Transcript 29 Hoarding Behavior in Seniors

Hoarding
The Nature of Our
Relationships with Things
C. Alec Pollard, Ph.D.
Saint Louis Behavioral Medicine Institute & Saint Louis University
General Definition of
Hoarding
The process of acquiring and saving possessions
Normal Hoarding
 Most people acquire and save things that other people
wouldn’t
 Hoarding is not necessarily abnormal or dysfunctional
behavior
 In many situations, hoarding promotes survival
 Collecting objects can be a popular hobby
What’s the difference between
a collector
and a hoarder?
Button Collector
Button Hoarder
What do people hoard?
Things
Animals
Information
Most people hoard some
things, so how do I know if I’m
a “hoarder?”
When Hoarding is a Problem
 Interferes with functioning
 Causes distress
 May involve conflicts with others
 Can create hazards
 Evidenced by cluttered living spaces
You’re not one of those hoarders,
are you?
Hoarding Disorder

Persistent difficulty discarding or parting with personal
possessions…due to strong urges to save items, distress,
and/or indecision…

…accumulation of a large number of possessions that fill
up and clutter the active living areas…

…significant distress or impairment…

…not due to a general medical condition or another
mental disorder
Specify if: with excessive acquisition
Specify insight level: “Good or Fair,” “Poor,” “Delusional”
Is it OCD?
 Some similarities: e.g., anxiety
 But some differences: e.g., addiction
 Relationship between OCD and HD is complex
Obsessive-Compulsive &
Related Disorders (DSM-5)
 OCD
 Hoarding Disorder
 Body Dysmorphic Disorder
 Trichotillomania (Hair-Pulling Disorder)
 Excoriation (Skin-Picking Disorder)
 Substance/Medication/Medical Conditioninduced OCD
 Other (e.g., other BFRB, obsessional jealousy)
Types of Problematic
Hoarding
1. Primary
2. Secondary
What Causes It?
 Genetics
 Biological Factors
 Environment
Psychological Factors that May Complicate
or Contribute to Hoarding
1. Ambivalence about or resistance to change
2. Organizational skill deficits
3. Problems with emotional attachments
4. Erroneous beliefs about possessions
5. Impulse control problems
6. Behavioral avoidance
What Can Be Done
About It?
A hoarder’s response to your
suggestions & help
You can wish for this
But be ready for this
Does Not Help
 Lecturing, nagging, arguing, pleading, threatening, etc.
 Throwing things out without the hoarder’s consent
 Court orders or jail time (without treatment)
 Appearing on Oprah
Makes Things Worse
 Isolation
 Unbridled freedom to acquire
 Enabling
 Stress, emotional problems
What can be helpful?
If the hoarder is receptive…
• Expressing concern
• Offering to help
• Providing education
• Negotiating
• Treatment
Therapeutic Options
 Medication: No drug targets hoarding directly. May be
used to treat accompanying symptoms (e.g.,
depression)
 Psychotherapy: Cognitive Behavior Therapy (CBT)
can be effective, but requires some motivation and
takes time.
 Support Group/Resources: Little research on
effectiveness, but may be helpful.
Components of Treatment (CBT)
for Hoarding Disorder
1.
Clarifying motivation and goals for recovery
2.
Cognitive interventions to reassess hoarding-relevant
beliefs
3.
Developing better organizational skills
4.
Getting better control over the desire to acquire
5.
Learning how to discard and putting it into practice
6.
Family involvement as indicated/feasible
Options if the hoarder is not
receptive…
1. Doing nothing
2. Crisis intervention
3. Relocation to a more controlled
environment
4. Family consultation
Family & Friends of the
Hoarder
 May be the forgotten victims
 May have leverage to increase the hoarder’s motivation
for recovery
 May need help to deal with the impact of the hoarding
on their lives
Hoarding Resources
 Web-based
-- YouTube Hoarding Channel
-- International OCD Foundation: www.ocfoundation.org
-- Hoarding of Animals Research Consortium: www.tufts.edu/vet/cfa/hoarding/
-- Children of Hoarders: www.childrenofhoarders.com
-- Clutterers Anonymous: www.clutterersanonymous.net
-- Messies Anonymous: www.messies.com
-- Hoarding Cleanup Nationwide Directory: hoardingcleanup.com
 Books
-- Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding (Tolin, Frost, &
Steketee)
-- Overcoming Compulsive Hoarding (Neziroglu, Bubrick,
& Yaryra-Tobias)
-- The Hoarder in You (Zasio)
Resources in St. Louis
 Support Groups:
- Obsessive Compulsive Anonymous
- St. Louis OCD Support Group
 Informal network
 Professional Organizers
 Handful of therapists with specialized knowledge
 Saint Louis Behavioral Medicine Institute:
- Individual therapy
-
Family consultation
Hoarding Group
Consultation to religious communities, community agencies
Intensive levels of treatment
Coordinated specialty care for religious
Q&A
Contact Information
Address:
1129 Macklind Avenue
St. Louis, MO 63110
Phone: 314-534-0200
Fax: 314-534-7996
Email: [email protected]
Website: www.slbmi.com