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

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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)

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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

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Types of Hoarding (continued)

• Animal Hoarding

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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)

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Causes

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

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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).

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Co-morbidity

• 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

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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)

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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)

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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)

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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

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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

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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_hoardin
  g.html.

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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/li
  b/2006/02/the-impact-of-obsessive-compulsive-disor
  der/.
• 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.