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Patients with hoarding disorder (HD) experience difficulties discarding that result in excess clutter in the home. HD causes distress and impairment for patients and family members and represents a significant public health burden, highlighting a need for treatment research. In this chapter, we provide an overview of cognitive behavioral therapy (CBT) for hoarding, a promising avenue to treat core HD features in a collaborative and time-limited manner. We begin by discussing etiological factors for HD, including familial features, information-processing deficits, and core beliefs about the self and possessions. Next, we describe HD assessment, including standardized measures and case conceptualization considerations. After discussing the research evidence for individual and group CBT for HD, we provide an overview of treatment components, including psychoeducation, motivational enhancement, skills training, behavioral exposures, cognitive techniques, and relapse prevention. Barriers to treatment are also considered. We end with a case vignette illustrating the successful application of CBT for HD in an individual outpatient setting.
Gene expression studies in psychiatric disorders have proven to be a useful partner to classic genetics approaches, and combined approaches such as convergent functional genomics (CFG) may provide shortcuts to the discovery of genes and overall understanding of the neurobiology involved. The combined approach has been applied with some success to bipolar disorder, alcoholism, and schizophrenia. For complete understanding of the illness, the analyses then need to be pursued at a biological pathway and mechanistic level, integrating environmental effects as key modulators of gene expression and phenotype manifestation. Progress in quantitative profiling of psychiatric phenotypes, and borrowing of concepts and paradigms from other medical fields that are farther along, such as cancer genetics and genomics, are exciting areas of advance for the near future. A (r)evolution in medical nosology in general, and psychiatric nosology in particular, will occur as a result of such studies.