Conceptualizing Hoarding Behavior Among Elderly Women: A Mixed-Methods Approach

Transcription

1 Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2006 Conceptualizing Hoarding Behavior Among Elderly Women: A Mixed-Methods Approach Susan Jan Murdock Virginia Commonwealth University Follow this and additional works at: Part of the Social Work Commons The Author Downloaded from This Dissertation is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact libcompass@vcu.edu.

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5 TABLE OF CONTENTS List of Tables... x List of Figures... xi Abstract..... XII PROBLEM STATEMENT... 1 Introduction... 1 Definition of Hoarding... 1 Hoarding as a Social Issue... 3 Prevalence... 4 Adult Protective Services Laws... 5 Task Forces on Hoarding... 7 Respoiise from the Courts... 8 Issues... 8 Hoarding as a Psychological Issue Assessment Treatment Intervention Strategies Relevance to Social Work Theoretical Framework Functionalism Social Order Roles Status Social Integration Deviance Anomie... 24

6 Values Socialization Individualism Social Functions Purposefulness of hoarding Gainfulness of hoarding Hoarding as motivated by internal drives Conclusion... 1 LITERATURE REVIEW Introduction History of Literature About Hoarding Case Studies Stories in the News Empirical Research Survey to Health Departments Nationwide Self-Neglect Study Survey Interview of Providers Study Comparing Hoarders and Non-Hoarders Self-Neglect Animal Hoarding Hoarding Among The Elderly Characteristics and Descriptions Prevalence Etiology Psychopathology Hoarding as a Self-Neglect Behavior Theory A means of social control A means of communication A means of reducing stress and frustration A way of resolving ~nner conflict... 60

7 A form of exploitation for personal gain Treatment and Intervention Belief Systems Deficits in Decision-Making Deficits in Categorization/Organization Difficulties with Memory Instinct Animals and Acquisition Accumulating and Keeping Non-Functional Objects Possessiveness Across Cultures Materialism Spirituality Attachment to Possessions Acquisition Possessiveness Discarding Meanings of Possessions Private Meanings of Possessions Public Meanings of Possessions Maintenance of Self-Identity Elderly Women and Their Possessions Conclusion METHODOLOGY Introduction 89 Mixed Methods Approach Conceptualization Functionalism as Theoretical Basis Purpose of the Study Hypotheses Methodology 92 Design... 93

8 Sample Protection of Human Research Subjects Operationalized Variables Nominal Variables Ordinal Variables Interval-ratio Variables Quantitative Study Data Collection Data Collection Instruments Reliability and Validity Qualitative Study Data Collection Interview Reliability Coding Acquisition: The Acquiring of Possessions Possessiveness: The Saving of Objects Discarding: The Reluctance to Throw Away Possessions RESULTS Assumptions Quantitative Findings Characteristics of Respondents Characteristics of Hoarding Cases Item Analyses Data Analyses Factor Analyses Regression Analyses Acquisition: The Acquiring of Possessions Possessiveness: The Saving of Objects Discarding: The Reluctance to Throw Away Possessions Qualitative Findings vii

9 Subjects Anne Bob Carol Donna Emily Qualitative Analyses Data Reduction Acquisition: The Acquiring of Possessions Possessiveness: The Saving of Objects Link to the past Substitute for close social relationships Comfort during a stressful transition Need for control Opportunity to use existing skills Fear of future deprivation Idiosyncratic Characteristics Discarding: The Reluctance to Throw Away Possessions Overall Hoarding 165 Data Display Conclusion Drawing DISCUSSION Idiosyncratic Characteristics Discrepancy Between Literature Review Findings and Research Results Functionalism Theory and Results of Study Functionalism and Acquisition Functionalism and Possessiveness Functionalism and the Reluctance to Discard Functionalism to Explain Hoarding Behavior Functionality of Possessions Hoarding as Self-Neglecting Behavior A Means of Social Control A Means of Comn~unication and Resolving Inner Conflict Vlll

10 A Means of Reducing Stress and Frustration A Form of Exploitation for Personal Gain Conclusion Belief Systems Possessions Provide Comfort and Security Possessions are the Responsibility of the Hoarder Objects are Useful. Functional. Valuable. and Irreplaceable Instinct Meanings of Possessions Private Meanings of Possessions Public Meanings of Possessions Self-identity Relationship of Elderly Women to Their Possessions Conclusion Components of Hoarding Acquisition Possessiveness Reluctance to Discard Conclusions Strengths and Limitations of Study Iniplications for Social Work Future Research REFERENCES Appendix A Appendix B Appendix C

11 List of Tables Table Page 1. Categorized Objects Hoarded by Gender of Hoarder Disorders Observed in Hoarders Items on Hoarding Questionnaire Emotional Attachment of Hoarding Elderly Women to Their Possessions Factor Score Covariance Matrix Correlations of the Three Items in Third Factor Final Factor Principal Axis FactoringIVarimax Factor Structure Loadings APS Workers' Level of Agreement with Acquisition Items Reluctance to Discard as Providing Explanation for Hoarding Behavior Characteristics of Interviewed Subjects Hoarding Component Statements

12 List of Figures Figures 1. Severity of Hoarding Conditions Perceived Outconle of Hoarding Cases Explanations for Hoarding, by Worker and Case Workers' General Explanations for Hoarding

13 Abstract CONCEPTUALIZING HOARDING BEHAVIOR AMONG ELDERLY WOMEN: A MIXED-METHODS APPROACH By Susan J. Murdock, M.S.W. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2006 Dissertation Committee Chairperson: Joseph Walsh, Ph.D. School of Social Work Hoarding in the con~munity involves substantial cluttering and impaired functioning, often exposing the hoarder to extensive health and safety risks. This research, based on Functionalism social theory, explores the three elements of hoarding-relentless acquisition, intense possessiveness of objects, and a reluctance to discard possessions-as a sociocultural phenomenon. The mixed methods methodology entailed a quantitative study involving a survey completed by 134 adult protective services workers throughout Virginia and a qualitative study of five randomly-selected adult protective services workers who volunteered for in-depth interviews. Findings revealed that adult protective services workers come in contact with very severe cases of hoarding, with over two-thirds of the cases cited having extremely xii

14 hazardous, unsafe, and cluttered living conditions. Similar to other research studies, hoarding was most prevalent among elderly women and the most common objects hoarded included printed materials such as newspapers, magazines, and junk mail. Factor analyses resulted in three factors with high loadings and correlations, particularly the factor that associates hoarding with a relentless need or desire to acquire more possessions. Content analyses of the qualitative data found that workers recognized several ways in which hoarding was functional, including emotional attachment to possessions, reducing stress, and providing meaning and identity. The mixed methods approach demonstrated that adult protective services workers tend to ascribe mental illness explanations to many hoarding cases, often equating hoarding to an addiction, although other published research finds only a nebulous connection between mental illness and hoarding behavior. Tliis research corroborates other studies that find that belief systems underlie hoarding behaviors, particularly how hoarders' possessions provide comfort and security; possessions are considered functional, valuable, and irreplaceable; and that the owner is responsible for maintaining control over possessions. The findings of this study have implications for social work practice and treatment models.... Xlll

15 Hoarding Among Elderly Women PROBLEM STATEMENT Introduction Hoarding is a universal issue that is insufficiently understood and poorly represented in empirical research, with most of the literature focusing on a psychiatric or psychological perspective. This dissertation represents an attempt to understand hoarding among elderly women within a broader framework, particularly the way in which hoarding is functional. The study is from the perspective of adult protective services (APS) workers because they, more than any other profession, have the unique experience of observing hoarding within the home. The general viewpoint of this dissertation is that hoarding is not an aberration so much as an overzealous attachment to possessions. Definition of Hoarding The definition of hoarding as "the acquisition of, and failure to discard, large numbers of possessions that have little use or value" (Frost, Steketee & Green, 2003, p. 323) is typically utilized in journal literature. The definition focuses on a cognitivebehavioral explanation to hoarding--relentless acquiring and reluctance to dispose--while other definitions focus on the resulting impairment in terms of functionality of the house or focus on the large quantity and uselessness of objects. For example, the definition utilized by Steketee, Frost, and Kim (2001) illustrates how hoarding impairs the hoarder's ability to use and navigate through the home:

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