9/10/2018. Hoarding Digging to the Bottom of the Problem. Hoarding Is Not A Messy Desk. Marilyn A Halpern MSW

Size: px

Start display at page:

Download "9/10/2018. Hoarding Digging to the Bottom of the Problem. Hoarding Is Not A Messy Desk. Marilyn A Halpern MSW"

June Joseph
5 years ago
Views:

1 Hoarding Digging to the Bottom of the Problem Marilyn A Halpern MSW Professional Guardian Client/Patient Advocate Medical Social Worker End-of-Life Doula Marilyn Halpern, LSW Hoarding Is Not A Messy Desk 1

History of Hoarding DSM 5 Criteria for Hoarding Disorder - 2013 A. Persistent difficulty discarding or parting with possessions, regardless of their actual value. B.

2 History of Hoarding DSM 5 Criteria for Hoarding Disorder A. Persistent difficulty discarding or parting with possessions, regardless of their actual value. B. This difficulty is due to the perceived need to save the items and to distress associated with associated with discarding them. DSM 5 Criteria C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g. family members, cleaners, authorities) 2

3 DSM 5 Criteria D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). The DSM-V also calls for the clinician to specify whether the individual is also experiencing excessive acquisition (e.g., do they acquire items that they don t need and for which they don t have space in their home?) and to specify the person s level of insight (good, fair, poor, or absent/delusional). Predisposition of a Hoarder History Vulnerability Cognitive deficits Beliefs about possessions Emotions Reinforcements 3

4 Saving & Accumulating (Excess) Acquiring Removal Organizing/Sorting (Insight & Executive Functioning) Halpern 2018 Acquiring Dollar Store Home Shopping Thrift stores Tree lawns Free samples Senior fairs (pens, clips, sanitizers) Trash Emotional $hopping Positive Emotions: Pleasure Excitement Pride Joy Fondness Satisfaction Negative Emotions: Grief/loss Anxiety Sadness Guilt Anger Frustration 4

wasteful I may need it I can fix this Someone will value it This is beautiful

5 Managing Possessions Possessions Hoarding Clutter Collecting Minimalist low Organization high Halpern 2018 Reasons for Saving Throwing things away is wasteful I may need it I can fix this Someone will value it This is beautiful These are my memories I have to see it or I will lose it These items are my identity 5

Depression Social isolation Health limitations

6 An Extension of Self HOARDING Executive Functioning Trauma Procrastination Disorientation Lack of Insight Perfectionism Churning Vulnerabilities Family History Losses Depression Social isolation Health limitations Acquiring inherited possessions Downsizing A lifetime to collect items 6

medical treatment Complex family relationships

7 Profile for Elders Problem solving Executive functioning Memory Decision-making Special Considerations Diminished health and wellness Chronic medical conditions Lack of access to medical treatment Complex family relationships Limited/fixed income Victimization Low rate of overall happiness 7

Co-Morbidity 60% Major Depression 30% Social Phobia 25% Anxiety Disorder Dementia Post Traumatic Stress Disorder (PSTD) Prolonged Grief Disorder Age at onset and clinical

hoarding are socially isolated and live alone. Int J Geriatr Psychiatry. 2010 Feb; 25(2): 142 149.

8 Co-Morbidity 60% Major Depression 30% Social Phobia 25% Anxiety Disorder Dementia Post Traumatic Stress Disorder (PSTD) Prolonged Grief Disorder Age at onset and clinical features of late life compulsive hoarding Onset childhood / adolescence Hoarding increases with each decade Generally people do not receive treatment Older adults with hoarding are socially isolated and live alone. Int J Geriatr Psychiatry Feb; 25(2): Onset Onset can start in childhood or early adolescence Severity increases over time (30s, 50s) Progressive and Chronic Negative life event (death, divorce) Psychiatric or Physical illness Ayers, et al. 2009; Grisham et al. 2006; Samuels et al

9 Collected Items Paper Newspaper/Magazines Clothing Food Books Trash Animals (rare) Alcohol bottles Cat hair Kim et al

use their bathtub 20% could not use the bathroom sink 10% could not use

10 The Impacts of Hoarding Hoarding Disorder in Older Adulthood 45% could not use their refrigerators 42% could not use the kitchen sink 42% could not use their bathtub 20% could not use the bathroom sink 10% could not use the toilet Am J Geriatr Psychiatry - January, 2014 Problems and Safety Issues 10

General Risks of Hoarding Fire Blocked egress Food

bed bugs) Poor/inadequate diet Hygiene issues

Problems with medication Poor/inadequate diet

11 General Risks of Hoarding Fire Blocked egress Food poisoning/contamination Infestations (rats, fleas, bed bugs) Poor/inadequate diet Hygiene issues Fines/evictions Geriatric Risks Chronic illness Problems with medication Poor/inadequate diet Increased fall risk ADL problematic Social isolation Eviction Family conflicts 11

image rating Bedroom, Livingroom, Kitchen (Tolin et al.

12 Assessment Saving inventory Revised (widely used) (Frost, Steketee & Grisham, 2014) Hoarding rating scale Clutter image rating Bedroom, Livingroom, Kitchen (Tolin et al. 2010) (Frost, et al. 2006) Saving Inventory Revised (2014) 12

13 Hoarding Rating Scale (Tolin et al., 2008) 13

possessions more accessible Improve decision making skills Improve family relations

14 Treatment Goals Improve the person s quality of life Improve functionality of target areas Create living space and free use of space Improve organizational skills Make possessions more accessible Improve decision making skills Improve family relations Reduce acquiring through substituting alternative satisfying behaviors Learn problem solving skills 14

Treatment Rules Touch nothing without permission Person makes all decisions about possessions Treatment should be systematic following a plan but leaving room for

modeling Teach skills Homework and compliance Get organized Use calendar Make a To Do list Work on problems Skills training Good enough Tolerate distress of discarding

15 Treatment Rules Touch nothing without permission Person makes all decisions about possessions Treatment should be systematic following a plan but leaving room for flexibility Person must think aloud while OHIO principle: (Only Handle It Once) Keep Discard Donate Display (sorting) Sorting criteria What Helps - Trust Emphasis on modeling Teach skills Homework and compliance Get organized Use calendar Make a To Do list Work on problems Skills training Good enough Tolerate distress of discarding Treatment Building trust Home Visits Important Education Organization Decision-making/Executive functioning Exposure to non-acquiring and discarding Cognitive Behavior Therapy 15

Cleaning Up The person must be involved in the decision-making

anxiety/distress sense of loss Clearing out is not always the

Personal Goals Encouraging incremental efforts Talk through the

16 Cleaning Up The person must be involved in the decision-making Hoarders are reluctant to part with anything Can cause anxiety/distress sense of loss Clearing out is not always the best approach Once cleaned recidivism is high Supporting Personal Goals Encouraging incremental efforts Talk through the process Articulate ambivalence By expressing empathy Rolling with resistance 16

is only a symptom of the problem Others are usually more aware of/bothered by the clutter than the

17 Case Studies Case 1 - Betty Case 2 - John Case 3 - Lou Keep in Mind A mental health disorder not a decision Not a moral issue; Not caused by laziness, lack of standards, lack of responsibility Clutter is only a symptom of the problem Others are usually more aware of/bothered by the clutter than the individual 92% of individuals have 1 or more mental health issues (depression, anxiety, OCD, social phobias) 17

Resources Boston s Center for Hoarding Intervention https://www.metrohousingboston.org/what-we-do/hoarding-intervention/ Children of Hoarders http://childrenofhoarders.

18 Resources Boston s Center for Hoarding Intervention Children of Hoarders Hoarding On-line Support Group (Free and National) Institute for Challenging Disorganization International OCD Foundation State and City Hoarding Task Force San Diego San Diego Hoarding in Older Adults Study mhalpern@securedalliance.org Marilyn Halpern, LSW 18

Hoarding Behavior in Elders

Hoarding Behavior in Elders Presented by: Emily B. Saltz, LICSW Elder Resources www.eldres.com NAPGCM Webinar January 11, 2012 Definition of Hoarding* 1) The acquisition of, and failure to discard a large