Existing psychological and pharmacological interventions for obsessive-compulsive disorder have not been particularly successful for compulsive hoarding, perhaps due in part to poor insight on the part of sufferers. Individuals with compulsive hoarding problems commonly display lack of awareness of the severity of their behavior, sometimes denying that they have a problem and often resisting intervention attempts and failing to follow through with therapeutic assignments. Using an internet-based survey, family and friends of individuals with reported hoarding problems (family/friend informants, N = 584) provided ratings of the hoarder’s level of insight. They also made several ratings of the severity of the person’s hoarding behavior, then rated the same items again with regard to how they thought the hoarder would respond to the items. Family/friend informants described the hoarder on average as having fair to poor insight. More than half were described as having “poor insight” or “lacks insight/delusional,” substantially worse insight than found in samples of OCD clinic patients using the same measure. Family/friend informants’ ratings of hoarding severity were significantly greater than were their estimates of the hoarder’s ratings. Hoarders described as showing less distress about the hoarding were described as showing poorer insight. These results suggest that compulsive hoarding is characterized by poor insight into the severity of the problem. Treatment development might need to emphasize strategies to bolster awareness, insight, and motivation.
