#OTalk 22nd May 2018 – The role of Occupational Therapy in compulsive hoarding

This weeks #Otalk is on the topic of “hoarding” and will be hosted by Orla Hughes (@Orlatheot).

What is compulsive hoarding?

Compulsive hoarding, or hoarding disorder, is a pattern of behaviour that is identified by the following characteristics:

  1. Having difficulty or an inability to discard possessions (NHS Choices, 2015).
  2. Excessively acquiring objects, regardless of their monetary value, which prevents use of living and work spaces (Tolin, Frost, and Steketee, 2014).
  3. As a result, considerable impairment or distress in occupational, social, or other critical areas of functioning is present (American Psychiatric Association, 2013).
  4. The hoarding symptoms are not restricted to symptoms of another mental or physical condition, for example, food storing issues as a symptom of Prader-Willi Syndrome (Mataix-Cols et al., 2010).

This condition was formerly recognised to be a symptom of obsessive–compulsive disorder (OCD) but due to recent research, it is now classed as a separate diagnostic entity by healthcare providers and in the Diagnostic and Statistical Manual of Mental Disorders (Pertusa et al., 2010; Royal College of Psychiatrists, 2016).

The prevalence of compulsive hoarding

Clients who have the behaviours of hoarding and acquiring are common issues faced by staff in health, social-care, housing and environmental services (Dissanayake, 2012). A prevalence rate of 2-5% in the population have been found through studies in Europe and the United States (Bratiotis, Schmalsich and Steketee, 2011). Yet, when analysing these figures, in studies such as Samuels et al. (2008), it is not clear whether the 4% of participants who were found to compulsively hoard would have met the new diagnostic criteria outlined for the condition in this study. As a result, more research is needed in this field to quantify the population who compulsively hoard.

Current MDT practice

Although guidance is provided for working with hoarding symptoms within OCD, there is no specific guidance for working with compulsive hoarding (NICE, 2005). However, the NHS Choices website describes the condition and recommends Cognitive Behavioural Therapy (CBT) as the common treatment for the condition (NHS, 2015). A comprehensive search of the literature, from the fields of psychology and psychiatry, revealed that compulsive hoarding is mainly treated with both CBT and medication (Tolin D.F. et al., 2015). Serotoninergic drugs, such as fluvoxamine, have seen benefits for clients, yet no medication is currently advertising to treat compulsive hoarding (Saxena, 2008; Soares, Fernandes, and Morgado, 2016). CBT can include motivational interviewing, psychoeducation, developing cognitive techniques highlighting dysfunctional beliefs, and the graded discarding and sorting of items (Steketee and Frost, 2014). This combination has shown modest clinically-significant results for clients finishing treatments and therefore papers call for further studies to investigate the issues these clients confront and how to improve their well-being (Tolin D.F. et al., 2015; Vilaverde, Gonçalves, and Morgado, 2017).

Compulsive hoarding and occupational therapy

Compulsive hoarding can decrease occupational engagement in many areas of life, appropriate for occupational therapy input, such as functional independence, roles, and the social and physical environment (Dissanayake, 2012). Recent quantitative research, conducted by Dissanayake, Barnard, and Willis (2017), investigates the role of occupational therapy in the assessment and treatment of compulsive hoarding and calls for further research involving occupational therapy and this population which can begin to inform clinical practice.

Here are the questions we will be discussing:

  1. How would compulsive hoarding affect a person, how they perform their occupations, and interact with their environment?
  2. Do you feel equipped to work collaboratively with this population?
  3. What ethical issues do you predict you would encounter with this population?
  4. What occupational therapy interventions could be utilised?
  5. Finally, what could the role of occupational therapy be in this setting (the assessment and treatment of compulsive hoarding)?


American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders. 5th edn. Arlington, VA: American Psychiatric Publishing.

Bratiotis, C., Schmalisch, S., and Steketee, G. (2011) The Hoarding Handbook: A Guide for Human Service Professionals. Oxford: Oxford University Press.

Dissanayake, S. (2012) ‘Clearing the Clutter,’ in OT News, February 20 (2) pp.24-25 published by The Royal College of Occupational Therapists: London, UK

Dissanayake, S., Barnard, E., & Willis, S. (2017): “The emerging role of Occupational Therapists in the assessment and treatment of compulsive hoarding: An exploratory study”. New Zealand Journal of Occupational Therapy, 64 (2) 22-30.

Mataix-Cols D, et al. (2010) ‘Hoarding disorder: a new diagnosis for DSM-V?,’ Depression Anxiety, 27(1), pp. 556–572.

NHS Choices (2015) Hoarding Disorder. Available at: https://www.nhs.uk/conditions/hoarding-disorder/ (Accessed on 2nd December 2017).

NICE (2005) Obessive-compulsive disorder. Available at: https://www.nice.org.uk/guidance/cg31/evidence/cg31-obsessivecompulsive-disorder-full-guideline2 (Accessed on 22nd February).

Pertusa A, et al. ‘Refining the diagnostic boundaries of compulsive hoarding: a critical review,’ Clinical Psychology Review, 30(1), pp. 371–386.

Polkinghorne, D.E. (1989) ‘Phenomenological research methods,’ In R.S Valle and S. Halling (Eds.), Existential phenomenological perspectives in psychology. New York, NY: Plenum Press, pp.41-60.

Royal College of Psychiatrists (2016) Hoarding. Available at: http://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/hoarding.aspx (Accessed on 2nd December 2017).

Samuels J.F. et al. (2008) ‘Prevalence and correlates of hoarding behavior in a community-based sample,’ Behav Res Ther, 46(1), pp. 836–844.

Saxena S. (2008) ‘Neurobiology and treatment of compulsive hoarding,’ CNS Spectrum, 13(14), pp. 29–36.

Soares, C., Fernandes, N., and Morgado, P. (2016) ‘A review of pharmacologic treatment for compulsive buying disorder,’ CNS Drugs 30(4) pp. 281–91.

Steketee, G., and Frost, R. O. (2014) Compulsive hoarding and acquiring: Therapist guide. 2nd edn. New York, NY: Oxford University Press

Tolin, D.F., Frost, R.O., and Steketee, G. (2014) Buried in Treasures. Help for Complusive Acquiring, Saving, and Hoarding. Oxford: Oxford University Press.

Tolin D.F. et al. (2015) ‘Cognitive behavioral therapy for hoarding disorder: a meta-analysis,’ Depression Anxiety, 32(3), pp. 158–66.

Vilaverde, D., Gonçalves, J., and Morgado, P. (2017) ‘Hoarding Disorder: A Case Report,’ Frontiers in Psychiatry. Available at: https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00112/full (Accessed on 10th November 2017).

Post Chat

Chat Host: Orla Hughes @Orlatheot

On the #OTalk Account: Kelly @otonthetracks

Online Transcript

#OTalk Healthcare Social Media Transcript May 22nd 2018

The Numbers

900.755K Impressions
329 Tweets
34 Participants
263 Avg Tweets/Hour
10 Avg Tweets/Participant

#OTalk Participants


Position Now Open Again: #OTalk Student Digital Leader Intern

Welcome to the Team (Permanently), Kelly!

The #OTalk crew are excited to announce that our Student Digital Leader Intern, Kelly (@OTontheTracks), has agreed to become a permanent member of the team.

image1 (7)

Kelly started her role in April 2015 and quickly became a valued member of our team, a rock we can depend on and a good friend. Kelly has shown tremendous dedication to her role, actively participating in chats and promoting #OTalk at every possible opportunity. She has made sure that all previous chats on the on the otalk.co.uk website have a transcript, and created a wonderful ‘Welcome to OT’ video. We really appreciate how motivated she is and how easy she is to get along with, and we are so happy to have her onboard.

image1 (13)

Now Recruiting for #OTalk Student Digital Leader Intern(s)

We love the fresh perspectives and energy that students bring to the #OTalk community, and we have always had students in the team (@GillyGorry and @GeekyOT both started their #OTalk journeys as students). With this in mind, we have decided to re-open applications for the position of #OTalk Student Digital Leader Intern.

We want to recruit one or two UK/Ireland-based interns who are pre-registration students at the time of application to support the running of #OTalk for a 6-9 month period. A list of responsibilities and projects can be found below, along with an indication of the skills we are seeking. In return for your support, you will receive mentoring in digital leadership from the #OTalk team, and guidance to host/support-host a few chats throughout the internship. This experience will help develop your professional networks and will look great on a CV. You will receive a reference on completion of the internship.

Our outgoing Student Digital Leader Intern, Kelly, summed up her experience saying:

“Undertaking the Student Digital Leader Intern position with the #OTalk team created so many fantastic opportunities that I could  never have imagined I would be a part of as a student occupational therapist.

Being part of the #OTalk team has opened up a world of expertise and experience to learn from. I have developed a range of transferable skills I can take with me into my career as qualified occupational therapist and had lots of fun along the way”


#OTalk Student Digital Leader Intern – Responsibilities and Project

  • OTalk Blog – Transcript posting.
    To support the team by posting transcripts for selected chats within 48 hours of a chat and in linking to the summary page
  • OTalk Facebook
    Creating a Facebook event for each chat from the OTalk Facebook page
  • OTalk Twitter – Promoting
    Regular tweets from OTalk and personal accounts to promote the chats.
  • OTalk Twitter – Follows.
    To review follows on the OTalk Twitter account, block spam accounts and to follow back/create lists for the OTalk account.
  • OTalk Twitter – Hosting.
    To host a minimum of one chat during the internship and to support an additional two chats with guest hosts (Training will be provided – more can be hosted as desired).
  • OTalk Experience Summary.
    Along with the OTalk crew to write up an account of the experience of interning for publication.
  • OTalk Development.
    Engagement in online team meetings to review chat effectiveness, suggest future development and feedback on the relevance of OTalk for students.


Interns ideally need to be:

  • Excellent communicators
  • Familiar with the use of Twitter
  • Familiar with the use of Gmail, Google calendars and Google Drive
  • Familiar with the use of Skype
  • Familiar with WordPress blog editing dashboard
  • Able to create PDFs of transcripts
  • Available on Tuesday nights between 8pm – 9pm at least once a month
  • Available for 30 minutes on Wednesdays or Thursdays to post chat transcript
  • Able to access the Internet and have a laptop/smartphone that will enable blog editing and Twitter/Facebook access.
  • Passionate about the occupational therapy profession
  • Promoters of the positive application of social networking for professional development
  • Responsible and professional in their use of social media (social media accounts of applicants will be reviewed as part of the application process)
  • Engaging with CPD on a regular basis

(Training to use the relevant software will be provided so please still apply if you meet most of the outline above)


If you are interested in this position please send the following to otalk.occhat@gmail.com by 23:55 on the 15th May:

  • A personal statement of no more than 500 words demonstrating your suitability for the internship
  • A Biography of between 100-200 words (that includes your name and university, and a link to your LinkedIn profile) [Write this as if you are introducing yourself to the #OTalk Community on the blog]
  • Your skype username
  • The name and e-mail of a referee who can be contacted if you are invited to interview

Please direct any queries to the team using the above email address or Direct Message us on @OTalk_

Shortlisted applicants will be invited to a Skype interview by the end of May and will be in post by the beginning of June.

Please note this is a voluntary role (we are all volunteers and #OTalk is not-for-profit.