1. Treatment Interventions for Adults with Hoarding Disorder
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Tracy Roach
GRC MSW Program
Abstract
Criteria New to the DSM-5
Comorbidities
Hoarding disorder is a new diagnosis in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Hoarding disorder is seen in approximately 5.8% of people in the United States. Individuals with hoarding disorder often face unique health and safety risks due to their accumulation of clutter. People with hoarding disorder have high comorbidity rates with other mental and physical health disorders and have co-occurring medical issues. This paper discusses comorbidities and addresses treatment intervention strategies and causes of hoarding disorder in adults. Findings show that the therapeutic relationship is a critical part of treatment for this disorder. Findings also suggest that motivational interviewing, cognitive behavioral therapy, and exposure therapy are effective treatment options. The use of an interdisciplinary team approach utilizing a therapist, doctor, and professional organizer has been shown effective in treating adults with hoarding disorder.
Difficulty discarding items, even if they are of no real value
A need to save or accumulate items, and marked distressed when trying to get rid of these items
Living areas become cluttered and cannot be used for their original purpose
The hoarding causes functional impairment in at least one area of functioning, such as social, occupational, or keeping a safe environment
American Psychiatric Association (2013) is the reference for this criteria
Estimates say that 75-92% (Kress et al., 2016; Hall, Tolin, Frost, & Steketee, 2013) of people with hoarding disorder have another mental health disorder
Depression and attention-deficit hyperactivity disorder have high comorbidity rates with hoarding disorder (Hall et al., 2013)
There is a weak correlation between hoarding disorder and obsessive compulsive disorder, however hoarding behaviors may be a symptom of obsessive compulsive disorder (Hall et al., 2013)
People with hoarding disorder also exhibit a high comorbidity with medical issues
Kress et al. (2016) report higher instances of the following in people with hoarding disorder: fibromyalgia, obesity, chronic fatigue syndrome, diabetes, sleep apnea, bleeding or heart problems, and arthritis
Ayers and Dozier (2015) add that high blood pressure, seizures, and stroke are medical comorbidities
Treatment Interventions
Risks
(Johnson, 2015)
Cognitive Behavioral Therapy (CBT) is the most widely-researched, and most accepted, form of treatment for people with hoarding disorder (Levy et al., 2017).
More specifically, the CBT method of Exposure and Response Prevention has been shown to decrease clutter and decrease hoarding symptoms (Hartl & Frost, 1999)
Psychoeducation, which provides clients with information and coping skills surrounding hoarding disorder, has also proven to be helpful (Levy et al., 2017)
Motivational Interviewing can be used to define goals when a client is feeling ambivalent (Steketee & Tolin, 2011)
Assessments should be given at mental health clinics
Causes & Theories
Can get sick from expired, or contaminated, food
Too much clutter can become a fire hazard and escape from a fire may be difficult
Clutter could also prevent emergency personnel from entering the house for rescue purposes
Insect infestations
Toxic odors
Falls in the home
Losing medications
Risk of eviction/homelessness
Possible visits from child protective or animal welfare services
Job loss
Kress et al. (2016) is the reference for all of these risks
49% of people with hoarding disorder have relatives who exhibit hoarding behaviors (Lynch et al., 2015)
Situational factors such as divorce, a move, the death of a spouse or parent, retirement, or a young adult moving out of the home can be causes. Dozier, Porter, & Ayers (2016) also add job loss or changing jobs
Loss and grief are common themes associated with hoarding
Social Learning Theory says that children who observe hoarding may take on those behaviors themselves (McLeod, 2016)
The client-therapist relationship is critical when working with people with hoarding disorder. A person-centered approach should be taken (Ayers et al., 2012)
Kress et al. (2016) suggest a multi-disciplinary approach