Comparison of medication treatment versus cognitive behavior therapy of hoarding behaviors in obsessive-compulsive disorder

Abstract

Obsessive-compulsive disorder (OCD) can be difficult to treat due to patient non-compliance and treatment efficacy. This anxiety disorder presents in behaviors such as checking, washing, repeating/counting, ordering/symmetry, harming obsessions, religious/sexual obsessions, obsessional slowness, pure obsessions and hoarding. Of these behaviors, hoarding is the most difficult to treat. Hoarding is defined as the inability to throw away items that are useless. Objective: To determine the best possible therapy for individuals with hoarding behaviors comparing the use of psychotropic medications, cognitive behavioral therapy (CBT) or both. Method: An extensive evidence-based medicine (EBM) literature review was conducted using Medline, PubMed, and FirstSearch databases. Included articles were published in English between 1995 and the present. Studies were then ranked from Levels 1 through 4 based on the quality of the study design. Results: Of the 19 studies that met the inclusion criteria in the EBM analysis, five were used primarily as background information, one supported the use of medication along with CBT, four supported the use of CBT alone, three did not support the use of medications, one did not support the use of CBT, one did not support either the use of medications or CBT, and four were inconclusive. Conclusion: This analysis reveals a Level C recommendation (inadequate number of Level 1, 2 or 3 studies) for use of medications with CBT, medication treatment alone or CBT alone.