HOARDING 101. Lisa O Neill, MPH Director of Education and Elder Abuse Resources Arizona Center on Aging The University of Arizona

Transcription

1 HOARDING 101 Lisa O Neill, MPH Director of Education and Elder Abuse Resources Arizona Center on Aging The University of Arizona Learning Objectives: Discuss Hoarding Disorder definition, assessments and treatment options. Describe different types of animal hoarding behaviors. Explain why an interprofessional and interagency approach to hoarding is needed and how a Hoarding Taskforce can help a community. DISCLOSURE OF COMMERCIAL SUPPORT Lisa O Neill, MPH does not have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and /or provider(s) of commercial services discussed in this presentation. 1

2 Hoarding 101 Lisa O Neill, MPH University of Arizona Center on Aging Definition The accumulation of and failure to discard a large number of possessions that would be deemed of limited or no value to others; significant distress, and/or indecision associated with discarding Excessive clutter that prevents normal activities for which rooms were designed Significant distress or impairment in functioning as a result of this accumulation 2 Squalor Filth or degradation from neglect Hoarding (volume of stuff) can occur without squalor (filth) Home Environment Index assessment tool for squalor only (Rasmussen, et al., 2009) 3 2

3 Hoarding Disorder DSM 4: Previously listed as one of eight criteria for Obsessive Compulsive Disorder (OCD) DSM 5: a stand alone diagnosis; 6 criteria must be met History Formal studies began early 1990 s our knowledge is still evolving 4 Prevalence Estimated approx 5% of US population = 16 million Prevalence greater in men, but women seek treatment more often average age in treatment = 50 Average age onset = Family history is common Occurs in all cultures, income and education levels; martial status: single, high divorce rate, tend to live alone 5 Collyer Brothers (1947) 3

4 How Acquired by: Compulsive buying Compulsive acquiring of free things Passive acquisition 7 Saving: Sentimental Instrumental Why 8 What happens Disorganization: Fear of putting things out of sight Random piles will include items of mixed importance 9 4

5 Health and Safety Issues Increased risk of falls, infections, respiratory problems Limited ability to move around in or access parts of the home High risk of fire w/ decreased ability to escape Co-occurring mental illness: Major Depressive Disorder; Social Phobias; Generalized Anxiety Disorder; Kleptomania 10 Health and Safety Issues Hoarders typically do not have people in their home due to shame, embarrassment, or fear of being found out Hoarding situations will continue to deteriorate until the health and safety of the individual and community are at risk 11 Emotions Suffer severe emotional distress when attempting to discard items Lack an awareness of the severity of their behavior; may get angry and defensive when asked about their possessions May feel overwhelmed by the burden of their possessions 12 5

6 Assessment Tools Several published assessment tools Structured Interview for Hoarding Disorder (SIHD) Hoarding Rating Scale Clutter Image Rating 13 Structured Interview for Hoarding Disorder (SIHD) The questions contained in this interview relate to each of the six criteria listed in the DSM 5 needed to evaluate the presence of hoarding. For a diagnosis of hoarding disorder all six criteria must be endorsed. If any of the criteria are not met, the diagnosis can be ruled out. 14 Hoarding Rating Scale Likert scale 0 (no problem) 8 (extreme, daily); 4 or higher is considered a significant response 15 6

7 Clutter Image Rating Scale: Kitchen OCD Foundation: 9 photos (Kitchen, Living Room, Bedroom) to measure degree of clutter Clutter Image Rating Scale: Kitchen 7

8 Treatment Options Remember that Hoarding Disorder is a mental health issue Counseling MUST occur Forced clean ups not a good idea Medication has little effect on hoarding behaviors 19 Treatment Options Cognitive Behavioral Therapy (CBT) CBT focuses upon creating a different relationship with one s possessions; work focuses on organizing, sorting, discarding, decision-making, problem solving and learning control the urge to acquire new possessions 20 Treatment Options Cognitive Behavioral Therapy paired with Exposure and Response Prevention (ERP) Therapy CBT can help manage illness; high risk of relapse 21 8

9 Treatment Options Some counselors are combining Loss and Grief Therapy with CBT no studies on outcomes yet 22 Communication Be respectful nonjudgmental in words and behavior Use their language Value their belongings Initially, use harm reduction approach to ensure safety Do not impose your feelings you will feel better if Praise, frequently and genuinely celebrate the little wins; acknowledge how hard this is for them 23 Communication things to know Mental illness: motivation and insight can fluctuate Combine verbal and written communication Use visual cues Non-compliance 24 9

10 Reasons for Resistance Poor insight Afraid we will throw their stuff away forced clean outs Different solutions in mind They have tried before, can t do it exhausted We don t understand how valuable their stuff is 25 Possible Solutions to Resistance Help them gain insight Assign small achievable tasks / past achievements Remove any obstacles Praise success 26 Animal Hoarding Accumulation of more animals than a typical pet owner; not a breeder Failure to provide adequate facilities for the animals; overcrowded or unsanitary living conditions, inadequate veterinary care, poor nutrition, animals unhealthy Reluctance to place animals in others care 27 10

11 Overwhelmed Hoarder: Animal Hoarder Types Initially can provide adequate care Understand a problem has developed but may minimize it Passively acquires animals May accept intervention from authorities 28 Rescue Hoarder: Animal Hoarder Types Strong compulsion to rescue animals from possible death or euthanasia Actively acquire animals May work within a network of animal welfare people Will avoid authorities 29 Animal Hoarder Types Exploiter Hoarder: Indifferent to harm caused to animals / no remorse Actively acquires animals Deny problem and reject authority 30 11

12 Similarities with object hoarding Large volume of items / disorganization Normal movement through the home is inhibited / rooms can t be used as intended Distress accompanies attempts to remove animals often refuse to give up animals who are sick, dying or already dead Low insight lack of awareness of severity of behavior Studies are showing that a large percentage of object hoarders also hoard animals 31 Differences with object hoarding Squalor only occurs in a minority of object hoarded homes nearly 100% of animal hoarded homes have urine/feces in living areas and sometimes dead animals Most object hoarders, hoard a variety of objects paper, clothes, containers Animal hoarders typically concentrate on one species More prevalent in women (studies are lacking) Hypothesized that traumatic event may trigger animal hoarding (studies are lacking) 32 Treatment Options Virtually no research on animal hoarding treatment Counselors focus on building a trusting relationship; reducing social isolation; themes related to grief, loss and attachment DSM 5 Hoarding Disorder Not enough etiological and prevalence data for full inclusion. Animal hoarding is listed in the Appendix

13 Lives in social isolation Common Red Flags Distinctive foul odor on person; clothing or around home Home in need of repairs History of veterinary shopping Records of complaints/tickets 34 Animal Hoarding / Cruelty to Animals is Against the law ARS REPORT IT Call: Police TPD Animal Cruelty Taskforce: Humane Society: Pima Animal Care Center: Case Review: Animal Hoarding 36 13

14 Interdisciplinary Approach to Hoarding Disorder Resources need to work together Depending on the mission and goals of the taskforce, some services that can be provided are: public education agency/community resource information staff trainings family support Southern Arizona Hoarding Taskforce First meeting February 2012 Founded by Lisa O Neill (University of Arizona), Rae Vermeal (APS), and Doug Clark (Arizona Assistant Attorney General) Our Mission: to provide educational information and available community resources on hoarding issues and related topics for working professionals in Southern Arizona 38 Neighbors What can I do? 39 14

15 40 Neighbors. What to do **If you are concerned about the welfare of anyone living in the home you can call: Tucson Police, ask for a welfare check (520) Adult Protective Services 1(877) Child Protective Services 1(888) Regarding the property: call code enforcement they can do an exterior inspection and if they feel the need they can involve the police or they can seek an administrative warrant to inspect the inside of the home 41 Concerns about a relative who lives out of state If you have a relative/friend who lives out of state and you are worried about their hoarding behavior 1)Safety first make sure they are safe and taking care of themselves 2)See if their region has a Hoarding Taskforce 3)Contact their local Area Agency on Aging they should have a list of resources for that community 4)Research Web for hoarder support groups and family support groups (i.e.: Children of Hoarders) 42 15

16 Hoarding References Bratiotis,C. Hoarding: A Community Approach to Prevention and Intervention. March 6, 2014 (lecture). Scottsdale, Arizona Bratiotis C., et al. The Hoarding Handbook: A Guide for Human Service Professionals. New York, NY: Oxford University Press., Frost, R. Patronek, G. & Rosenfield, E. (2011) Comparison of Object and Animal Hoarding. Depression and Anxiety. 28: Hoarding of Animals Research Consortium (HARC). International ODC Foundation. Tests for Hoarding. Mental Health Association of Orange County. International Exchange on Hoarding. Nordsletten, A.E., Fernández de la Cruz, L., Pertusa, A., Reichenberg, A., Hatch, S.L., & Mataix-Cols, D. (2013). The Structured Interview for Hoarding Disorder (SIHD): Development, usage and further validation. Journal of Obsessive Compulsive and Related Disorders, 2(3), Steketee G, et al. Compulsive hoarding and acquiring: Therapist guide. New York, NY: Oxford University Press., Steketee G. et al Symptoms and history of hoarding in older adults. Journal Obsessive-Compulsive and Related Disorders. 2007:1:1-7. Tolin DF, et al. Buried in treasure: Help for compulsive acquiring, saving, and hoarding. New York, NY: Oxford University Press Thank you Questions? 44 16