Hoarding and Developmental Disabilities:
Coping and Prevention
June 3, 2015
To offer specialized programs and services that are accessible to older Manitobans that support and enhance their social, emotional, physical, intellectual and spiritual lives and promote active participation in all aspects of community life.
To develop and deliver innovative programs and services that improve the quality of later life.
• A not-for-profit organization that provides programs and services to older adults 55+
• Established in 1957 in response to the need from older adults and their caregivers
• Governed by a Board of Directors
3 Pillars of Innovative Programs & Services: • Safety & Security
• Social Engagement
• This Full House • What is Hoarding?
• Assessment • Best Practices • Resources
‘This Full House’ • Voluntary program for older adults (55+) that
addresses hoarding and squalor • Client participation is essential • Uses cognitive rehabilitation and exposure
therapy with the goal of harm-reduction • Involves counseling, sorting/cleaning services,
follow-up, and referral
Getting Help Referrals come from a variety of sources: • Self-referrals • Family/Other Supports • Community/Government Agencies • Housing Contact A & O and request to speak with Intake *In order for referral to be made, consent must be given 8
Problem behavior? Symptom of
Only on TV?
Excuse for being lazy?
• The acquisition of, and failure to discard a large number of possessions that appear to be of useless or of limited value;
• Living spaces sufficiently cluttered so as to preclude activities for which the spaces were designed; and
• Significant distress or impairment caused by the hoarding.
(Frost & Hartl, 1996)
Hoarding Disorder Diagnostic criteria for DSM-5 (Obsessive-Compulsive & Related Disorders
category): 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).
Collecting vs. Hoarding Collecting: • Organization • Mint condition • Kept in specific areas • Quality of life not
compromised • Pride
Hoarding: • Usually disorganized • Takes over areas of
home • Cause of distress • Risk to health • Safety concerns
• The state of living in unsanitary conditions which
may include human or animal feces, rotting food, and infestations of rodents/insects
• May or not involve hoarding behaviors • Like hoarding, squalor can pose a myriad of
health and safety concerns
Hoarding Profile Who? • Often begins in adolescence, severity increases with
age • Might occur alongside other conditions (e.g.
depression, anxiety) • Often single • Treatment sought in 50’s – women more than men • Range of education, income
What? • Clothing • Written information/material • Food • Craft items • Containers, bags • Used wrappers, bottles, tissues • _______________________
Where? • Own home • Multiple properties • Storage • Vehicle • Friends/parents • Acreage
Why? • Other illnesses/diagnoses • Family History of Hoarding
– Genetics, environment • Beliefs about Possessions
– Sentimental value, utility, beauty • Cognition
– Differences in brain function and thought processes • Avoidance
• Object has emotional significance • Losing important information • Wasting useful objects • Object is beautiful or unique • It “doesn’t feel right” to get rid of it
How? • Shopping • Online shopping • Garage sales, free weekends • Relatives, friends • Trash, recycling bins • Workshops, fairs
• Physical Health & Safety – Falls, tripping over clutter – Unable to use bed, eat at table, navigate stairs – Food poisoning – Infestations – Services may not be available (e.g. plumbing,
electrical, Home Care)
• Emotional/Social – Shame, embarrassment – Anxiety – Depression – Feel overwhelmed – Family/marital discord – Reluctant to have visitors – Stress from family, landlords, etc.
• Financial – Cost of accumulating belongings – Moving due to eviction – Complying with City orders – Fines – Damage to home/property – Losing bills/important documents
• Home Safety - falls, fire hazards, rotting food, animals, infestations, structure, other parties
• Personal Safety - coping, social support, self-care, distress, risk of homelessness, overall health
• Basic Strategies • Curiosity over Criticism • Reducing Acquiring • Treatment
– Harm Reduction – Cognitive Rehabilitation – Sorting/Discarding *Aim for client participation wherever possible – goal is sustainable change that involves client
Basic Strategies • Establish trust and
respect • Don’t touch • Share concerns about
safety • Ask questions • Respect each
individual’s process • Allow the individual to
take control • Provide resources • Respect decision(s) • Encourage any
progress • Be patient • Family – take a step
back • Pick your battles
Avoid: • Judgmental language • Touching / removing items • Forced clean ups • Arguing • Overwhelming demands / unrealistic expectations • Manipulation
• Lack of trust • Past attempts • Physical barriers • Mental health concerns • Dementia • Lack of motivation • Time/Deadlines
Curiosity over Criticism • Why are you keeping this item / Can you tell me
about this item? • What might happen if this was lost or was thrown
away? • How do you feel about your bedroom/home/space? • How were you feeling / what were you thinking
about before buying this item? • How did you feel after buying it? *Match the language used by the individual
Reducing Acquiring • Determine the source • Redirect – replace with other pleasurable
activities • Positive reinforcement – rules/rewards • Find a safer (or smaller) item to collect • Limit access (space, locks, funds)
Harm Reduction • Target most concerning areas without requiring
hoarding behaviors to stop completely – Create safer living environment by working on one
goal at a time (i.e. pathway to front door) – Reduce collecting by setting limit (i.e. 1 item/week,
cannot exceed shoebox)
Cognitive Rehabilitation • Approach designed for older adults • Targets executive functioning skills (memory,
attention, problem solving) – Calendar Use, To Do List, Goal Setting – Problem Solving Model – DBESTE
Sorting/Discarding • Strategies based on exposure therapy • Repeated exposure to decision-making about
belongings (sorting/discarding) which, over time, leads to a decrease in distress
• Client involvement required for long-term change
Sorting/Discarding • Tracking distress: emotion
faces, numbers, etc. • Hierarchy – least to most
distressing • Prepare – supplies etc. • One area at a time • Make a list ahead of
time/visualization • Rule Lists
• Rewards • Limit time spent sorting • Space/numerical limits • Categorizing: looks like? • Choose between items • Social stories • Multi-disciplinary approach
Resources • A & O – This Full House • OCD Centre Manitoba Other Helpful Services: • Employment & Income Assistance • City of Winnipeg (Bylaws & Community Services) • Contracted professional services
– Professional Organizers – Cleaning Services – Hauling Services
References Ayers, C., Twamley, E., Espejo, E., Saxena, S., and Wetherell, J. (2011). CREST: Cognitive Rehabilitation and Exposure/Sorting Therapy for Compulsive Hoarding. VA San Diego Healthcare System, University of California. Berry C. and Schell, R.M. (2006). Reducing Hoarding Behavior with Individualized Reinforcement and Item Return. Behavioral Interventions 21, 123-135. Gallo, K., Wilson, L., and Comer, J. (2012). Treating hoarding disorder in childhood: A case study. Journal of Obsessive-Compulsive and Related Disorders 2, 62-69. Tompkins, M. and Hartl, T. (2009). Digging Out. New Harbinger Productions, Oakland CA. Steketee, G. and Frost, R. O. (2000). Compulsive Hoarding and Acquiring: Therapist Guide. Oxford English Press. Storch, E., Rahman, E., Park, J., Reid, J., Murphy., and Lewin, A. (2011). Compulsive Hoarding in Children. Journal of Clinical Psychology Vol. 67 (5). Tolin, D., Frost, R., and Steketee, G. (2014). Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding. Oxford University Press. www.iocdf.com https://www.autismspeaks.org/blog/2015/02/06/autism-hoarding-adult-son-fears-parent%E2%80%99s-help-overflowing-room
A & O Services
Safety & Security • Elder Abuse
Prevention Services • Safe Suite Program • Older Victim
Services • SafetyAid • This Full House
Social Engagement • Senior Centre
Without Walls • Connect Program • Entry Program for
Older Adult Immigrants
• Centres/Meals Programs
Counselling • Information &
Referral • Intake • Counselling • Housing • Legal Clinics
A & O: Support Services for Older Adults 200-280 Smith St. Winnipeg, MB R3C 1K2 Phone: 204-956-6440 Toll-free: 1-888-333-3121 Fax: 204-946-5667 e-mail: [email protected]
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