Insight-Related Challenges in the Treatment of Hoarding

Abstract Compulsive hoarding is a chronic and debilitating condition that has proven difficult to treat. The cognitive behavioral approaches that have otherwise been successful for people suffering from obsessive-compulsive disorder do not work very well for hoarding (Abramowitz, Franklin, Schwartz, & Furr, 2003). Many have suggested that this is due to the ego-syntonic nature of the symptoms and the accompanying lack of insight. This paper describes several challenges related to insight that limit the effectiveness of traditional cognitive behavioral approaches for compulsive hoarding. Problems with anosognosia, overvalued ideation, and defensiveness that characterize hoarding are described and suggestions offered for dealing with them.