Abstract
This article examines the complex, multilevel challenges involved in treating hoarding disorder and argues that effective care requires more than a single therapeutic modality. The authors propose a hierarchically organized yet dynamically traversed framework that integrates community-based, harm-reduction approaches with mechanism-focused psychotherapeutic interventions. Foundational levels of care prioritize environmental risk management, housing stability, and safety under conditions of limited insight and motivation, whereas higher levels target cognitive, emotional, and behavioral mechanisms through specialized treatments such as CBT. The article synthesizes patient-, family-, provider-, and system-level barriers to care and outlines future directions for advancing etiologic research, treatment innovation, and coordinated community implementation.