Hoarding Disorder

Tovani does not treat this with ketamine

This page is here for honesty and completeness. Ketamine is not an appropriate treatment for Hoarding Disorder, and in some cases it is contraindicated. Below is what the condition is and the treatments that genuinely help — and where, if at all, ketamine has any narrow role (usually only for a separate co-occurring depression). If you’re in crisis, call or text 988.

The short version

●Hoarding disorder is persistent difficulty parting with possessions because of a perceived need to save them and distress at discarding, leading to clutter that makes living spaces hard to use.
●It is now its own diagnosis (separate from OCD), and tends to be chronic and to worsen with age if untreated.
●It often comes with strong emotional attachment to items, beliefs about responsibility or waste, and difficulties with attention and decision-making.
●The most effective treatment is a specialized form of CBT for hoarding; standard OCD treatments work less well.¹ ²
●Medications have a limited role and mainly target co-occurring depression or anxiety.
●Ketamine is not a treatment for hoarding disorder; this page is here for completeness and to point toward the care that helps.

Clinical definition

Hoarding disorder is defined by persistent difficulty discarding or parting with possessions regardless of actual value, driven by a perceived need to save items and distress associated with discarding them. The result is accumulation that congests and clutters active living areas and substantially compromises their intended use; if spaces are clear, it is only because of others' intervention. It causes clinically significant distress or impairment (including unsafe conditions) and may be accompanied by excessive acquisition. Once considered a subtype of OCD, it is now a distinct diagnosis with characteristic information-processing features (attention, categorization, decision-making) and strong emotional attachments to possessions.

How it differs from related conditions

vs. OCD

Hoarding was once classified under OCD, but it differs in mechanism and responds less well to standard OCD treatments; the saving is not typically driven by classic obsessions/compulsions.

vs. Body dysmorphic disorder

Another obsessive-compulsive-spectrum condition that hoarding is grouped near but is distinct from.

vs. Major depressive disorder

Depression commonly co-occurs and can worsen motivation and clutter; treating it supports hoarding treatment.

First-line treatments

Hoarding-specific CBT

The best-supported treatment — motivational work, skills for sorting/decision-making, cognitive work on saving beliefs, and graded discarding practice.

Skills and home-based practice

Building organizing and decision-making skills, ideally with in-home or practice-based components.

Treating co-occurring conditions

Addressing depression, anxiety, or ADHD that interfere with progress.

Harm reduction + support

For severe cases, improving safety and function even when full clearing is not immediately feasible.

When standard treatments fail

Because hoarding can be hard to treat and motivation often fluctuates, persistent cases benefit from longer or repeated courses of hoarding-specific CBT, group formats, family or community involvement, and attention to co-occurring conditions. Harm-reduction and safety-focused approaches help severe cases. Ketamine has no established role in this pathway.

Where ketamine fits

Ketamine is not a treatment for hoarding disorder. The evidence-based approach is a specialized form of CBT developed specifically for hoarding — addressing the saving beliefs, emotional attachments, and decision-making and organizing difficulties that drive it — since standard OCD treatments are less effective.¹ ² There is no evidence base for ketamine in hoarding disorder, and it does not address the disorder's mechanisms. Where a co-occurring depression or anxiety disorder is present, that can be treated on its own terms — which may indirectly support engagement in hoarding treatment — but the hoarding itself calls for hoarding-specific CBT.

Where this fits with Tovani

Tovani's focus is mood, anxiety, PTSD, and certain pain conditions — not hoarding disorder, which is best treated with hoarding-specific CBT delivered by a clinician experienced in it. If depression or anxiety co-occur with your hoarding (they often do), we may be able to help with those, which can make engaging in hoarding treatment easier. But the hoarding itself needs its own specialized therapy, and this page is here to point you toward it.

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Frequently asked

Can ketamine help hoarding disorder?

No — there is no evidence for it, and it does not address what drives hoarding. The most effective treatment is a specialized form of CBT for hoarding. Ketamine could only be relevant for a separate co-occurring depression, not for the hoarding itself.

Isn't hoarding just a type of OCD?

It used to be classified that way, but it is now its own diagnosis. It differs in mechanism — the saving is driven by attachment and beliefs about possessions rather than classic obsessions and compulsions — and it responds less well to standard OCD treatments, which is why hoarding-specific CBT was developed.

What actually treats hoarding?

Hoarding-specific CBT: building motivation, teaching sorting and decision-making skills, gently challenging beliefs about saving, and practicing discarding — often with home-based work. It takes time, and treating co-occurring depression or anxiety helps.

Does Tovani treat hoarding disorder?

No — it needs hoarding-specific CBT from a clinician experienced in it. We can potentially help with co-occurring depression or anxiety, which may make hoarding treatment easier to engage in, but the hoarding itself needs its own specialized therapy.

References

Tolin DF et al. 2015, Depression & Anxiety — Meta-analysis of cognitive behavioral therapy for hoarding disorder. (PMID 25639467)
Frost RO & Steketee G 2012, Annual Review of Clinical Psychology — Diagnosis and assessment of hoarding disorder. (PMID 22035242)

Last reviewed by Dr. Ben Soffer, DO on June 2, 2026. This page is educational and not a substitute for clinical evaluation. A physician determines whether ketamine therapy is appropriate for your specific situation.