November 17 | 7:15 PM – 8:30 PM ET | Virtual

Hoarding: Chasing a New Diagnosis Through Brain, Body, and Behavior

David F. Tolin, Ph.D., ABPP, Director, Anxiety Disorders Center, The Institute of Living
Adjunct Professor of Psychiatry, Yale University School of Medicine
2021 President, Association for Behavioral and Cognitive Therapies

David TolinDr. Tolin is the Founder and Director of the Anxiety Disorders Center at the Institute of Living, and an Adjunct Professor of Psychiatry at Yale University School of Medicine.  He is the President of the Association for Behavioral and Cognitive Therapies and the Past-President of the Clinical Psychology Division of the American Psychological Association. His research is funded by the National Institutes of Health. He received the Award for Lifetime Contribution to Psychology from the Connecticut Psychological Association. Dr. Tolin is the author of over 200 scientific journal articles, as well as several books including Doing CBT: A Comprehensive Guide to Working with Behaviors, Thoughts, and Emotions, and Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding. Dr. Tolin has been featured on the reality TV series Hoarders and The OCD Project and has been a recurrent guest on The Oprah Winfrey Show and The Dr. Oz Show.

Participants earn 1 continuing education credit.

Category: Obsessive Compulsive and Related Disorders
Keywords: Hoarding, Psychophysiology, Neuroscience

All levels of familiarity

Hoarding disorder (HD) is a relatively new diagnosis in DSM-5. Characterized by excessive clutter and difficulty discarding objects, this condition is both common and potentially debilitating. Cognitive-behavioral therapy has been demonstrated to be efficacious, but most patients remain clinically symptomatic after treatment. I suggest that current CBT faces an “efficacy ceiling” due to our currently fragmented understanding of the disorder. I will discuss a body of research aimed at increasing our understanding of central and peripheral nervous system correlates of HD and will describe how those correlates are reflected in behavior. We will also examine current research on neural moderators and mediators of CBT treatment. The ultimate aim of this research is to develop a working model of HD that will inform specific, targeted intervention efforts. To this end, we will review novel interventions that might more specifically target dysfunctional brain mechanisms and provide greater symptom relief.


1.    Review of HD symptoms and prevalence

2.    Efficacy and limitations of CBT for HD

3.    Understanding poor insight through blunted responding

4.    Understanding decision-making deficits through central and peripheral hyperactivation

5.    Discussion of novel interventions targeting biological dysfunction

At the end of this session, the learner will be able to:

  • Review the efficacy and limitations of CBT for HD.
  • Discuss how HD is associated with abnormalities of peripheral physiology.
  • Describe the neural correlates of HD and its treatment.

Long-Term Goal

  • Discuss an emerging biopsychosocial model of HD.

Recommended Readings:

Levy, H. C., Nett, A., & Tolin, D. F. (2019). Discarding personal possessions increases psychophysiological activation in patients with hoarding disorder. Psychiatry Research, 272, 499-506. doi: 10.1016/j.psychres.2018.12.163

Stevens, M. C., Levy, H. C., Hallion, L. S., Wootton, B. M., & Tolin, D. F. (2020). Functional neuroimaging test of an emerging neurobiological model of hoarding disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 5, 68-75. doi: 10.1016/j.bpsc.2019.08.010

Tolin, D. F., Wootton, B. M., Levy, H. C., Hallion, L. S., Worden, B. L., Diefenbach, G. J., . . . Stevens, M. C. (2019). Efficacy and mediators of a group cognitive-behavioral therapy for hoarding disorder: A randomized trial. Journal of Consulting and Clinical Psychology, 87(7), 590-602. doi: 10.1037/ccp0000405

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