Can Occupational Therapy Address the Occupational Implications of Hoarding?
Cathy Clarke
PMID 30956628WHAT IT FOUND
There is almost no occupational therapy evidence on hoarding, and existing responses often focus on psychology or forced clearing.
A client-centred approach is proposed that helps people build safer, meaningful daily activities instead of only removing possessions.
Key findings
01Searches for occupational therapy literature on hoarding found no published research evidence on occupational therapists working with this population.
02Cognitive behaviour therapy was the most common hoarding intervention, but only 20% of cases commonly received it, with poor outcomes and poor compliance reported.
03The author proposes occupational therapy that does not immediately require the person to stop hoarding and can use harm reduction principles.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The review was not conducted as a systematic review, so the literature included may reflect the author's search choices and interpretation. It found almost no occupational therapy research on hoarding, so the proposed occupational therapy frameworks are not tested interventions. Much of the literature came from psychology and psychiatry and framed hoarding medically, which may have limited occupational perspectives. Older studies may be flawed because people who hoard were not separated from people with obsessive compulsive disorder. Prevalence estimates were from studies before 2013 and may include people with obsessive compulsive disorder rather than only people who hoard. Most evidence was from affluent Western populations, so cultural differences in hoarding and responses are not well covered. The paper reports no new patient outcomes, so it cannot show whether the proposed approach changes health, safety or hoarding behaviour.
The easy way to misread this
Do not treat the proposed occupational therapy approach as evidence that it works. The review found no published research on occupational therapists working with people who hoard, so the suggestions are conceptual and need testing.