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Hoarding pt.1

Date post:13-May-2015
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2. DEFINITIONS OF HOARDING Acquisition of and failure to discard useless or limitedvalue possessions Living spaces cluttered and unusable Distress caused by hoarding Significant risk to health and safety Compulsive hoarding interferes with basic activities,including cooking, cleaning, showering and sleeping. 3. COMPULSIVE HOARDING Hoarding is the compulsive acquisition or savingof items that are perceived by the individual tohave intrinsic value or importance. Hoardingcan be a symptom associated with eitheranother disorder such as depression, or canoccur all by itself. Individuals who hoard mayexperience obsessions, cognitive distortions,and or compulsions about their possessions. 4. HOARDING DATA Hoarders make up approximately 2 to 5% of the generalpopulation, in APS hoarding occurs in 12% of our cases. According to Frost & Hartl, l996, 18% to 42% of peoplediagnosed with OCD are hoarders There are other mental disorders in which HoardingBehavior is seen, Anorexia Nervosa, Dementia andsometimes Psychotic Disorders as well as Depression Between one in four to one in five people with dementiaare also hoarders 20% of schizophrenics become hoarder 5% of general population would account forapproximately 15 million in the US 5. WARNING SIGNS OF HOARDING Extreme collection and storage of items in the home and in theoutside areas Accumulation of combustible materials (newspapers, magazinesand rubbish as well as paint, solvents and multiple examples ofcleaning products) Blocked exits (doors/windows) All windows covered with diverse materials including piled objects(books, newspapers, boxes and occasionally sheets and tarp) Narrow pathways in the home Rat and/or insect infestations also including maggots, bed bugs,fleas and even reptiles. Rotting food and/or used food containers Human and/or animal waste Long-term neglect of home maintenance Non-working utilities, such as heat, running water, sewer,refrigeration 6. DANGERS OF HOARDING The collection of newspapers, magazines, old clothes, paint andchemical products may cause fire and exacerbate the fire once itbegins. Animal hoarding can spread contagious diseases EMTs often are unable to find people during fires until it is too late Large piles of items can fall upon the hoarder and helpers, bothinjuring and in some instances killing the people. Adjacent property owners are also at risk primarily of fire, insectinfestation and the risk of the hoarders property falling on theneighbors property The amount of heat released from the contents (BTUs) oftenexceed the design of fire protection systems and fire wall ratings. Affects ability to escape for those in the house and for those whohave gone in to help rescue the residents. Rapid fire spread/high heat decreases time of failure for fireresistant materials (collapse). Substantial weight increase can exceed the structural design.Weight can be from materials themselves or from absorbing water. 7. CLUTTERING VS. HOARDING Where are the THINGS? Many older people by definition have lived many years. There are things that they have collected over the years and as their energy decreases; and maybe depression develops, they no longer have the energy to weed out things they no longer need or to put things away even when they come back from grocery shopping or even when some brings the food in. Where do they put things? They may have to move other things to make room. This action takes effort that they cant bring about. Some people collected favorite things but have now moved to an apartment from a single family home. They have boxes to unpack, but dont have the energy or the room to place another thing. They dont even have the energy to throw or give it away. That is a picture of cluttering. The person who clutters might not have the energy to get to the magazines that are arriving. Thus, they remain in piles. 8. What is a hoarder? Now let us look at the picture of hoarders. They might also havemoved into a smaller abode. They might receive groceries fromfriends, shoppers or get them themselves. However, they mightborrow from the McDonalds when they go there. They take packetsof sugar, packets of salt, pepper, ketchup and, of course, they willkeep the container in which the McDonalds came from. They mightask for an extra container every time they go to a restaurant. Theymight wash out the containers, but more than likely, they will justleave it in a pile which is co-mingled with other piles. They mighteven go to trash bins next to groceries and bring back some of thatbread that someone threw out by accident. After all, who woulddream of throwing away good bread. It might come in handy ifsomeone is hungry. The hoarder goes out and gets magazinessometimes from the next door neighbors stoop or more than likelyfrom another valuable trash bin. Their piles of newspapers dateback years and years. They might, in fact, sleep on thenewspapers. Their beds are piled too high to get to the top. 9. COMMON HOARDINGCOMPULSIONS INCLUDE Inspecting possessions Purchasing more items Counting items Checking garbage (own and others) for objects Looking through circulars for sales Maintaining clutter Making piles/clutter visible Making discard piles without actually discarding Calling others to check on items Perspective on objects differs from others who donot see the something special in specific items. 10. COMMON HOARDING BEHAVIORS Difficulty Organizing Tasks Perfectionism Poor Attention (ADHD 15% 20% ) Excessive Acquisition Inefficiency Indecisiveness Impulsivity Impaired or special Sensitivity 11. COMMON HOARDING OBSESSIONS AND COGNITIVE DISTORTIONS Thoughts about the importance and/or necessity ofobjects Fear of running out of objects Fear of discarding an object and then needing it Fear of losing control of saved objects Fear of discarding items with emotional value Fear of losing sight of an item Fear of being irresponsible Fear of making a mistake regarding a choice ofdiscarding or saving an item 12. WHY DO OLDER PEOPLE HOARD Items are perceived as valuable Items provide a source of security Fear of forgetting or losing items Constant need to collect and keep things Obtaining love not found from people Fear others will obtain their personal information Physical limitations and frailty Inability to make changes Lack of motivation The hoarder does not recognize a problem with his/herlife style Hoarding is a successful compulsion 13. NEUROBIOLOGICAL ASPECTSOF HOARDING OCD and Hoarding Compulsive Hoarders and Brain GlucoseMetabolism Anterior cingulated gyrus Posterior Cingulated gyrus Anxiety Disorders Dementia 14. TREATMENT STRATEGIES Medication: SRIs vs. Ritalin CBT (Cognitive Behavior Therapy) Multiple approaches simultaneously 15. Psychotherapy Why does the person hoard? Group therapy is a good starting point Small goals, small gains very BIGaccomplishment Learning to organize Learning to give something up Continue therapy as a means to preventrelapse. 16. TREATMENT FOR COMPULSIVE HOARDING Education about the problem and the treatment The hoarder and the therapist establish goals related tobasic organization and de-cluttering. With gentle challenges, the need to collect is devalued The pace is as slow as the hoarder requires Only a small area of the hoarders living area is workedupon at any one time The hoarder, with the therapists help, make decisionstogether Things can be thrown out, kept or donated. Before and after pictures are taken in order to help thehoarder see the accomplishments Maintenance and the prevention of relapse continues fora lengthy period

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