The acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value. Living spaces sufficiently

Transcription

1 Sandra McMillan

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3 The acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value. Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed. Significant distress or impairment in functioning caused by hoarding (Frost & Hartl,1996, p. 341)

4 A: A persistent difficulty discarding possessions, regardless of their actual value B:This difficulty is due to a perceived need to save the items and to distress associated with discarding them C: This difficulty results in the accumulation of possessions that congests and clutters active living areas and compromise their use E: The hoarding is not attributable to another medical condition F: the hoarding is not better explained by the symptoms of another mental disorder

5 Has a survival element to it which may explain its high prevalence Compulsive hoarding community prevalence rate of 4% - 4.6% (Samuels et al., 2008; Mueller, Mitchell, Crosby, Glaesmer, & de Zwaan, 2009). More frequent in men 2 x Onset in childhood/adolescence Less likely to be married 30% of people with OCD also meet criteria for compulsive hoarding, up to 80% have compulsive buying Can also co-occur with schizophrenia, organic mental disorders, eating disorders, brain injury, dementia, and impulse control disorders.

6 Family history of hoarding Family history of OCD Attentional deficits Trauma Parental psychopathology, physical discipline before age 16 Paranoid, schizotypal, avoidant and obsessivecompulsive personality traits Not related to material deprivation (possible links to parental material deprivation) Other illnesses e.g. dementia may be related to secondary brain damage, likelihood of change is low in these cases

7 Frost and Hartl (1996) proposed a cognitivebehavioural model of hoarding. They viewed hoarding as a multi-faceted problem involving: problems in forming emotional attachments behavioural avoidance erroneous beliefs about the nature of possessions information processing deficits

8 A phenomenon of strong emotional attachment to possessions where the possessions are viewed as an extension of themselves or other people Higher levels of hoarding were significantly associated with a reliance on possessions for comfort and a greater emotional attachment to possessions (Frost, Hartl, Christian, & Williams, 1995). Possessions can be kept, controlled, protected a certainty that does not exist with attachment to other people Possessions are uncritical, non-judgmental source of positive feeling v self criticism for clutter The cluttered home acts as a means of avoiding interactions with others

9 Rather than discard items that they feel attached to, and feel the resulting anxiety and sadness, they will delay making a decision and retain the item. This indecisiveness has been linked to perfectionism, where they avoided making the wrong decision. A process of churning occurs where items are moved from room to room but not discarded. Avoidance can include staying out of certain rooms, not opening cupboards, not discussing the hoarding with others

10 Beliefs associated with positive feelings: Sentimental (emotional) - possessions associated with attachment to positive memories or associations Instrumental (useful) possessions valuable in their usefulness Intrinsic (aesthetic) possessions seen as attractive/decorative Beliefs associated with avoidance of negative feelings Need to maintain control of possessions I need to keep hold of these items Responsibility for possessions I have to keep the possessions for others/i can t waste them Beliefs about memory I will forget something important without this possession to remind me Perfectionism I do not want to make a mistake and discard something important/necessary

11 Problems with organising (information and possessions), making decisions and possible problems with memory (Frost, Steketee, & Greene, 2003, p.324). Individuals have deficits in the ability to arrange and categorize information seen by the disorganised clutter and difficulty finding desired possessions. Under-inclusiveness - each possession is seen as unique and belonging in a category by itself, difficulty in grouping possessions due to the specialness of each item (Grisham, Norberg, Williams, Certoma, & Kadib, 2010). My research identified deficits in forming effective categorisation strategies, inadequate feedback responses, problems in concept formation, and impulsivity (McMillan, Rees & Pestell, 2013).

12 Savings Inventory-Revised clutter, difficulty discarding, acquisition Savings Cognition Inventory - emotional attachment, concerns about memory, control over possessions, and responsibility toward possessions Clutter Image Rating Home assessment - % clutter, photos (great for reassessment with patient) Depression/OCD Risk assessment

13 Initial assessment and feedback on reasons for hoarding behaviours Therapeutic discussion Acknowledge and validate reasons for keeping possessions Explore positive and negative impacts of hoarding Identify goals of person and discuss compatibility to current behaviours/living situation Identifying and challenging underlying erroneous beliefs Excessive acquisition Beliefs related to positive feelings and avoiding negative feelings

14 Exposure and response prevention Person identifies room/items to begin with, using hierarchy of difficulty (start with easiest) Identify rules for sorting small number of categories Only individual sorts their possessions thinking aloud Begin in one area Person discards own items Homework more sorting, keeping sorted area clear Organisational skills Storing, categorising, problem solving Mood management Developing other coping skills, Developing positive engagement with others Developing more appropriate engagement with pleasurable activity

15 Frost, R. O., & Hartl, T. L. (1996). A cognitive-behavioural model of compulsive hoarding. Behaviour Research & Therapy, 34, Frost, R. O., Hartl, T. L., Christian, R., & Williams, N. (1995). The value of possessions in compulsive hoarding: Patterns of use and attachment. Behaviour Research & Therapy, 33, Frost, R. O., Steketee, G., & Greene, K. A. I. (2003). Cognitive and behavioural treatment of compulsive hoarding. Brief Treatment & Crisis Intervention, 3, Grisham, J. R., Norberg, M. M., Williams, A. D., Certoma, A. D., & Kadib, R. (2010). Categorization and cognitive deficits in compulsive hoarding. Behaviour Research & Therapy, 48, McMillan, Rees & Pestell (2013). An Investigation of Executive Functioning, Attention and Working Memory in Compulsive Hoarding Behavioural and Cognitive Psychotherapy, 41, 5, Mueller, A., Mitchell, J. E., Crosby, R. D., Glaesmer, H., & de Zwaan, M. (2009). The prevalence of compulsive hoarding and its association with compulsive buying in a German population-based sample. Behaviour Research & Therapy, 47, Samuels, J., Bienvenu, O. J., Grados, M. A., Cullen, B. A. M., Riddle, M. A., Liang, K. Y., et al. (2008). Prevalence and correlates of hoarding behaviour in a communitybased sample. Behaviour Research & Therapy, 46,