1. Dawn White MHS.,BScN.,RegN
Hoarding
Dawn White MHS.,BScN.,RegN

2. Did You Know
Hoarding is not limited to social class, race, culture or education level
Interventions are normally costly, complex and time consuming
Without proper intervention, the hoarders environment will continue to evolve until the safety of the individual and the community might be put at risk

3. What is Hoarding?
Excessive accumulation and failure to discard proportionately (animals or things)
Activities of daily living are impaired by spaces which cannot be used for intended purposes
Distress or impairment in functioning to the person hoarding or others such as neighbours/family/fire department/landlord/condo corporations

4. Is Hoarding Cluttering?No
In cluttering the volume is less
Clutterers are still able to discard things, albeit it may take effort on their part
The clutter does not debilitate their lives to the same degree as those who hoard
Cluttering MAY be a stage in developing hoarding

5. Prevalence 1-5% of General Population
USA based stats. No stats yet for Canada
Increases as person ages
OCD may be part of it, but is not evident in majority of those who hoard
In London, those who hoard could range from 3,500 to 17,500 people in the city
If you had a complex of 64 units, with an average of 2 ppl per unit = 1-6 hoarders

6. Why Do People Hoard?
No conclusive answer yet but as of 2013 it will become an official psychiatric diagnosis
It legitimizes it as an illness and not simply slovenly or lazy behaviour
New brain imaging research (Tolin, 2012) has revealed that hoarders, when faced with being asked to pick and discard even junk mail feel intense discomfort and anxiety
Their brain does not activate the area that allows us to decide what is important and what is not so everything can feel important

7. Why do People Hoard? (cont)
Hoarders also took much longer to decide what to discard.
Parts of the brain responsible for motivation and insight also under-performed, which might account for why hoarders are able to live with such extreme living conditions.
They notice it, but feel no motivation to clean it up nor do they seem to recognize what a problem it is. This is also seen in people with autism.

8. Why Do People Hoard (cont)
Another part of their brain was over-stimulated; the part which causes attachment to personal objects and the ability to make decisions about their possessions that others would consider reasonable
This causes the anxiety, irritability, tearfulness, feelings of being overwhelmed, grief and sadness that is the hallmark of what someone who hoards experiences at the thought of throwing any of their possessions away

9. Why Do People Hoard Genetics: May be a genetic link
84% have a close family member with hoarding behaviour
37% have a history of OCD
No conclusive proof, but it does seem to run in families
Learned behaviour would also play a major role as well

10. Why is this an important subject?
For the person who hoards and their families: It can create impaired activities of daily living/unhealthy living conditions/unsafe living conditions
For property managers, condo corporations/general public who live in close proximity: It can be a legal, public health and safety issue. Examples may be vermin, fire load, structural collapse and lack of ability for Emergency Responders to access the individual
Often people who hoard will not voluntarily get help. It is often found by accident

11. Hoarding Types Common hoarding
Subcategories of generalist vs specialist
Diogenes Syndrome
Animal hoarding

12. Common Hoarding Anything can be hoarded
Generalists save everything. Very valuable items may be mixed in with garbage
Specialists save only specific items, ie dolls or tools.

13. Characteristics Belief that emotional comfort comes from objects
Objects may be connected to important people in their lives; therefore the object BECOMES the person
Having these objects is almost like having the person still a presence in their lives
This is why it may be so hard to discard objects. It is as if they are discarding their loved one

14. Characteristics
Fear of losing something important “I might need that!”
Feeling of loss of self or identity
Need for control of possessions
Due to distress of throwing away possessions; it is avoided at all costs

15. Characteristics and Beliefs
Just in case—I might need it
Item must be saved because it could be useful in the future if not for the hoarder, then for someone else
Sentimental saving– I can’t part with this..it means too much to me
I love this—aesthetic saving; something about an object gives aesthetic pleasures and person cannot part with it

16. Diogenes Syndrome Self neglect Domestic squalor Hoarding
Found in aproximately .5/1000 of the general population
In London this would equal 175 cases
Generally affects seniors

17. DS Elderly Live alone Often above average intelligence
Reclusive, irritable, refuses help
Isolates self from society
60% do not have a diagnosable mental illness (although now with hoarding dx, they will)
Dementia onset may be a factor
High risk and mortality (46%)

18. Animal Hoarding
Like other forms of hoarding; no one is sure why it develops
Factors may range from genetic predisposition to attachment disorders
Research shows that animal hoarders may grow up in chaotic homes with inconsistent parenting where animals were the only source of consistent emotional contact (Arluke et al 2002, Patronek 2001)

19. Animal Hoarding
An individual acquiring more animals than they can care for
Inability to provide even minimal standards of nutrition, sanitation, shelter and veterinary care, with this denial often resulting in starvation, illness and death
Denial of the inability to provide this minimum care and the impact of that failure on the animals, the household and the human occupants of the dwelling

20. Animal Hoarding Three types of animal hoarders:
Overwhelmed Caregiver Hoarder—more based in reality, become overwhelmed by the number of animals that they take in
Rescuer Hoarder—mission driven, they are actively and compulsively acquiring animals
Exploiter Hoarder—feel no empathy towards animals or humans, acquire animals to serve their own needs

21. Animal Hoarding 71 incidents across USA and Canada were reviewed:
83% involved woman ( 71% were widowed, divorced or single)
53% of AH residences were home to other individuals including children(5%), elderly dependents and disabled people (21%)

22. Animal Hoarders
Often essential utilities and major appliances such shower, heaters, stoves, toilets and sinks were not functional
93% Residential home interiors were usually unsanitary
70% had a fire hazard
16% of AH residences were condemned as unfit for human habitation
25% of AH were placed under either permanent or temporary protective custody

23. What can be done?
Safety is the most important goal. If the fire load looks extreme; contact the Fire Department. In London, Inspector James Hind
Public Health Unit for health risks to building, ie bedbugs/vermin
London City Hall has a bylaw that limits animals to a total of two
London is in the process of forming a community coalition to address hoarding. City Hall, Fire Department, Health Unit and community agencies such as CMHA and specialized cleaning services

24. Practical Tips for Condo Corp
May need to use all legal means to ensure that unit is cleaned up. Ie court/bylaws/declarations
If Property Managers are part of engaging clean up crews; be sure to hire ONLY bonded crews
If the person does not receive help and the risk was sufficient that a ‘clean sweep’ was done; be prepared for the situation to occur again
The safety of the neighbouring units may be at risk, so inaction is not an option if the situation appears severe

25. Practical Tips for Condo Corp
Remember the person may be challenging to work with and may want to resist every intervention, but safety of others is paramount
If the person ASKS for help, suggest they call service agencies such as the London branch of the Canadian Mental Health Association at , or they could speak to the Fire Department if they are worried about the excess materials in their home (not likely, but possible)

26. 10 Most Common Things Hoarded
Paper especially newspaper
The things used in everyday life which don’t get put away
Excessive recycling materials which don’t get recycled
Clothing
Plastic bags
Sentimental things
Mechanical things, car parts, tools, nuts etc
Wool, fabric, craft supplies
Furniture
Animals (Birchall Consulting)

27. 5 Red Flags that Hoarding Might Becoming a Problem
How many areas of your home can’t be used for their intended purpose, without shifting things around?
How easy is it to find things when you want them?
How difficult is it to walk through each of the rooms of your home because of clutter?
To what extent are furniture tops cluttered?
When you see things you want, do you feel compelled to have them? (Birchall Consulting)

28. Hoarding Quiz
Rating Scale: 0=not at all 2=mild 4=mod 6=severe 8=extreme
Because of the number of possessions you have, how difficult is it to use the rooms in your Home?
How upsetting is it for you to have your home in its current condition?
How upsetting/concerning is it for others to have the home in its current condition?

29. 0=not at all 2=mild 4=mod 6=severe 8=extreme
4. Have other people/agencies tried to intervene (offer to help you tidy up) because of the clutter?
How difficult/distressing is it for you to get rid of things?
How often have you spent money you don’t really have because you saw something and “just had to have it”

30. Scoring
If you answered above 2 to questions 1, 4 or 5; Assess your situation by asking for feedback from someone you trust who knows you and ask for help accordingly
If you answered 2 keep an eye on your situation, these situations are red flags
If you answered 4 or higher to questions 2,3 or 6 ask for feedback from a trusted friend who knows you and search yourself for the reasons and your ability to tackle the problems yourself (Birchall Consulting)

31. Websites www.hoarding.ca Birchall Consulting
YouTube: look up Dr. Randy Frost
This is the imaging study
This discusses the new DSM category
London Fire Dept
Birchall Consulting
YouTube: look up Dr. Randy Frost
This is the imaging study
This discusses the new DSM category
London Fire Dept