Hoarding Disorder: What s the Big Deal? For (PACA) Pennsylvania Association of County Administrators of Mental Health and Developmental Services

Transcription

1 Hoarding Disorder: What s the Big Deal? For (PACA) Pennsylvania Association of County Administrators of Mental Health and Developmental Services One Individual at a Time Presenter - Sharon D. White, MSS, LCSW Program Director, Older Adults Counseling Services Program Co-Chair, Delaware County Hoarding Task Force for Seniors

2 I ve always had trouble throwing things away. Magazines, newspapers, old clothes What if I need them one day? I don t want to risk throwing something out that might be valuable. The large piles of stuff in our house keep growing so it s difficult to move around and sit or eat together as a family.

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6 My husband is upset and embarrassed, and we get into horrible fights. I m scared when he threatens to leave me. My children won t invite friends over, and I feel guilty that the clutter makes them cry. But I get so anxious when I try to throw anything away. I don t know what s wrong with me, and I don t know what to do

7 Myths About Hoarding the person is simply lazy The person is unmotivated The person is gross Clean-outs or partial clean-outs will solve the problem A single professional alone can handle a hoarding situation

8 What is Hoarding Disorder? DSM-IV - hoarding is as a symptom of OCD (Obsessive Compulsive Disorder) and referring to it as 'compulsive hoarding'. But in recent years, researchers found that hoarding did not respond to OCD treatments. DSM-V (1) redefine hoarding as a discrete disorder and not just a symptom of other disorders such as OCD (Obsessive Compulsive Disorder) or connected with anxiety. and (2) giving it a new name 'hoarding disorder'.

9 What is Hoarding Disorder? A psychological disorder. Hoarding disorder is sometimes referred to as compulsive hoarding. The main feature is a person s irrational, persistent difficulty in discarding or parting with possessions regardless of their actual value. It is a long-standing difficulty, not just something related to a one-time circumstance (such as having difficulty discarding property from something you inherited from a loved one).

10 What is Hoarding Disorder? Two behaviors characterize hoarding: 1. acquiring too many possessions and difficulty discarding or getting rid of them when they are no longer useful or needed. 2. When these behaviors lead to enough clutter and disorganization to disrupt or threaten a person s health or safety, or they lead to significant distress, then hoarding becomes a disorder." Simply collecting or owning lots of things does not qualify as hoarding.

11 What is Hoarding Disorder? A major feature of hoarding is the large amount of disorganized clutter that creates chaos in the home. Such as: Rooms can no longer be used as they were intended Moving through the home is difficult Exits are often blocked

12 Statistics on Hoarding Approx 2-5 % of pop displays clinical hoarding 75% of people who hoard engage in excessive buying 50% excessively acquire free items 15% Acknowledge their behavior is irrational. 50% of people who hoard grew up with family members who hoard. Usually start during the teen years. The average age at onset of fist symptoms is /50 gender split

13 Types of Hoarding Structures Volcano Structure Important stuff on top of pile. Reverse Structure Actively working on it. Pathway Structure There is structure, trying to get to something there. Rolling Hill No structure, stuff every where. Squalor like.

14 Symptoms and Behavior Someone who hoards may exhibit the following: Inability to throw away possessions Severe anxiety when attempting to discard items Great difficulty categorizing or organizing possessions Indecision about what to keep or where to put things Distress, such as feeling overwhelmed or embarrassed by possessions Suspicion of other people touching items Obsessive thoughts & actions: fear of running out of or needing item in future; checking trash for accidentally discarded objects Functional impairments, including loss of living space, social isolation, relational discord, financial difficulties, health hazards

15 Hoarding vs Collecting is there a difference? Yes there is! Collectors have a sense of pride about their possessions. Those who hoard usually experience embarrassment about their possessions Collectors experience joy in displaying and talking about them. They usually keep their collection organized, feel satisfaction when adding to it, and budget their time and money. Those who hoard usually feel uncomfortable when others see them.

16 Hoarding vs Collecting is there a difference? Yes there is! Collectors usually keep their collection organized, feel satisfaction when adding to it, and budget their time and money. Those who hoard often have clutter at the expense of livable space. Collectors experience joy in displaying and talking about them. They Those who hoard often feel sad or ashamed after acquiring additional items, and they are often in debt.

17 Language & Interaction Hoarders People who hoard People with hoarding tendencies NO YES Yes Interaction: empathy, respect, intergrity

18 What do people who hoard save? It may seem people who hoard save only trash or things of no real value. But most people who hoard save almost everything. Many times purchases never opened. The most frequently saved items are: clothes newspapers Other commonly hoarded items include: Containers Books junk mail craft items

19 Causes and Risk Factors for Hoarding Not clear on what causes hoarding disorder risk factors identified by researchers below: More common among individuals with a family member who is also a hoarder. Brain injuries have also been found to cause secondary or acquired hoarding symptoms in some patients. Associated with distinct abnormalities of brain function and neuropsychological performance, distinct from those seen in people with OCD or other disorders. Other psych disorders, such as dep, anx disorders, attention deficit/hyperactivity, or alcohol use disorder. A stressful life event, such as the death of a loved one, can also trigger or worsen symptoms of hoarding.

20 Consequences of Hoarding Impaired social, occupational, and other important areas of functioning. Health and safety concerns, such as fire hazards, tripping hazards, and health code violations. Can also lead to family strain and conflicts, isolation and loneliness, unwillingness to have anyone else enter the home, and Inability to perform daily tasks such as cooking and bathing in the home.

21 Barriers to Helping People Who Hoard Stigma Lack of insight, awareness Shame Fear of being labeled or put away Psychological connection to items Lack of appropriate/helpful support

22 Help for People Who Hoard Professional organizers and clean-up companies are useful and necessary partners in the work, but they do not begin to be the totality of the intervention, and portraying that as the solution is to diminish the painful and difficult work needed to overcome a hoarding problem, Christiana Bratiotis, PhD, LCSW, a postdoctoral fellow and Compulsive Hoarding Research Project director at Boston University

23 Helping Someone Who Hoards What not to do: Premature Clean outs/ throw aways/give aways Shame Intimidate Threats What to do: Assess for and reduce safety issues realize it takes time and patience build positive relationships model acceptance coax into getting help/treatment Communicate the highest level of compassion

24 Treatment for People Who Hoard Treatment can help people who hoard decrease their saving, acquisition, & clutter, and live safer, more enjoyable lives. 2 MAIN TYPES OF TREATMENT: (1) cognitive-behavioral therapy (CBT) and (2) medication. With CBT, they learn to discard unnecessary things with less distress, diminishing their exaggerated perceived need/desire to save for these things. They also learn to improve skills such as organization, decision-making, and relaxation. 70% respond positively to CBT (helpforhoarding.net). Certain anti-depressant medications may be helpful and may produce more rapid improvement.

25 References Fugen Neziroglu, PhD, ABBP, ABPP. n.d. Hoarding: The Basics. The Anxiety & Depression Association of America (ADAA). March 15, Randy Frost, PhD,. n.d. Overview of Hoarding. International OCD Foundation (IOCDF) - Hoarding Center. October 2013.