Hoarding Disorder: A Case Report

Daniela Vilaverde, Jorge Gonçalves, Pedro Morgado

Hoarding disorder is characterized by a persistent difficulty discarding items, the desire to save items to avoid negative feelings associated with discarding them, significant accumulation of possessions that clutter active living areas and significant distress or impairment in areas of functioning. We present a case of a 52-year-old married man who was referred to the psychiatry department for collecting various objects that were deposited unorganized in the patient's house. He reported to get anxious when someone else discarded some of these items. This behavior had started about 20 years earlier and it worsened with time. The garage, attic, and surroundings of his house were cluttered with these objects. On admission, in the mental status examination, it was observed that the patient was vigil, calm, and oriented; his mood was depressed; his speech was organized, logic, and coherent; and there were no psychotic symptoms. A psychotherapeutic plan was designed for the patient, including psychoeducation, cognitive restructuring, and exposure to discarding objects. A pharmacological treatment with fluvoxamine 100 mg tid and quetiapine 200 mg was added to the therapeutic plan, with the progressive improvement of the symptoms. Nine months later, the patient was able to sell/recycle most of the items. Studies evaluating treatment for HD are necessary to improve the quality of life of the patients and to reduce the hazards associated with the disorder.