Transcript Understanding Compulsive Hoarding

Clear Developments Training
www.cleardevelopmentstraining.co.uk
Clear Developments Training 2012
Tell me WHAT compulsive
hoarding means to you?
Is it a classified mental health
condition?
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Compulsive hoarding is a distressing and
debilitating psychological condition that
is only just beginning to be recognised
A very basic description of a compulsive
hoarder is someone unable to dispose of
excess or unused things to the point
where their belongings are clogging their
living space.
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DSM-IV listed hoarding 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.
This led them to investigate further.
The result of various studies has been a move
to redefine hoarding in DSM-V as a discrete
disorder severing it from OCD and giving it a
new name 'hoarding disorder’
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Hoarding CAN be a symptom of OCD but its
fairly uncommon
It can co-occur with OCD but we will usually
find slightly different patterns of hoarding
The items hoarded in OCD will usually be
more bizarre – fingernails, human waste etc
There will usually be a lot more ‘checking’
behaviour when OCD related CH is present
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Based on estimates from a study of US
college students the prevalence of
compulsive hoarding is roughly 2 4%.
 We suspect that this is a very
conservative estimate and it is much,
much higher, probably nearer 5%.
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Education. It is suspected that those who have a
higher level of education, may be more likely to
hoard things.
Age. It seems that hoarding behaviour begins in
childhood or adolescence, however it often
doesn't become a problem until the later years of
life. The problem has always been there it is just
that no-one has noticed.
Marital status. People with this problem tend to
be single. Those who get married, tend to get
divorced and live alone. Hoarders are often very
isolated people.
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Working alone can you please note down 5
personal possessions that you would rate as
being ‘important’ to you.
This can be your mobile phone, car – but NOT
a person
Please write down next to them why they are
important – what purpose they serve – why
you need / have them
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See all decision as punishment
Are chronically disorganized
Are unsure how to group or categorize things
See each item as irreplaceable, complex and
unique
May not be confident about their memory
People will attempt to ‘organise’ things –
examine an object only to place it back in the pile
from which it was drawn
The result is a pile of related and unrelated
objects that get “churned”
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May not be confident about their memory
People will attempt to ‘organise’ things –
examine an object only to place it back in the
pile from which it was drawn
The result is a pile of related and unrelated
objects that get “churned” during attempts to
organize and result in ‘losing’ important
things
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Hoarding is an extremely difficult condition
to LIVE with and to TREAT
The clogs and clots of things pile up into
protective shells for their owners.
For some hoarders forced clear out can be
fatal – a state in the US abandoned forced
clear outs after three separate individuals
returned to their cleared homes and died
suddenly through no discernible cause
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Look at your list of 5 items
 1 of them has to go – YOU CANNOT
PURCHASE A REPLACEMENT!
 Which one is it?
 How do you choose?
 How does it make you feel?
 What would your life be like without
it?
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The compulsive
hoarder feels
like this about
EVERY ITEM they
have!
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How do YOU decide what to keep and what to
throw away?
Studies have shown that hoarders suffer from
poor decision making processes deep within
the brain – including problems with their
cerebellum and medial gyrus which results in
excessive activity in these areas when
attempting to decide whether something is of
value.
They also associate decision making with
punishment
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Overwhelmed Care Givers
Own multiple pets and care for them well
until there is a big change in their life. This
can be a death, sudden illness or job loss.
The person becomes overwhelmed – and as
they are usually isolated they do not know
how to get help.
Of the 3 categories these are the most cooperative hoarders in resolving the problem.
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Mission Driven Animal Hoarders
These represent the majority of animal
hoarders. Their desire to save animals from
death or suffering drives them to rescue and
home far too many animals.
They object to neutering and euthanasia and
seek out animals they believe to be at risk.
They actively avoid any intervention from
authorities but sadly their animals end up
suffering more at their hands than before
‘rescued’.
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Exploiters
These people have very little connection to
their animals. Sometimes the driving force
with this type of animal hoarder is
psychologically rooted in the desire to control
other living things. These are the most
difficult hoarders to manage as they often
lack remorse and social conscience. They
genuinely do not realize they are doing
anything wrong and can be delusional.
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The acquisition of, and failure to discard
large numbers of possessions that appear
(to others) to be useless or of limited value
Living or other spaces sufficiently cluttered
so as to preclude activities for which those
spaces were designed
Significant distress or impairment in
functioning caused by the hoarding
Not explained by another organic or
psychiatric disorder
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Difficulty discarding or parting with possessions
– regardless of their actual value.
Due to strong urges to save / distress in
discarding
Symptoms result in accumulation that fills up
home / active living areas
OR if areas are uncluttered this is only due to
intervention of family / friends / others
Symptoms NOT associated with any other
medical condition ie brain injury
Symptoms must not be a result of / restricted to
another mental disorder – examples to follow
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Hoarding due to obsessions in
OCD
Decreased energy in major
depressive disorder
Delusions in schizophrenia
Cognitive deficits in dementia
Restricted interests in ASD
Food storing in Prader-Willi
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It is also important to differentiate between a
hoard and a collection.
A collector is someone who is proud of the
collected things and wants to show them off.
They invite guests to admire their collections. A
hoarder is the opposite.
They do not want anyone in their home. For
hoarders, barring visitors has to do with a fear
that the visitor will move or destroy something.
There are cases where trauma can tip a collector
over the edge into becoming a hoarder.
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Extreme compulsive hoarding can result in;
 A major health hazard – both to the individual
and those around them
 A fire risk
 Infestations of vermin
 Deterioration in peoples quality of life
 Isolation and exacerbation of mental health
problems
 For some tenants this may be loss of their
tenancy and home
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The results showed that
53% were reported as being ‘delusional’ and /
or lacking insight by their families
6% of compulsive hoarders within the survey
had contributed to their own deaths in house
fires
Most reported feelings of trauma and shame
in childhood – with female family members
reaching the point of dissociation
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The process of a cluttered home becoming a
hoard storehouse is a gradual one.
Traumas, illness and bereavement can slow
down the normal digestion and sorting of
belongings.
It can start as “getting behind”.
When someone gets far enough behind,
dealing with it becomes daunting.
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In most cases, a
hoard has taken 10
or more years to
acquire and settle.
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Clutter is easily shifted and is part of a lively,
sometimes disorganized life. Clutter does not
describe how much stuff someone has. Some
people are disturbed by small amounts of
disorganization or disorder. Others thrive in
the midst of a 'creative mess'. There are no
absolutes.
What matters is: Are the things being used?
And can the owner get rid of things easily?
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Clots are when collections of clutter aren't
used or moved for 6 months or more. The
household still works. The rooms can still be
entered and lived in but there are 'dead'
places.
The physical clots are often accompanied
hoarder rationales, and avoidance.
Touching clots or moving them can provoke
the same cries and panic that hoarders have
when their things are touched or moved.
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The clot we see most is post. Lots of people dread what
is in all those envelopes: bills, final demands, dentist
appointments. Some people have as many as 3 years of
unopened post.
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An ever increasing laundry pile that is never completely
folded or put away. Items are added the top layer but the
foundations can be untouched for 2 years or more.
Unfinished clearouts - the bags or boxes that have
happened after a sort out but the rejects have never
made it out the door to the charity shops or the rubbish
bins.
Unfinished projects - collecting fabric for a quilt, cutting
the first bits and then not touching it again for 5 years.
Unwanted purchases in their original packaging. These
have sat there so long that they can no longer be
returned, but the owner doesn't know what to do with
them.
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Clogs are when clots all over the house have
become stuck to one another.
Eventually it is impossible to open the door or get
into the room. That is a clog.
When a whole house is clogged it is a completed
clog. The things have become a hoard.
Circulation has stopped.
The possessions are no longer being used. The
person is now serving their things rather than the
other way around.
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Clinical compulsive hoarding tends to run in
families.
Several studies have shown that approximately
50% of hoarders report a first degree relative,
e.g. a parent, sibling or offspring who hoards.
Some of the latest research into compulsive
hoarding has been into genetic factors.
How much of the risk is of becoming a
compulsive hoarder is genetic and how much
is learned behaviour and upbringing is yet
uncertain.
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A person suffering from a mental
disorder may be detained under the
Mental Health Act 1983 if it is
necessary for his own health or
safety or for the protection of other
people and treatment cannot be
provided otherwise.
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Chief question to be balanced is:
Protection of self and
others
versus
Personal Liberty
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The MHA 1983 has many sections
and subsections.
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You will mostly encounter Section 2 and
Section 3.
Under Section 2, a person is detained for up
to a month for psychiatric assessment.
Under Section 3, a person is detained for 6
months for psychiatric treatment
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Are known by the acronym
 Fairness
 Respect
 Equality
 Dignity
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Right to life (article 2)
Right to property (article 1)
Freedom from inhuman and degrading
treatment (article 3)
Right to liberty (article 5)
Right to respect for private and family life,
home and correspondence (article 8)
Right not to be discriminated against
(article 14)
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No duty to make safeguarding enquiries if the
person is regarded as vulnerable but able to
take steps to help themselves
NOT all embracing – tied to the person
considered ‘at risk’ because of health and
social care needs – and the impact of these
on their ability to look after themselves
IF the person denies they have care / support
needs – but the LA thinks this is delusional or
as a result of coercion it must still assess.
The most crucial part of
tackling a hoard is the
person themselves, not how
much stuff there is.
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Increase people’s understanding of their
hoarding
Create living space
Organise possessions to make them
accessible
Improve decision making skills
Reduce compulsive buying / acquiring REPLACE IT
Help people evaluate the way they think
about possessions
Prevent future hoarding
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The average hoard has taken 10 years to
accumulate – you wont ‘solve’ the matter in
days or weeks
Refer to the tenancy agreement
It will probably take a variety of
interventions – medical – clinical – family /
circle of support for them to be ‘stable’
and at stop their acquiring at the least
If someone is embarrassed by the state of
their home this is a good sign that they are
ready to accept help and have some insight
into their illness
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