Hoarding disorder

Hoarding

disorder

“It is clear that between what a man calls me and what he

simply calls mine, the line is difficult to draw. We feel and act

about certain things that are ours very much as we feel and

act about ourselves.”

-William James

CONFUSION REGARDING OCD

AND HOARDING DISORDER

• Although hoarding is often considered a symptom of obsessive–

compulsive disorder (OCD), and is included in most structured

interviews and questionnaires of OCD symptoms, it is not directly

mentioned in DSM-IV-TR or in ICD-10 as a typical symptom of OCD.

• This can be confusing as clinicians may struggle deciding when a

diagnosis of OCD is appropriate, particularly when hoarding

appears in the absence of other prototypical OCD symptoms.

Depression and Anxiety 0:1–17, 2010.

A model of the overlap between compulsive hoarding and obsessive-compulsive disorder as well the percentage of sampling types

within the sample studied by Pertusa et al. (2008).

Past and current

scenario

• Bratiotis et al. (2011) noted that published articles about

hoarding have increased approximately four-fold since

Frost and Hartl’s (1996) definitive work in which they

defined and operationalized research on compulsive

hoarding.

• Thanks to this upsurge in attention, there is now critical

information regarding the scope of the problem as well as the

consequences involved.

Epidemiology

• Current estimates indicate that 14% of the population will

engage in hoarding behaviors sometime in the life course

• Point prevalence studies indicate clinically significant

compulsive hoarding occurs in 1.5% to 4.6% of the

population comparable to other major psychiatric conditions,

and greater than the prevalence of OCD (1.2%)

Molecular Psychiatry, 2010:15(1), 53-63.

WHAT IS IT?

• Hoarding disorder, a new

disorder in DSM-5, is characterized

by a persistent reluctance to

discard objects, resulting in

severely obstructed living spaces,

distress, impairment and, often,

adverse repercussion both for the

sufferer and for those around this

individual

The British Journal of Psychiatry (2013) 203, 445–452

HOARDING

• Hoarding is not the same as collecting; collectors look for

specific items, such stamps, and may organize or display them.

• People with hoarding disorder often save random items and

store them haphazardly

• In most cases, people save items that they feel they may need

in the future, are valuable, or have sentimental value; some

may also feel safer surrounded by the things they save.

American Psychiatric Association www.psychiatry.org

CLINICAL

DEFINITION

Hoarding behaviour is, in fact, quite common but problematic hoarding

consists of three components:

• The acquisition of and failure to discard possessions that appear to

be of little use or value

• Living spaces sufficiently cluttered so as to preclude activities for

which those spaces were designed

• Significant distress or impairment in functioning caused by the

hoarding

Frost & Steketee, 1999

REASONS FOR SAVING

• Sentimental – “This represents my life. It’s part of me.”

• Instrumental – “I might need this. Somebody could use this.”

• Intrinsic – “This is beautiful. Think of the possibilities!”

HOARDING

BEHAVIORS

• Saving: Sentimental,

instrumental, intrinsic

• Acquisition: Buying, acquisition

of free things

• Clutter/Disorganization:

Random piles, churning

• Difficulty in Discarding:

Indecision, attachment

March 2012 Satwant Singh

Manifestation of

hoarding

• Usually begins in childhood- long standing

• Compulsive acquisition

• Lack of organisation

• Saving behaviours and inability to discard

• Avoidance- dealing with the problem, others

• Trust issues- letting others help

• Lack of insight/acceptance of problem e.g. the place is too

small, I don’t have time to organise

consequences

• Impairment and distress to the individual

• Impairment to social functioning and relationship issues, social

isolation

• Health and safety- fire hazard, infestation, poor living conditions

(lack of heating etc), hazard to the environment e.g. building

with the lack of poor maintenance

• Mental health issues e.g. depression, psychosis etc


REASONS FOR

HOARDING

• Usually begins in childhood, more common in males

• Family history of hoarding and OCD

• Often linked to some sort of trauma e.g. loss, abuse, divorce etc

• Material deprivation

• Severe and enduring mental illness and other mental health

problems

As noted by prominent researchers Frost and Steketee (2010)

in their recent book on compulsive hoarding,

“The boundaries between normal and abnormal blur when

it comes to hoarding. We all become attached to our

possessions and save things other people wouldn’t. So we all

share some of the hoarding orientation”

SIMILARITIES AND

DIFFERENCES

Hoarders and non hoarders save the same things but the

differences are:

- Quantity

- Emotional attachments (sentimental)

- Perceived use of object (instrumental)

- Over valued beliefs

- The object as an extension of self


Understanding of

condition

Different from OCD and other conditions as:

• Do not view their behaviour as unusual

• Less insight into their behaviour

• Have reasons why they need to “save” “I need this just in

case” “It reminds me of marriage, good times in my life”

HOARDING ASSESSMENT

SCALES

• UCLA Hoarding Severity Scale (Saxena et al, 2007)

• Saving Inventory-revised (Frost et al, 2004)

• Hoarding Rating Scale-Interview (Tolin et al, 2010)


DIAGNOSING

HOARDING DISORDER

An assessment for hoarding may include questions such as

• Do you have trouble discarding things that most other people

would get rid of?

• Because of the clutter or number of possessions, how difficult is

it to use the rooms and surfaces in your home?

• To what extent do you buy items or acquire free things that you

do not need or have enough space for?


DIAGNOSING

HOARDING DISORDER

• To what extent do your hoarding, saving, acquisition, and clutter

affect your daily functioning?

• How much do these symptoms interfere with school, work, or

social or family life?

• How much distress do these symptoms cause you?


MANAGEMENT OPTION

• Cognitive-behavioral therapy (CBT)

• Medication


INEFFECTIVE

INTERVENTION

STRATEGIES

Make decisions (about a plan of action) for a tenant

Argue or Persuade

Pressure the tenant to discard

Tell the tenant how to feel

Give verbal and non-verbal cues that are judgmental or

negative in nature

EFFECTIVE INTERVENTION

STRATEGIES

Be clear about expectations and limitations

Ask open-ended questions

Reflectively listen

Use respectful, non-judgmental language

Mirror the language used by the tenant

“Work with” the tenant instead of “doing for”

• During CBT, individuals gradually learn to discard unnecessary

possessions with less distress, diminishing their exaggerated

perceived need or desire to save for these possessions.

• They also learn to improve skills such as organization, decision-

making, and relaxation.

• For many people, certain anti-depressant medications may be

helpful and may produce more rapid improvement American Psychiatric Association www.psychiatry.org

Thank you

Hoarding disorder

Health & Medicine

Transcript of Hoarding disorder