A Closer Look at Hoarding Behavior

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A Closer Look at Hoarding Behavior

• Presented By
• Patrick Arbore, Ed.D.
• Institute on Aging
• San Francisco, CA

2
Center for Elderly Suicide Prevention Grief
Related Services (CESP)

• CESP is currently a program of the Institute on
  Aging, San Francisco.
• CESPs inaugural services was the 24-hour
  Friendship Line, which began in 1973.
• [phone] Local Line and [phone]
  Natl Line
• [phone] Assessment Information
• Grief Services for People of Any Age 8-week
  group Saturday Drop-In Grief Group (1030-Noon)
  Individual Grief Counseling Call [phone]
  for information
• Director Founder Patrick Arbore (415)
  750-4180x230 parbore_at_ioaging.org

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Definitions

• HOARDERS Can be referred to as hunter/gatherers
• PACK RATS Stockpile haphazardly and seldom use
  the things that are stored
• CLUTTERES An out of control need to accumulate
  things
• COLLECTORS Orderly, systematic organization of
  thingsoften on display

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A Closer Look At Those Who Clutter

• Hiding may be what people who clutter are
  pursuing
• Shame may be what motivates their desire to hide
• Fear, anger, sadness are additional emotional
  obstacles
• Most compulsive behavior involves a kind of
  desperate longing to fill the holes in the soul
  (Moore, The Inner Loneliness)
• Inner Loneliness cannot be eased through clutter,
  people, possessions, games, achievement, work,
  television viewing, the internet, excessive
  exercise, etc.

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Primary Characteristics of Hoarding

• Three main types of problems
• Compulsive acquisition
• Saving behavior or difficulty discarding
  possessions
• Disorganization in many areas of life, but that
  mainly manifests in extensive clutter

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Differences between Cluttering Hoarding

• Cluttered conditions may result from a variety of
  causes including physical fraility, dementia or
  hoarding behavior.
• Clutter becomes problematic when areas of the
  home cannot be used for their intended purpose.
• Possessions pose a safety hazard or endanger a
  persons living situation.

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Differences Continued

• Hoarding is a behavior characterized by
  collecting things that either do not serve a
  purpose or are redundant collecting but not
  discarding extreme emotional attachment to the
  items collected and an inability to part with
  them without significant anxiety and stress.

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The Person Who Hoards

• Because hoarding is a long-term behavior, it is
  seen particularly in the older adult. However,
  the hoarding behavior started decades earlier.
• Hoarders exhibit socially eccentric behavior.
• Is the behavior gender specific? Often seen in
  older women(women generally outlive their male
  partners). No empirical data on gender.
• Hoarders are (generally) mentally competent.
• Hoarders exhibit an indifferent attitude toward
  their behaviors
• Hoarders dont understand why anyone should be
  concerned about their behavior.

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The Person Who Hoards Continued

• Usually lacks self-care skills (but may appear
  well groomed in public).
• Perceives themselves to be socially isolated.
• The hoarder can see no difference between
  treasure and trash.
• Appears to be no socio-economic differences.
• Most do not meet the diagnosis for
  Obsessive/Compulsive Disorder but may have
  features.
• Hoarding behavior is increased in older people
  with dementia.

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Dynamics of the Hoarder

• There are three important concepts
• Dirt Can be identified with aggression and
  defiance, which can lead to guilt, shame, and
  fear. People can react by defying authority.
• Time Dawdling and procrastination show the
  struggle with control and mastery.
• Money Rather than love, money and status are
  the foundation of emotional security.

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Reasons for Hoarding

• Items are perceived as valuable
• Items provide a source of security
• Fear of forgetting or losing items
• Constant need to collect and keep things
• Obtaining love not found from people
• Fear others will obtain their personal
  information
• Physical limitations and frailty
• Inability to organize
• Self-neglect
• Stressful life events

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Negative Aspects of Hoarders

• Experience a high degree of shame and
  embarrassment
• They know that something isnt normal
• Overwhelm they dont know where or how to start
  to think this through
• Feel out of control
• They ask themselves Am I crazy or not?
• Fear being found out
• They live in dread that a repair person or a
  paramedic may come
• They are easily distracted
• They often smoke and/or abuse substances
  including alcohol
• They cannot seem to initiate organizational
  behavior

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Feelings Associated with Those Who Clutter/Hoard

• Anxiety
• Boredom
• Distractedness
• Fatigue
• Grief
• Hopelessness
• Overwhelmed
• Resistance
• Shame/Guilt
• Anger/Rage/Hostility
• Sorrow

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Resistance

• What is it?
• Milton Erickson Resistance is a vitally
  important communication of a part of the persons
  problems and often can be used as an opening into
  their defenses.
• Resistance is a defense against insight.
• A person will become more resistant is a helper
  becomes pejorative Look at all this trash!
• The helper must help the person become friendly
  with the resistance Explore the unknown may be
  a better approach

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Resistance Continued

• A resistance, regardless of its source, is
  triggered by anxiety, conscious or unconscious.
• Resistance may take the form of overt hostility
  or more subtle communication of frustrating
  feelings.
• Resistance can also be a healthy sign that the
  person has a lot of energy.

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Resistance and the Hoarder

• People with problematic hoarding behavior often
  refuse help.
• Researchers have found that it may be effective
  to help the clutterer sort through possessions
  rather than discuss discarding all the redundant
  material.

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Inquiring about Clutter

• Be non-judgmental when you ask these questions
• Are you reluctant to have people come over
  because of clutter in your living space?
• Are you able to use your kitchen appliances?
• Is there a place to sit down and eat?
• Do you have to move things off the furniture to
  sit?
• Are you able to sleep in your bed?
• Are there clear pathways to the bedroom and
  bathroom?

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Questions Continued

• Can you easily use your toilet, tub and shower?
• Do you have trouble finding things because of too
  much stuff in your home?
• Have you fallen over the clutter in your home?
• Are you behind in paying your bills because you
  cannot find your mail?

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Minimum Safety Guidelines

• General Guidelines include
• Working toilet and sink
• Adequate walking paths in rooms used on a regular
  basis
• Safe walkway (flooring uncluttered)
• No infestations of insects and/or rodents
• No excessive accumulation of garbage
• Absence of fire hazards, including no
  combustibles near radiators or stoves, no blocked
  exits, no overloading of outlets

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Guidelines Continued

• For home care professionals, a chair surface
  without clutter for the worker to sit on (if
  necessary)
• Working phone or nearby access to one

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Shame

• To feel shame is to feel seen in a painfully
  diminished sense.
• The self feels exposed both to itself and to
  anyone else present.
• It is this sudden, unexpected feeling of exposure
  and accompanying self-consciousness that
  characterizes the essential nature of the affect
  of shame.
• We feel deficient in some vital way.
• To live with shame is to experience the very
  essence or heart of the self as wanting.

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Characteristics of Shame

• The binding effect of shame involves the whole
  self.
• Sustained eye contact with others becomes
  intolerable.
• The head is hung.
• Spontaneous movement is interrupted.
• Speech is silenced.
• Feeling exposed opens the self to painful inner
  scrutiny.
• We are suddenly watching ourselves, scrutinizing
  critically the minutest detail of our being.
• Exposure heightens our awareness of being looked
  at or seen.

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Shame An Impotence-Making Experience

• To the person who hoards/clutters, it feels as
  though there is no way to relieve the inner pain
  except to hide within the clutter.
• One has simply failed as a human being.
• There is nothing they can think of to do to make
  up for this dreadful feeling.

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Shame/Rage

• The greater the individuals shame, the more
  savagely and frequently they rage.
• Rage increases the experience of shame.
• Shame, however, cannot be eliminated by raging.
• This shame/rage spirals into misery.
• This misery continues feeding the conflict that
  one feels with the world/family/caregivers.
• Until the pattern of shame/rage can be broken,
  the person may (1) be emotionally/physically
  abusive (2) dependent on alcohol and other
  substances and (3) experience suicidal thoughts.
  

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The Role of Grief Loss

• What is Grief?
• A process of experiencing the psychological,
  behavioral, social, and physical reactions to the
  perception of loss.
• Grief is a continuing development it is not a
  static state it involves changes over time.
• It is natural and expectable reaction.
• It is a reaction to all type of loss.
• It is dependent upon the individuals unique
  perception of loss.

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The Dark Emotions

• According to Miriam Greenspan (2003)
• Suppressed Grief often turns into depression,
  anxiety, or addiction.
• Benumbed Fear can lead to irrational prejudice,
  toxic rage, and acts of violence.
• Overwhelming Despair can lead to severe psychic
  numbing or expresses itself through destructive
  acts to oneself (suicide) or others (abusive
  behaviors).
• An inability to express and experience grief,
  fear and despair in a healthy manner can lead to
  depression, anxiety, addiction, irrational
  violence, and psychic numbing.

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How Hoarders are Perceived by Others

• They are perceived by family members, neighbors,
  other non-professionals as crazy, lazy, mentally
  ill.
• There is a distinct and unpleasant odor in their
  environment People want to get away from them.

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How Professionals Perceive Hoarders

• Professionals find these individuals
• Interesting and curious
• Bright, creative, artistic
• Living their lives in their own way
• Fiercely independent
• Strong willed

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How Hoarders Perceive Professional Helpers

• At best, nice but not very helpful
• Judgmental
• Arrogant
• Pushy
• Impatient, Hasty
• Not understanding
• Perceived as though they do not want to
  understand
• Negative/nagging
• Threatening/bullying
• Disrespectful
• Invasive
• Overly serious way, way too serious

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Tips The Do Nots

• Dont work with the hoarders/clutterers if you
  feel negatively about this behavior
• Dont belittle
• Dont talk patronize
• Dont expect overnight miracles
• Dont overwhelm or threaten them
• Dont take anything away without a discussion
• Dont get into power struggles
• Dont do surprise clean ups
• Dont tackle this on your own
• Dont force interventions
• Dont use the persons first name unless give the
  okay

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Do Nots Continued

• Dont talk to others who are in the room about
  the person as if she/he is not present
• Dont criticize the environment
• Be aware of your non-verbal behaviors (facial
  expressions of disgust)

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Tips The Dos

• Establish a positive relationship
• Maintain respect
• See their point of view (use empathy)
• Name the problem and define the standards (e.g.
  at this facility there are safety codes that we
  have to meet for the protection of all residents,
  etc.)
• Help them maintain some sense of control over the
  setting

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The Dos Continued

• Help in setting goals
• Establish boundaries, time frames for getting
  this started
• Work collaboratively
• Offer physical help/emotional support
• Be persistent
• Use a soft, gentle approach let the person tell
  their story
• Respect the meaning and attachment to possession
  by the person may be as intense as human
  attachment
• Be calm factual, caring and supportive
• Praise effort often and sincerely

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The Dos Continued

• Offer referrals to professional organizers if
  needed
• Gently suggest the importance of professional
  help such as grief counseling, individual
  therapy, 12-step program, physician, psychiatrist
• Family intervention

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Affirmations for Hoarders/Clutterers

• I understand that there are too many things in my
  living space.
• I am ready, willing, and able to clear and clean
  these areas.
• I will pare down my stuff to a more manageable
  and usable quantity.
• I gladly give away, recycle, or toss out what can
  be used by others and given back to the
  environment.

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Affirmations Continued

• I will do this with commitment, purpose, and
  without regret, because what I am doing clears
  space in my life for other people, events, and
  usable things to enter.
• I rejoice that I have been able to lessen the
  load of possessions that hamper living my life in
  a way that I know or dream that I can.

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The Role of Spirituality

• Mel Ash, The Zen of Recovery, has said
• In surrendering to ones own original sense of
  order and harmony, ones compulsion is abated.
• Recovery from clutter is more than removing
  stuff from our living space.
• It is removing old ways of thinking and believing
  from our minds in order to free our souls.

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What is Spirituality?

• May mean different things to different people.
• Spirituality may be defined as a motivating force
  that searches for meaning and purpose in life
  through connectedness.
• Spirituality is a dynamic lifelong search process
  that arises from life and spiritual experiences.

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What is Religion?

• Religion originates in an attempt to represent
  and order beliefs, feelings, imaginings and
  actions that arise in response to direct
  experience of the sacred and the spiritual.
• It becomes a process that creates meaning for
  itself on a sustaining basis in its originating
  experiences and its own continuing responses

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Wonderment

• The hoarder/clutterer/pack rat does not have an
  attitude of wonderment of the immediacy of life
  and a new ability to live in the present moment.
• When living in the moment, one is aware of the
  elemental realities of life and their
  significance family, friends, co-workers,
  plants, nature, music, physical and emotional
  touching, the textures of color and shape.
• The price of this birth of wonder is an
  acceptance of lifes limitations something the
  hoarder/clutterer does not yet understand.

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Wonderment Continued

• The discipline of acknowledging certain limits
  simplifies life our vision is uncluttered.
• Wonder is the prelude to gratitude.
• Encourage the clutterer to develop an attitude of
  gratitude.

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Vision

• According to William Penn Mott Jr., California
  State Park Director
• A vision is a powerful thing. It is a dream
  based on clear perceptions of the future combined
  with a commitment to take the necessary steps to
  make it happen.

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Fear of Letting Go

• Ralph Waldo Emerson You must let go of a thing
  for a new one to come to you.
• Clutterers fear letting go of things because it
  involves taking a risk.
• Despite many offers for help over the years
  clutterers hold on to their overwhelming
  possessions and resentments they move farther
  and farther away from help.

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Spirituality of Aging

• Must begin with our very existence as older
  persons.
• How do we define this complex process called
  aging?
• Many older people regard age as a mental concept.
• How we age depends upon the way we internalize
  societys images of the old.
• If we start to see ourselves as used up and
  useless, we begin to act accordingly.
• Changes associated with aging do not occur all at
  once and no two individuals experience exactly
  the same changes at the same stage of their
  lives.
• The decades of ones fifties and sixties can be
  very different from the seventh, eighth and ninth
  decades of life.

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Challenges

• To recognize how our society has distorted the
  experience of aging Ageism
• In The Coming of Age, Simone de Beauvoir stated
  that confronting the reality of aging in our
  culture means changing the whole fabric of
  existence.
• A spirituality of aging calls into question the
  deepest values of our civilization.
• If the aging process reveals to us the mystery of
  life, then lifes ultimate meaning cannot lie in
  speed, consumerism, youth, achievement,
  celebrity, and physical beauty.

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Challenges Continued

• The present situation of many older people, old
  and young alike, has been described as a disease
  of the imagination.
• People have accepted the negative images of old
  age, made them their own, and begun to live out
  of these images of incompetence and
  insignificance.
• The task of a spirituality of aging is to convert
  the imaginations of both old and young to a new
  vision of the human.
• This can only happen if the old themselves refuse
  to let society define themand instead
  internalize new images of the later years.

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Confronting Our Own Mortality and Eventual Death

• Face the awareness of our own mortality and a
  willingness to discuss it without hesitation.
• Cultivate an affirmative outlook on death review
  your understanding of death based on your
  spiritual beliefs.
• Speak to loved ones about funeral arrangements.
• Tell personal stories about the past and present.
• Reach out for help from family, friends,
  caregivers and others.

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Psychic Clutter

• Clutter doesnt just happen on the physical
  plane. The physical is a reflection of their
  conscious mind.
• The clutterer holds on to old grudges,
  resentments, long lost relationships, old
  disappointments.
• Clutterers carry a never ending supply of hurt
  and sadness that sours their souls.

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A Clutterers Approach to Fixing Things

• In one word MORE more of everything physical
• Clutterers put their faith in broken chairs,
  unusable cabinets, more money, different
  relationships, stacks of newspapers, engines from
  cars, and so on.
• They clutter their souls with resentments, fears,
  shame, and grudges because they believe that no
  one can help them.

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Five Basic Emotional Needs

• There are five basic emotional needs that are
  deeply ingrained in us attention, approval,
  acceptance, admiration, and affirmation
• To feel fully alive and human, we need to give
  and receive these emotional gifts
• If these basic needs are unmet, life becomes
  meaningless
• Everyone needs these gifts There temporary
  absence can be tolerated for a little while

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Needs Continued

• We become depleted if we are deprived of
  attention, approval, acceptance, admiration, and
  affirmation
• People become emotionally starved when they dont
  get enough of these emotional supplies
• Emotional hunger is the breeding ground for
  emotional desperation and that sets the stage for
  rage

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Meaningful Conversation

• Communication that is deeper, richer and more
  sincere
• Originates from a deeper place inside us
• Open, inviting, friendly, caring
• Based upon interest in the other person
• Free of cliches or superficiality
• Alive both in the speaking listening components

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Immersion in Behavior

• People derive instrumental, intrinsic, and
  spiritual value when they are (1) absorbed in a
  conversation (2) captivated by a lecture (3)
  transfixed by the music, (4) caught up in the
  game, or (5) lost in the pursuit of a question.
• Anything that might disrupt this immersion, e.g.
  illness, grief, shame, resentment, may diminish
  the notion of meaning.

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Do I Believe?

• C.S. Lewis writes (1949)
• The moment one asks oneself Do I believe? all
  belief seems to go. I think this is because one
  is trying to turn round and look at something
  which is there to be used and work fromtrying to
  take out ones eyes instead of keeping them in
  the right place and seeing with them. I find that
  it happens about other matters as well as faith.
  In my experience only very robust pleasures will
  stand the question, Am I really enjoying this?
  Or attentionthe moment I begin thinking about my
  attention (to a book or lecture) I have ipso
  facto ceased attending.

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C.S. Lewis Continued

• St. Paul speaks of Faith actualized in Love.
  And the heart is deceitful you know better
  than I how very unreliable introspection is. I
  should be much more alarmed about your progress
  if you wrote claiming to be overflowing with
  Faith, Hope, and Charity.

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Maintaining Connection

• Communication both verbal and non-verbal
  enables caring to develop and be maintained
• As communication and caring develop, a deep
  connection and commitment may begin to unfold

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Necessary skill to an Intimate Relationship

• The central communication skill in an intimate
  relationship is telling the truth.
• This skill includes telling the truth in any
  given moment in a way that does not blame the
  other.
• Stay with the communication until the other
  person comprehends your words and your intention.
• It is important to maintain truthful
  communication especially during times of distress
  and upset.

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Helping Clutterers Through Compassion

• Compassion contains and expresses feelings of
  openness, caring and interconnectedness
• Compassion is a sustained and practical
  determination to do whatever is possible to help
  alleviate someones suffering
• Compassion Understanding Love
• People who suffer need to be shown as
  unconditional love

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People Who Clutter Suffer

• See the sufferer as a person just like you, with
  the same needs, the same fears, the same
  loneliness Your heart will open to the person.
• Imagine that you are the sufferer. Imagine that
  you are in their pain and loneliness. What would
  you need?
• What the sufferer most wants is what you would
  want to be loved and accepted.
• There is something about hoarding that often
  interferes with our ability to express
  compassion.

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Insight into the Nature of Suffering

• Compassion stems from the recognition of
  suffering.
• If we recognize our own suffering, we will become
  more powerful and effective in recognizing the
  suffering of the others.
• Our compassion for others grows as our ability to
  recognize their suffering grows.

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Insight Continued

• By maintaining compassion we will be able to be
  close to those who suffer as a result of their
  being continuously under the control of negative
  emotion. This form of suffering (being
  continuously under the control of negative
  emotion) is difficult to recognize. It is not the
  acute misery of the ill this pervasive suffering
  is profound and permeates all aspects of life.

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Caring for Others

• Understanding of their world
• Be with the other
• I am both with and for the other

63
Caring and Growing

• The basic pattern of caring is helping the other
  person grow.
• I experience the others development as bound up
  with my own sense of well-being.
• I respond affirmatively and with devotion to the
  others need, guided by the direction of his/her
  growth.
• Caring is always about someone or something
  specific that is cared for

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Resentment

• Is chronic anger that may be entirely subjective.
• It is a combination of the emotions and actions
  and thought patterns resulting from our
  unresolved anger at an injustice.
• Resentment comes from anger just as smoke comes
  from fire.

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Resentment

• According to Paul Ekman (2003)
• Resentment is a long-standing feeling of being
  treated unfairly and unjustly.
• Resentment can fester like a boil and occupy our
  mind all the time.
• Hatred, like resentment, is long standing.
• Hatred involves at least three emotionsdisgust,
  anger, and contempt.

66
Unforgiveness

• According to Worthington (2001) Five Steps to
  Forgiveness
• Unforgiveness is defined as delayed emotions
  involving resentment, bitterness, residual anger,
  residual fear, hatred, hostility and stress,
  which motivate people to reduce the unforgiveness.

67
Self-Forgiveness

• According to Colin Tipping (2002) Radical
  Forgiveness
• Self-forgiveness is difficult we are trying to
  be judge, jury, defendant and witness all in the
  same case.
• Some people who speak of self-forgiveness
  actually indulge in self-blame and recrimination.
• They may use self-forgiveness as another way to
  beat themselves up.

68
Self-Forgiveness Continued

• Tippings appeal is made, not to our human self,
  but to our Higher Self our I Am consciousness.
• This is the part of ourself that is with us at
  our core, observing us but never judging us.
• Self-forgiveness helps us move beyond the wounds
  that may have occurred in the childhood years.
• Once we experience self-forgiveness, a person can
  then be open to feel unconditional love and
  acceptance.

69
Self-Forgiveness Continued

• According to Safer (1999) Forgiving and Not
  Forgiving
• Forgiving yourself involves coming to terms with
  the one person you can never get away from you
  can cut out everyone but there is no escaping
  yourself for the rest of your life.
• Three tasks are specific to self-forgiveness
  (1) taking responsibility (2) grieving for
  losses you have caused and (3) hating yourself
  less as a result.

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What Triggers Self-Forgiveness?

• Safer states that moments of kindness or caring
  that a person expresses to another, whether they
  are registered consciously or not, may exert a
  subliminal beneficent influence later on.
• Holding yourself accountable, without hatred or
  denial, for the damage you do to the person in
  the mirror is the prerequisite for every other
  act of forgiveness.

71
Some Rules to Live By

• According to Carolyn Myss (1996)
• Make no judgments
• Have no expectations
• Give up the need to know why things happen as
  they do
• Trust that the unscheduled events of our lives
  are a form of spiritual direction
• Have the courage to make the choices we need to
  make, accept what we cannot change, and have the
  wisdom to know the difference