Hoarding Disorder
Hoarding Disorder
Hoarding Disorder
Volume 4 Article 4
Issue 2 Volume 4, Issue 2
December 2013
Bradley Klontz
Kansas State University
Part of the Counseling Psychology Commons, Family, Life Course, and Society Commons, Finance
and Financial Management Commons, Social Psychology Commons, and the Social Work Commons
Recommended Citation
Canale, A., & Klontz, B. (2013). Hoarding Disorder: It’s More Than Just an Obsession - Implications for
Financial Therapists and Planners. Journal of Financial Therapy, 4 (2) 4. https://doi.org/10.4148/
1944-9771.1053
This Article is brought to you for free and open access by New Prairie Press. It has been accepted for inclusion in
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Journal of Financial Therapy Volume 4, Issue 2 (2013)
Hoarding Disorder:
It’s More Than Just an Obsession -
Implications for Financial Therapists and Planners
Compulsive hoarders feel emotional attachments to their money and possessions, making it
difficult for them to spend or discard accumulated items. Traditionally, hoarding has been
seen as a symptom of Obsessive Compulsive Disorder (OCD) or Obsessive Compulsive
Personality Disorder (OCPD). However, hoarding behavior can be a problem in its own right,
without someone meeting the diagnostic criteria for OCD or OCPD. Despite being a mental
health disorder that poses a serious public health problem, social costs to the public, and
strain on families, there is little empirical work that has examined Hoarding Disorder (HD)
from a financial perspective. As with other money disorders, for the compulsive hoarder,
financial health and mental health symptoms are intertwined. This paper explores the
financial psychology of HD and its implications for financial therapy and personal financial
planning.
INTRODUCTION
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
criteria for obsessive-compulsive personality disorder (OCPD) includes “a miserly
spending style toward both self and others; money is viewed as something to be hoarded
for future catastrophes” (American Psychiatric Association, 2013, p. 679). While this
statement connects hoarding and financial behavior, little research exists that explores
these concepts. Klontz and Klontz (2009) and Klontz, Britt, Archuleta, and Klontz (2012)
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identified compulsive hoarding as a money disorder that not only includes the acquisition
and retention of objects, but also takes a positive behavior like saving to an unhealthy
extreme.
Hoarding behavior poses a serious public health problem, social costs to the public,
and strain on families (Frost, Steketee, & Williams, 2000; Tolin, Frost, Steketee, Gray, &
Fitch, 2008). Hoarding can have a profound effect on one’s own health and safety (Frost,
Steketee, & Tolin, 2012). Relatively few studies have examined hoarding despite its
prevalence and association with significant distress and functional impairment (Coles,
Frost, Heimberg, & Steketee, 2003). This paper explores the hoarding of possessions and
the hoarding of money. After a review of the literature on hoarding disorder’s onset,
diagnostic criteria, and interventions, the financial psychology of hoarding is also explored.
Frost and Gross (1993) referred to hoarding disorder (HD) as the acquisition and
failure to discard a large number of possessions. It is argued in this paper that hoarding
disorder is not just a mental health disorder of concern to psychologists and
psychotherapists. HD is a money disorder that has a direct effect on financial planners, the
financial planning process, financial therapy, and the financial health of clients. While there
is little research that connects hoarding and financial behaviors, in practice, addressing
financial issues, such as risk tolerance, miserliness, or money disagreements among
couples and family members can be informed by these connections. Understanding the
financial aspects of hoarding can alert financial practitioners to look for symptoms of
hoarding behavior and interventions that might be effective for their clients. This paper
will explore the connection between the hoarding of possessions and the hoarding of
money, offering a theoretical basis for further study of this connection. For the purposes of
this paper, and to be consistent with the new release of the DSM-5, hoarding behaviors
that cause clinically significant impairment are referred to as hoarding disorder, unless
citing the work of others who have referred to it as hoarding or compulsive hoarding. From
the review of the literature, these appellations are used to describe the same condition.
LITERATURE REVIEW
Prior to 1993, little research existed in the mental health literature related to
hoarding behavior (Frost et al., 2012). Within the past two decades hoarding has been
identified as being a prevalent and serious condition (Mataix-Cols et al., 2010). Several
studies have shown that the point prevalence rate of clinically significant hoarding
behaviors is 2% to 6% of the population (American Psychiatric Association, 2013; Iervolino
et al., 2009; Mueller, Mitchell, Crosby, Glaesmer, & de Zwaan, 2009; Samuels et al., 2008).
This is two to five times the prevalence of obsessive-compulsive disorder (OCD) (American
Psychiatric Association, 2013; Samuels et al., 2008). To put that into context, the National
Institute of Mental Health (2010) reported prevalence rates in a given year for adults in the
United States of 2.6% for Bipolar Disorder, 3.5% for Posttraumatic Stress Disorder, and
6.7% for Major Depressive Disorder. Given the paucity of research in the area of HD, these
numbers suggest that HD is a prevalent disorder, but has been relatively ignored by the
mental health field.
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One reason for the lack of research in this field is that, until recently, compulsive
hoarding behavior was not considered a distinct disorder, but rather a diagnostic criterion
for OCPD (Frost et al., 2012) and a symptom of OCD (Mataix-Cols et al., 2010). OCD can
usually be distinguished from OCPD by the presence of true obsessions or compulsions,
such as intrusive anxiety-provoking impulses (obsessive) and urges to perform behavioral
or mental acts (compulsive) (Abramowitz, Wheaton, & Storch, 2008). Hoarding had been
considered a symptom of OCD, and therefore most of the research has investigated
hoarding within the context of OCD rather than as a distinct disorder. Research subjects
may have been diagnosed with OCD based on other symptoms and hoarding behaviors
could have been absent. Recent studies have shown that many people that hoard have no
other symptoms of OCD (Frost et al., 2012). While 75% of individuals who suffer from HD
have a co-occurring anxiety or mood disorder, only 20% of individuals who meet the
criteria for HD also meet the criteria for OCD (American Psychiatric Association, 2013). As
a result, many of the findings around hoarding in OCD populations may not have been
representative of people with hoarding behaviors (Frost et al., 2012). Consequently,
hoarders have been underrepresented in most cognitive behavioral therapy studies of OCD,
limiting the ability to generalize research findings to individuals with hoarding symptoms
only (Mataix-Cols, Marks, Griest, Kobak, & Baer, 2002).
Hoarding as a Disorder
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mattresses, building up stockpiles of food, and saving things like scrap metal and fuel oil
were means of survival and in many cases those habits and fears about not having enough
were passed down from generation to generation. Many children of hoarders from the
Great Depression became hoarders and underspenders by adopting their parents’ money
scripts and modeling their parents’ behaviors (Klontz & Klontz, 2009). Significant financial
losses or periods of economic turmoil, such as the 2008 recession, have been linked to
symptoms of posttraumatic stress and changes in beliefs and approaches to investing
(Klontz & Britt, 2012a).
Traumatic or stressful events may also play a role in the onset and expression of
hoarding (Tolin, 2011). Cromer, Schmidt, and Murphy (2007) found that hoarders were
significantly more likely than non-hoarders to report experiencing at least one traumatic
life event. They further found that patients who were determined to be hoarders and also
had experienced traumatic life events had greater hoarding severity than those who had
not experienced trauma (Cromer et al.). Related studies have also shown evidence of
problematic food hoarding behaviors among children in foster care (Casey, Cook-Cottone,
& Beck-Joslyn, 2012). While more research is needed, evidence supports the notion that
whether from direct experience or modeling from caregivers, hoarding behaviors can
emerge in response to troublesome life events, poverty, or financial trauma. The resulting
fear of not having enough can lead to an irresistible urge to excessively acquire and
persistently hold onto resources to protect oneself from a period of future potential lack.
Frost and Hartl (1996) developed the following diagnostic criteria for HD that have
been further refined and widely adopted in the field:
In addition to the diagnostic criteria, the guidelines of DSM-5 include two specifiers for
HD (Frost et al., 2012):
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In the development of the Klontz Money Behavior Inventory (K-MBI), Klontz and
colleagues (2012) identified the following symptoms in their Compulsive Hoarding scale:
1. I have trouble throwing things away, even if they aren’t worth much.
2. My living space is cluttered with things I don’t use.
3. Throwing something away makes me feel like I am losing a part of myself.
4. I feel emotionally attached to my possessions.
5. My possessions give me a sense of safety and security.
6. I have trouble using my living space because of clutter.
7. I feel irresponsible if I get rid of an item.
8. I hide my need to hold on to items from others.
These symptoms of compulsive hoarding have been found to be more common in men with
lower levels of net worth (Klontz et al.). Money avoidance and money worship beliefs can
predict higher scores on the K-MBI Compulsive Hoarding scale (Klontz & Britt, 2012b).
Klontz and Britt (2012b) also found compulsive hoarding to be significantly correlated with
other disordered money behaviors, including Compulsive Buying Disorder and Pathological
Gambling.
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accumulating money (Klontz, Kahler, & Klontz, 2008b; Klontz & Klontz, 2009). Forman
(1987) described a financial hoarder as having a fear of losing money, distrust of others
around money, and trouble enjoying money. Klontz and Britt (2012b) identified a link
between money attitudes and hoarding behaviors. They found that money status scripts
and money worship scripts predicted compulsive hoarding behaviors. Specifically,
individuals who linked net worth to self-worth and held the belief that the key to happiness
and the solution to all of their problems was to have more money were significantly more
likely to engage in hoarding behaviors. The DSM-5 criteria for OCPD also included a
miserly spending style and the need to hoard money (American Psychiatric Association,
2013), adding support for the link between hoarding and money.
Hoarders save items for reasons related to sentimental attachment, usefulness, and
aesthetic qualities, and possessions become an extension of the self (Belk, 1988).
Discarding an item feels like losing a piece of oneself or like the death of a friend. Objects
serve as reminders of important past events and provide a sense of comfort and security.
The hoarder’s identity to an extent is wrapped up in everything they own. This becomes
such an issue that there is a tendency to assign human qualities to things they own (Belk,
1988). Hoarders feel exaggerated beliefs about responsibility for their possessions
reflected in a need to be prepared for any contingency. They do not want to waste
something with a useful life, and feel a sense of guilt in discarding (Belk, 1988). Saving is
not restricted to worthless or worn out things and many saved items are new and never
used (Frost et al., 2012). People who hoard are also less willing to share possessions.
Clinically significant distress or impairment is indicated when living areas or the workplace
are in such disorganized clutter that finding important items is difficult (Frost et al., 2012).
Clinically significant impairment could also result from interpersonal stress related to the
hoarding behaviors, including marital conflict and/or disapproval from family members or
friends.
For some individuals, hoarding symptoms overlap with OCD symptoms (Frost et al.,
2012). HD can resemble OCD in a number of ways: (a) the avoidance of discarding items for
fear that it may be needed in the future, (b) the avoidance of discarding because of an
emotional attachment, and (c) the fear of making a mistake as to what to discard. These
avoidances and fears have been said to be similar to obsessions (Mataix-Cols et al., 2010).
The difficulty in discarding possessions may be an obsession, while the avoidance of
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Intervention
While HD is challenging to treat, recent studies have shown some promise. The most
encouraging data has come from multimodal intervention that focuses on four main
problem areas: (a) information processing, (b) emotional attachment, (c) behavioral
avoidance, and (d) erroneous beliefs about possessions (Gaston, Kiran-Imran, Hasseim, &
Vaughan, 2009). Motivational interviewing is used to address ambivalence and poor
insight. Cognitive behavioral therapy (CBT) is used to help decrease clutter and resist the
urges to accumulate. Cognitive restructuring is used to address the fear of discarding. This
multimodal treatment is lengthy and success depends on the motivation of the patient
(Gaston et al., 2009). Klontz and Klontz (2009) advocated resolving unfinished business
associated with trauma as an approach to the treatment of money disorders (including
compulsive hoarding) using an intensive group experiential therapy approach that has
garnered some empirical support for its clinical utility (Klontz, Bivens, Klontz, Wada, &
Kahler, 2008). Muroff, Steketee, Bratiotis, and Ross (2012) also found that weekly group
cognitive behavior therapy sessions, along with non-clinician home visits over a 20 week
period, showed significant reductions in hoarding symptoms.
An open trial of CBT designed for hoarding with 26 individual sessions and monthly
home visits over nine to twelve months revealed decreases in saving behavior and reduced
clutter (Tolin, Frost, & Steketee, 2007). Turner, Steketee, and Nauth (2010) found
improvements in clutter, reductions in acquiring and difficulty with discarding, and
improvements in safety concerns with specialized CBT techniques for hoarding with a
sample of elderly patients. The treatment approach was primarily home based and lasted
approximately 35 sessions, focusing on motivational enhancement, cognitive skills,
organizational skills, and decision-making and non-acquiring skills.
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Steketee, Frost, Tolin, Rasmussen, and Brown (2010) conducted a waitlist controlled
trial of modified CBT hoarding treatment where participants were randomly assigned to
immediate treatment or to a 12-week waitlist. After only 12 weeks, improvement for
participants in the CBT group was statistically greater than those in waitlist group on most
hoarding severity measures. Pekareva-Kochergina and Frost (2009) found that
bibliotherapy group intervention conferred considerable benefit over a 13-week group
intervention. Because of the lengthy and costly process of CBT, video-enhanced and web
based CBT therapy has been an ongoing intervention since 1998 (Muroff, Steketee, Himle,
& Frost, 2010). Online-based CBT therapy appears to be promising as an intervention
strategy that can extend access to a much broader group.
Tolin (2011) offered practice recommendations for working with hoarding patients,
which included motivational leverage from friends and family, compliance with homework
assignments, consistent praise over completed assignments, and a focus on harm reduction
treatment goals rather than symptom resolution. Tolin also recommended assessment and
treatment of comorbid Axis I and Axis II disorders and neuropsychological evaluation if
cognitive impairment was suspected.
Parallels have been drawn between money and psychology throughout history.
However, money has been argued to be one of the most neglected topics in psychological
research and practice (Klontz, Bivens, et al., 2008; Lowrance, 2011; Trachtman, 1999). A
New York Times article mentioned hoarding as a problem financial behavior identified by
psychologists in recent years (Kershaw, 2008), yet very little research specifically related
to HD as a money disorder has been conducted. The psychoanalytic notion of money as foul
and corrupt may explain why so little research has been devoted to money (Doyle, 1992;
Trachtman, 1999). The following section will identify some of the characteristics of money,
and the psychology of money from the early writings of Karl Marx, to the exploration of
money beliefs that can lead to present day money disorders.
Early Parallels. Early writings hint at the connection between psychology and
money going back to Karl Marx in 1867 (Marx, 2010), as cited by Lea and Webley (2006),
who believed that tradable economic commodities appear as “independent beings
endowed with life” through a process he identified as “commodity fetishism” (Lea &
Webley, 2006, p. 167). This seems to be a logical fit with how the hoarder views
possessions, not as practical items but as having human qualities, making it even more
difficult from which to part. It is not inconceivable for someone with HD to commoditize
money and view it as having human like qualities as well. There are impelling reasons for
the tendency to hoard, which are both psychological and economic (Somerville, 1933).
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Adaptive Behavior. The desire for money is related to the desire for the things it
can buy, but the two are logically distinct (Lea & Webley, 2006). The psychology of
possessions and how it leads to the psychology of money can be traced back for centuries.
Humans will use time and effort to acquire artifacts, such as newspapers, radios, and
television sets (Lea & Webley, 2006). From the beginning of modern psychology, hoarding
has been considered a human instinct (James, 1890) and represented as a strategy of self-
preservation (Bouissac, 2006). This behavior is not distinctly human. Animals, birds, and
insects hoard food and collect nonfood items for storage and courtship rituals (Sherry,
1985). This behavior is adaptive and has obvious value for contingencies and emergency
situations (Lea & Webley, 2006).
Slater (1980) considered a case that is specifically relevant to the hoarding of money
or miserliness. As Slater reported, hoarding money is distinct from the accumulation of
money for precautionary or investment purposes and has historically been a concern for
psychoanalysts. Research and clinical observations have offered some support to the
Freudian notion that miserliness and hoarding are components of OCD and are associated
with negative financial indicators and other disordered money behaviors (Frost et al.,
2002; Klontz & Britt, 2012b; Klontz et al., 2012). There seems to be ample anecdotal
support to argue for a deeper exploration of the correlations and distinctions between the
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hoarding of money and the hoarding of possessions. This connection has been identified in
psychology research long ago, which makes it all the more peculiar that hoarding has not
been examined in the literature from a financial standpoint.
Money Beliefs. Hoarding behavior may be of no surprise since people have gotten
contradictory messaging about money throughout time. The Protestant Ethic associated
the hoarding of money and the attitude that time is money, as a way of promoting a strong
work ethic (Tang, 1992). The Protestant Ethic is a belief system that there is a world to
come where the rewards and punishments of the next life will be based on the effort and
industriousness exerted during the current life (Neustadt, 2011). The Protestant Ethic,
which encourages hard work, thrift, and the earning of money as a sign of God’s blessings,
also proscribes the enjoyment of money that was earned as a result of the hard work that
was exerted (Belk & Wallendorf, 1990). Judeo-Christianity extols the virtue of humanistic
sacrifice, while people are exposed to the individualistic, acquisitional nature of capitalism
in the economic system. Money is esteemed, yet demonized, and both sacred and profane at
the same time (Belk & Wallendorf, 1990). According to Karl Marx, “Money is not only an
object of the passion for riches; it is the object of that passion” (Somerville, 1933, p. 335).
The Christian Bible described the love of money as being the root of everything evil and
warns that it is difficult for a rich man to enter heaven. There is some empirical evidence to
support this seemingly contradictory simultaneous vilification and worship of money in
hoarders. Klontz and Britt (2012b) found that hoarding symptoms are associated with
money worship scripts, which is the belief that money is the key to happiness and the
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solution to life’s problems, which in turn, is associated with money avoidance scripts (i.e.,
the belief that money is bad and people of wealth are greedy and corrupt).
When money is viewed as having only quantitative meaning it fails to identify the
more emotional, qualitative meanings of money (Belk & Wallendorf, 1990). In that case, it
does not provide an adequate account of the dominance of affect, norms, and values in our
dealing with money (Etzioni, 1988). The disciplines of law and economics view money as a
profane commodity (Belk & Wallendorf, 1990). However, if money is itself sometimes
considered sacred or having qualitative rather than quantitative meaning, its presence may
not necessarily corrupt the objects and people it touches (Belk & Wallendorf, 1990). In fact,
it may provide feelings of security and comfort similar to feelings experienced by someone
with HD. In some cases, the acquisition of money is hoped for because it is seen to promise
a ritual transformation of the individual (Belk & Wallendorf, 1990).
Money has at some point been revered, it has been feared, worshipped, and treated
with the highest respect. In sociological terms, money is considered sacred (Durkheim,
1915). “There may be some things that money cannot buy, but even their non-
purchasability is cast in doubt when life (e.g., children, surrogate motherhood), death (e.g.,
contract murder, abortion), ‘love’ (e.g., bridesprice, prostitution), prestige (e.g., publicity,
political campaigns), and even immortality (e.g., religious contributions, philanthropy) are
all bought and sold with money” (Belk & Wallendorf, 1990, p. 36). This passage is a perfect
example of how much power is placed on money and how hoarding it seems to make sense
in capturing its power.
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Doyle (1992) hypothesized that a driver is someone raised in a family with at least
one cold and distant parent who dealt with failure with more coldness and distance.
Drivers use achievement to avoid rejection and isolation. The driver uses money as a
talisman against the fear of being found incompetent, spends money on things that will
prove success (possessions), and engages in behaviors that emphasize independence and
enjoyment of the money process (acquiring), and the use of money as competition.
Hoarders are typically isolated and may view money and possessions as ways to prove
their competence and keep score, which prohibits them from spending and enjoying it.
The amiable likely grew up in a family with at least one extremely dependent parent
who was clingy, but displayed little true affection (Doyle, 1992). The amiable uses
relationships to counteract isolation, feels unworthy of affection, and suffers anxiety at the
thought of loss of relationships. They use money as a talisman against the fear of losing
affection, save money to hold on to people, and have low self-esteem. The amiable hoarder
may hold onto money to protect him or herself against anticipated future loss of affection,
love, or security.
The analytical personality type may be the most vulnerable to hoarding behaviors.
The analytical probably grew up in a fearful family that stressed tidiness and avoided
unpleasant things like bodily functions and misbehavior (Doyle, 1992). They learned to use
order to avoid isolation and have a fear of losing control. They use money as a talisman
against the loss of control, save money to avoid unarmed threats, engage in behaviors such
as bargain hunting, hoarding, indecisiveness, cautiousness, and have an unusual ability to
defer gratification (Doyle, 1992). In the extreme, the analytical displays indifference to
social relationships, restricted emotional experience, preference for solitary activities,
OCPD, unattainable standards, perfectionism, and exaggerate the risks of doing something
routine (Doyle, 1992). Hoarders amass money for fear of losing control, hold irrational
fears of not having enough, and exaggerate the risks of reasonable spending or investing as
a way of holding on to their money.
These personality types and their relation to money might help financial planners
and therapists understand a client’s money hoarding impulses. Hoarders may hoard money
for fear of not having enough based on the experience of poverty, living through a global or
local financial downturn, surviving a personal financial tragedy, or experiencing a non-
financially related traumatic experience. They may hoard money because they have
adopted the money scripts and financial habits of their caregivers. They may hoard money
to keep score against feelings of low self-worth. They may hoard money as a manifestation
of a genetic vulnerability. No matter how much money is accumulated the hoarder will
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think about the future uncertainties and the chance that it will be needed in the near term.
The hoarder may also be in debt even though he or she is holding low yielding assets or has
sufficient funds stuffed under the mattress or buried in the back yard with which to pay the
debt. This behavior manifests itself from a fear that they don’t have enough. Hoarders may
also feel strongly about their responsibility to future generations and may hoard cash to
leave a legacy to their heirs.
As Cromer et al. (2007) reported, hoarders are more likely to have experienced
traumatic life events, and as a result may exhibit greater hoarding severity. Studies have
also shown evidence of food hoarding among children in foster care because of
maltreatment, early attachment difficulties, or reliable access to food (Casey et al., 2012).
The hoarder may feel a responsibility to future generations, the items they possess,
and the environment, and while consumer culture identifies with spontaneity, the
hoarder’s behavior emphasizes the continuity between past and future times (Cherrier &
Ponner, 2010). The prevalence is greater in older individuals, and those with limited
household income, and these demographic characteristics should be considered in focusing
community interventions (Samuels et al., 2008). Hoarders feel a responsibility for future
generations, which will motivate them to underspend as they hoard money not for
themselves but for their descendents.
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1999). As a clinical psychologist, Lowrance (2011) wrote: “In light of the pervasiveness of
dysfunctional financial psychology in our culture, every practicing mental health
professional needs some basic level of knowledge to enable them to adequately tend to
money-related issues when working with clients” (p.18). Lowrance further insisted that the
mental health field must encourage mental health professionals to work with financial
therapeutic issues. Klontz and colleagues (2008) argued that: “While evidence exists to
support the notion that destructive financial behaviors are the manifestation of underlying
psychological disturbance, the field of psychology has done little to identify the problems as
a focus of treatment or to develop effective treatments aimed at improving financial health”
(p. 306). They went on to urge “therapists to consider the potential value of assessing for,
and targeting disordered financial beliefs and behaviors in their provision of holistic and
effective mental healthcare” (p. 306).
Research that links the world of finance and mental health is a step in the right
direction. Now that HD is listed as an Obsessive-Compulsive related-disorder in the DSM-
5, increased attention to populations that exhibit hoarding behaviors can occur.
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resulting money scripts, such as “there will never be enough,” hoarding behaviors, and
their impact on one’s financial health, relationships, and life satisfaction. While financial
planners may not be in a position to treat hoarding behavior, they are certainly in a
position to help increase clients’ awareness of the psychotherapeutic aspects of hoarding.
They can help expose clients to the anxiety of letting go of possessions or money through
recommendations to spend and/or give to charity. They can also help process the
experience with clients. In cases of HD, where financial hoarding behavior is having a
significant impact on a client’s quality of life, a referral to a psychotherapist would be
beneficial.
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