1. Understanding and working with hoarding behaviors
Eileen Dacey, MSW, LCSW
North Shore Center for Hoarding and Cluttering

2. We cannot effectively resolve what we do not fundamentally understand.

3. What do you know about Hoarding Disorder?
Misinformation, Misunderstanding, and Stigmas
Processing and Categorization Issues
Bio-psychosocial Effects

4. A study by John Hopkins showed that an estimated 3 – 5% of the population suffers from Hoarding Disorder however; it is considered a low representation of the actual percentage.
Making this a very common condition

5. Hoarding behavior can start in adolescence Genetics Epidemiology
Difficult to diagnose in young children
Genetics
Epidemiology
Prevalence hoarding of 1 out of every 20 people.
Behavior triggered by trauma or loss
All pre-disposed to mental health issues
More men than women
Average age of treatment 55
Higher IQ, education level, creative ability,
Perfectionism

6. Most frequently hoarded items:
Paper
Clothing
Gifts
Most prevalent careers:
Teacher
Attorney
Social Worker

7. Have you ever?
Sentimental – representation of self and life memories (grief attachment)
Instrumental – item has value for future use, could be repaired
Intrinsic – seeing the beauty in an item
Security- items as possibilities

8. Viewing hoarding as a mental health issue is often hard to understand.

9. DSM-5 Diagnosis
A. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding. B. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace, or other personal surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g., family members, authorities) to keep these areas free of possessions. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). D. The hoarding symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease). E. The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, lack of motivation in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autistic Disorder, food storing in Prader-Willi Syndrome).

10. Specifiers of Insight Good or fair insight Poor Insight Absent Insight
Excessive Acquisition
Excessively collecting, buying, or stealing items that are not needed or for which there is no available space

11. Understanding the symptoms of hoarding
Difficulty Discarding: Reluctance to discard personal possessions, including objects that might be considered worthless or have little intrinsic value. Beliefs for saving items are more intense and rigid, and applied to a greater number of possessions. Attempts to discard usually cause substantial emotional distress.
Excessive Clutter: Most visible component of hoarding. Can create significant difficulty using living spaces. Clutter can cover beds, chairs, tables—rendering them unusable. In severe cases can prohibit movement throughout the house.
Excessive Acquiring: Compulsive buying, collection of free items, rummaging through trash bins, and inheritance. Distress related to overspending/debt.
(Tolin, Worden, Wooten, and Gilliam 2017)

12. Co-occurring Disorder
% of the time Hoarding Disorder shows up alongside another mental health diagnosis
Co-occurring Disorder
92% of the time Hoarding Disorder is diagnosed alongside another mental health diagnosis.
Research shows that over 53% of individuals suffering from hoarding disorder are also diagnosed with Major Depressive Disorder, approximately 40% are diagnosed with ADD or ADHD, and another 27% are diagnosed with Social Anxiety Disorder…
(Steketee, 2007)

13. Processing Issues
To complicate things more, individuals with hoarding disorder experience trouble in processing information. These processing deficits affect attention, memory, categorization, and decision-making.
(Frost, 2008)

14. Clarifications Hoarding is a mental health disorder not a decision
Hoarding is not a moral issue; it is not caused by laziness, lack of standards, lack of responsibility
Clutter is a symptom of the problem
Hoarding and squalor are not the same
squalor: filthiness or degradation from neglect
hoarding: volume of clutter, not cleanliness

15. When trying to understand hoarding, imagine an iceberg.

16. What about clean-outs?
By the time hoarding cases gain public attention, they likely:
Require intensive, lengthy, costly, strategic and complex responses
Enormous emotional and psychological costs to the homeowner
Creates psychological and emotional impact on clients
It is not sustainable
BUT sometimes it is necessary
Clean-outs are NOT effective
They can be traumatizing, can do more damage than good in the long run
Individuals in crisis cannot make basic decisions
Limbic system on overload

17. Clutter’s Interference with Basic Functioning
Cooking
Cleaning
Moving through the house
Sleeping
Likelihood of:
Fire
Fall Risks
Poor Sanitation
Pest Infestation
Risk to those who live in the home and neighbors
Hoarding accounts for 24% of preventable fire fatalities

20. building trust Connect Take time to NOT talk about the STUFF
Demonstrate a Desire to Understand
Empathy
Empowerment
The person believes they have new choices they didn’t have before or a new freedom they haven’t experienced before. Of course, formally, they always had these choices, but they didn’t see that they had them. Empowerment is the seeing.
Increases self-confidence, courage, & motivation giving individual opportunity to become a stakeholder in their own treatment

21. Why is Empathy Important?
“I've learned that
people will forget what you said,
people will forget what you did,
but people will NEVER forget
how you made them feel.”
- Maya Angelou

22. Engagement and Motivation
1. If you woke up tomorrow and your home was just the way you want it to be, how would your life be different?
2. What is something you want to do that you currently are not doing or cannot do because of the clutter in your home?
Piano

23. What we want success to look like.

24. What success really looks like.

25. OZ vs. Kansas

26. Resources