Compulsive Hoarding

1. Compulsive Hoarding Barbara J. Chromy

2. Definition of Hoarding • No consistent definition of hoarding • The term is used in different clinical and non-clinical contexts to describe a broad spectrum of behavioral abnormities (Maier, 2004)

3. Commonly Accepted Definition • The acquisition of, and failure to discard, a large number of possessions that appear to be of useless or limited value

4. Definition (continued) • Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed

5. Definition (continued) • Significant distress or impairment in functioning cause by the hoarding (Frost, Hartl, & Gross)

6. Types of Hoarding • Scarcity Mentality Hoarder • “What if the depression returns?” • Frugality Mentality Hoarder • Nothing should be wasted • Frozen Indecision Hoarder • Finds no decision easy (NSGCD, 2003)

7. Types of Hoarding(continued) • Ordinary Hoarders • Primarily objects • Animal Hoarders • Can have in excess of 300 animals in a home • Trash Hoarders • Syllogomania

8. Types of Hoarding(continued) • Animal Hoarding

9. Animal Hoarding Defined • HSUS defines an animal hoarder as a person who has more animals than he or she can properly care for • A defining characteristic of animal hoarders is their refusal to acknowledge their inability to care for the number of animals they have accumulated (Simmons, 2006)

10. Causes • Little is known about onset and course of compulsive hoarding Grisham, Frost, Steketee, Kim and Hood (2006)

11. Prevalence • 1.4 to 2 million people in the United States have compulsive hoarding syndrome (Maidment, 2005; Collingwood, 2006). • Hoarding accompanies OCD in 25% to 40% of individuals diagnosed (Understanding Hoarding, 2005; Seedat and Stein, 2002). • 2-3% of the general population has OCD and up to one-third of those diagnosed with OCD exhibit hoarding behavior (Cohen, 2004; Haggerty, 2006).

12. Anorexia nervosa Bipolar disorder Dementia Depression Impulse control disorders Such as compulsive buying or gambling Social phobia Obsessive-compulsive disorder Personality disorders Schizophrenia Diogenes syndrome Prader-Willi syndrome Head injury Autism Co-morbidity

13. Hoarding Dangers • Health hazards • Injury • Isolation

14. Impact on Elderly • Compulsive hoarding is known to co-exist with both dementia and Diogenes syndrome; two conditions that are correlated with age • Compulsive hoarders are more likely to be socially isolated, live alone, and to be female

15. Impact on Elderly (continued) • Hoarding medications is not uncommon among the elderly who have many ways to obtain drugs (MacIsaac & Bartus Adamson, 1989)

16. Treatment • No known ‘cure’ for compulsive hoarding (Understanding Hoarding, 2005) • Traditional treatments for OCD have not proven to be effective with compulsive hoarders (Saxena and Maidment, 2004)

17. Treatment(continued) • Intensive multimodal treatment found effective in pilot studies following a course of up to one year • This treatment focused on the following areas 1) discarding; 2) organizing; 3) preventing incoming clutter; and 4) introducing alternative behaviors (Saxena & Maidment, 2004)

18. Applications • Educators need to bring educational programs about hoarding to their communities • Need to spearhead or gain access to community hoarding task forces to protect the interest of older adults • Research how hoarding manifest itself in the elderly, the special concerns of elderly hoarders, and effective treatment protocols for older hoarders

19. Conclusion • Compulsive hoarding is a devastating disorder that is not well understood and is difficult to treat • Prevalence rates are unclear and the causes have not been identified • Early intervention is essential

20. References • Maier, T. (2004). On phenomenology and classification of hoarding: A review. Acta Psychiatr Scand,110, 323-337. • Frost, R.O., & Gross, R.C. (1993). The hoarding of possessions. Behavioral Research and Therapy, 31, 367-381. • Frost, R.O., & Hartl, T. (1996). A cognitive-behavioral model of compulsive hoarding. • Behavioral Research and Therapy, 34(4), 341-350. • National Study Group on Chronic Disorganizations (NSGCD). (2003). Types of hoarding: Different perspective [fact Sheet 02 3-03], 1-2. Retrieved from www.nsgcd.org. • Simmons, R. (2006). Behind closed doors: The horrors of animal hoarding. The Humane Society of the United States. Retrieved 11.27/06 from http://www.hsus.org/pets/issues_affecting_our_pets/behind_closed_doors_the_horrors_of_animal_hoarding.html.

21. References (continued) • Grisham, J.R., Frost, R.O., Steketee, G., Kim, H. & Hood, S. (2006). Age of onset of compulsive hoarding. Journal of Anxiety Disorders, 20, 675-686. • Cohen, J. (2004). The danger of hoarding. USA Today; 2/19/04 [Electronic version]. • Haggerty, J. (2006). The impact of obsessive-compulsive disorder. Psychcentral.com, retrieved 11/27/06 from http://psychcentral.com/lib/2006/02/the-impact-of-obsessive-compulsive-disorder/. • MacIsaac, A.M., & Bartus Adamson, C. (1989). Multiple Medications: Is your elderly patient caught in the storm? Nursing, July, 60-64. • Saxena, S. & Maidment, M. (2004). Treatment of compulsive hoarding. JCLP/In Session, 60, 1143-1154.