesting genetic vulnerability (Tolin, 2011). People with hoarding tendencies always have first degree relatives who have the same tendencies (Sorensen, 2011). An aunt of Jenny looks like she possesses similar tendencies since when she went to Andrew’s bedroom she noticed that it was filled with stuff linked to Andrew. Jenny inquired from her mother about this on their way home and the reply was that Aunt Olivia was grieving and appeared to be collecting anything connected to Andrew.

A main event in childhood that triggered a fit was when her mother bought some designer clothing for Jenny. In an attempt to surprise the daughter, she went to her daughter’s room to put the clothes in the closet but the closet was packed with cardboard boxes, toys and clothes. She made a decision to move some of the clothes into Jenny’s dresser so as to create room. She was appalled to find out that pretty much every drawer was filled with empty toilet paper and small boxes. She didn’t have an idea as to why she kept that much of stuff in her drawers. She got irritated that sorting out the stuff took too much time. She took a garbage bag and dumped empty boxes enough to fill four drawers. On returning home, Jenny was proudly shown the contents of her closet by her mother. Grace, the mother, gave an explanation that in order to create room for new clothing, she had decided to arrange the closet and discard the junk that had been saved by Jenny in the drawers. On hearing this, instead of being excited to see the new clothes, she ran to the dresser and opened every drawer frantically. She screamed at her mother asking why she threw her things away. She was screaming that she had been saving them for someday and now they were no more. She began sobbing on the floor. Grace walked out of Jenny’s room surprised at the irrationality of her daughter.

How is it that Jenny didn’t think she had a problem until after she had been in treatment for some time?

As with almost all patients having a similar disorder Jenny was defensive of her habits and she also possessed poor insight. Responding poorly to treatment is often attributable to poor insight. Hoarding patients are generally rated by clinicians to have poorer insight. This explains their unlikeliness to seek help or treatment and the likelihood of their dropping out in case they seek help. Some individuals are even unaware of the extent of their hoarding problem. In a study of members of a family having hoarding problems, 55% of the respondents are reported to have said that their loved ones were of ‘poor insight’ or were ‘delusional.’ High levels of anxiety also contribute to this problem. Hoarders apparently experience unusual emotional reactions, become violent at times, at the thought of any one violating their strong beliefs on waste, identity and emotional significance. It is difficult to understand this experience’s intensity. Several of the female clients have informed counselors independently that having other individuals discarding their belongings is a kin to being raped. Others said that the experience is extremely hurtful and makes them feel like ‘they just want to die.” They consider it so horrible that it is hard for them to stand it. When such levels of distress accompany even the most basic of discarding attempts, they are likely to avoid discarding at all costs. A majority of the clients take great measures to ensure they don’t undergo such distress. Some of them do not even use terms like ‘discard’, ‘garbage’ or ‘trash’ to refer to their stuff; he pictures created by such images are so painful to them (Frost, Tolin & Maltby, 2010).

Describe the cognitive-behavioral model of hoarding

The cognitive behavioral model links compulsive hoarding to 4 main problem issues, including information processing deficit, problems with emotional attachment, issues of behavioral avoidance and wrong beliefs on the nature of possessions. Information processing deficit include problems in making decisions concerning possessions, difficulty in categorization and organization of items, lower confidence in their memory, and wrong judgment on the significance of recalling information. These particular deficits cause them to acquire and save items for use in the future and also for financial value. Problems that arise include emotional and sentimental attachment to possessions that are connected in some way with their past. Behavioral avoidance is related to the problem patients have in trashing items as a way of escaping anxiety feelings that arise due to decision making, and also the work of sorting the items and doing away with clatter. False beliefs are centered on attachment to the items and the perceived safety provided by the items (Pogosian, 2010). Given this model, professionals have come up with a multi-model CBT approach aimed at targeting the mentioned issues that compulsive hoarders experience, including information processing difficulties and erroneous beliefs on possessions, the emotional distress linked to discarding items and avoiding behaviors that limit the distress linked with the discarding of the possessions. Importance is laid to the setting of specific goals focusing on establishing therapy rules and the improvement of daily functioning like having living spaces used appropriately.

Further, the established therapy rules need patients to make all decisions (save vs. discard) about their possessions. Group therapy, including didactic sessions gives additional support (Pogosian, 2010). In this case, Dr. Starder also explains hoarding’s cognitive behavioral model that consists of excess acquisition and problem discarding things, which leads to excess clutter in the environment. He goes on to say that a lot of evidence exists suggesting that hoarding is rooted in a combination of information processing deficits, wrong behaviors and beliefs and emotional avoidance and distress. The cognitive-behavioral model gives suggestions that hoarders possess strong emotions about the items they own like joy or pleasure in their acquisition or saving. This makes it difficult to alter this pattern without help.

List some of the beliefs that Jenny had that Jenny had about why it was important to hold onto things

Dr Strader began working on cognitive restructuring of the beliefs held by Jenny about the significance of acquiring and saving possessions. He assisted Jenny in figuring out the beliefs that made her do this. He inquired from her about anything at home that ought to have been discarded but was still kept at home. Jenny said there was a bicycle that was broken at home and that it belonged to Andrew, her cousin. The belief identified was that she felt like throwing the bicycle was like throwing Andrew out. She also did not possess several of Andrew’s property and it was a pain allowing someone to take something outside of Andrew’s room. She believed that throwing away Andrew’s stuff was disrespectful.

Literature gives an explanation that exaggerated or maladaptive beliefs on possessions seem to play a key role in compulsive hoarding. Several hoarders talk of an increased sense of responsibility for their possessions. For several of them, simply thinking of a possible use of the item gives them enough reason to save it. Emotional attachment is characterized by overly appreciating an object’s value or its aesthetics. In certain cases, patients report feelings of greater attachment to these items than they do to people. They therefore equate discarding property to losing someone they love or a crucial time in the life of the person or their identity (Tolin, 2011).

Furthermore, Jenny had some beliefs on holding items when she was a kid. She saved boxes and empty toilet paper imagining that she might use them at a later date.

Jenny also imagined that it was important keeping her toys’ packaging since she had arranged with her parents that she would sell them and keep for herself the money she got. She was however only able to sell one item because of her indecisiveness on whether to sell or not.

Why would it not have been effective just to call a junkman to clear everything out of Jenny’s house and make a clean start?

Calling a junkman would have been very ineffective since the therapy’s goal is enabling the patient lead a functional and decisive life. The therapy takes care of Jenny’s indecisiveness and her unhelpful beliefs. For as long as Jenny still has the beliefs and remains indecisive, the problem hasn’t been solved. Treatment alone can assist hoarders lower their unhelpful habits and lead healthier lifestyles. The two main kinds of treatments are medication and cognitive-behavioral therapy (CBT).

In the course of CBT, the patients slowly learn how to do away with possessions that are unnecessary without undergoing through much distress and so diminishing the exaggerated need to save the items. They learn to improve organization, relaxation and decision-making skills. For a number of patients, some anti-depressants can be of help (American Psychiatric Association, 2014).

How did Jenny’s hoarding interfere with her life?

Jenny’s hoarding had a huge effect on her life in several ways resulting in her childhood being dysfunctional. She faced several problems with academics in her early schooling years. Furthermore, she became lonely and had a preference for being alone. She also found it hard concentrating on her job. Her office began appearing smaller in size because of the things she had stacked up in her office but she continued saying to herself that there would be less clutter when she “became organized.” She tried keeping her office door shut most of the time. Her boss mentioned to her that she was giving a bad impression to the students. Her marriage became stressful. The husband was shocked when she saw old papers and garbage boxes. The things were piled up in no order and a box was filled with empty toilet paper.

On Steven confronting Jenny about this issue, she became angry and defensive. She informed him that it wasn’t his business. Steven told her that it was his business now that the two of them had tied the knot and her stuff filled more than half the house. On getting her first born, Jenny felt down on some occasions. She often wondered if she suffered from postpartum depression. She recalls similar feelings from her childhood at the times when her father was away. Jenny and the husband grew apart emotionally and he finally decided to walk out. The hardest moment for her was her children and husband leaving her.


American Psychiatric Association. (2014). Hoarding Disorder. Retrieved 26 February 2015, from

Frost, R., Tolin, D., & Maltby, N. (2010).Insight-Related Challenges in the Treatment of Hoarding. Cognitive and Behavioral Practice, 17(4), 404-413. doi:10.1016/j.cbpra.2009.07.004

Pogosian, L. (2010). Treatment of Compulsive Hoarding: A Case Study. The Einstein Journal of Biology and Medicine, 8-11. Retrieved from

Sorensen, R.J. (2011). Hoarding Disorder (Compulsive Hoarding): A Comprehensive Literature Review and Professional Training to Prepare Clinicians to Treat Problematic Hoarding. Retrieved from

Tolin, D. (2011). Understanding and treating hoarding: A biopsychosocial perspective. Journal of Clinical Psychology, 67(5), 517-526. doi:10.1002/jclp.20795

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