Understanding Hoarding Behaviors
Marnie Matthews, MSW, LICSW North Shore Center for Hoarding and Cluttering
978-624-2207 [email protected] Not for reproduction or use without the expressed written permission of
Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
We cannot effectively
resolve what we do not
fundamentally understand.
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
What do you know about Hoarding Disorder?
• Misinformation, Misunderstanding, and Stigmas
• Epidemiology
• DSM V
• Mental Health - Comorbidities
• Processing Issues
• Bio-psychosocial Effects
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Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
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.
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
FAQs • Hoarding behavior can start in adolescence
– Difficult to diagnose in young children
• Genetics vs. learned behavior
• 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
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FAQs
• Most frequently hoarded items:
– Paper
– Clothing
– Gifts
• Most prevalent careers:
– Teacher
– Attorney
– Social Worker
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Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
• 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
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• Bought something you didn’t need or really like or more than you needed because:
It’s such a great deal!
It’s too good to pass up!!
I could wear it at some point.
Aw, I know who would love this.
It’s brand new!
I could sell it and make money!
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Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
Mental illness is often hard to consider when faced with a hoarding situation.
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Why Can’t You Just…..
Clean Up Get Rid
Of It Just Throw
It Out
Hoarding Disorder 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).
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Hoarding Disorder vs. Hoarding Behavior • Hoarding Disorder Symptoms
– Chronic
– Progressive
• Hoarding Behavior Symptoms – Sudden onset in adulthood
• TBI
• Cerebrovascular Disease
• Disease(s) causing cognitive deficits
– Restricted to other mental health disorder • obsessions in Obsessive-Compulsive Disorder,
• lack of motivation in Major Depressive Disorder, in Schizophrenia or another Psychotic Disorder
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Restricted to Mental Health Disorder
OCD • Impulse control • Complex informational processing Depression • Motivation • Energy levels • Ability to concentrate • Memory • Anxiety level • Sleep
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Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
Frontal Lobe Duke Keonavongsa Jacob Bisher Cody Snyder Asante Muhammad
Neuropsychological Impairment
“The initial clues that hoarding was related to frontal-lobe dysfunction came from case reports of pathological collecting and saving that began after a brain injury, typically along with other changes in personality and social functioning.”
- Grisham, Norberg (2010)
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Symptoms Restricted to General Medical Condition
“Any medical condition that impacts overall functioning can be a vulnerability factor for hoarding…..If other vulnerability factors are
present, any medical condition may be enough to tip the scales and minor problems with
discarding and clutter can become more severe.”
-Riddle-Walker (2011)
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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)
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
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)
How does it get that bad?
• Hoarding is a progressive and chronic disorder.
• Level of insight.
• Hoarding behavior can start in early adolescence.
• Hoarding behavior is triggered or exacerbated by trauma or loss.
• Isolation
• Embarrassment
• Shame
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
How does this information help me resolve cases?
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
When trying to understand hoarding, imagine an iceberg.
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
What is Empathy?
em·pa·thy (noun)
the ability to understand
and share the feelings of another
The Healing Power of Empathy – ‘the care effect’
Harvard Medical School’s Program in Placebo Studies and the Therapeutic Encounter
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Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
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
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Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
What is Empowerment?
...empowerment is the flip side of helplessness. - Joss Whedon
Focusing on client strengths provides the fuel
and energy for that empowerment. Miley et al, (2004:91)
(http://www.bemidjistate.edu/academics/publications/social_work_journal/issue14/articles/rankin.htm)
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Why is Empowerment Important?
The result of empowerment is that 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.
(http://www.mediate.com/articles/oReardonD3.cfm)
increases self-confidence, courage, & motivation giving individual opportunity to
become a stakeholder in their own treatment
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Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
Result of Empowerment
• Skills
• Resources
• Opportunity
• Motivation
• Accountability
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Engagement
ENGAGEMENT OF THE INDIVIDUAL • Empathy and empowerment work together
to engage the individual as an integral part of
the team approach.
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Assessment Tools • Clutter Image Rating
– Assessing ‘volume’
http://www.ocfoundation.org/hoarding/cir.pdf • H.O.M.E.S. – Multi-disciplinary Hoarding Risk
Assessment – Assessing risk
http://www.masshousing.com/hoarding • Uniform Inspection Checklist – Hoarding /
Excessive Clutter – Minimum safety and sanitation standards
http://www.masshousing.com/hoarding
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Hoarding vs. Squalor
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As humans, we respond to situations based on our
perceptions of the situation, not necessarily to an objective
review of the facts. Our perceptions are influenced by our life experiences, culture,
values, and beliefs.
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
Why Start with Harm Reduction The primary goal is for safety and functionality
of the living conditions and living space . It is NOT about resolving or treating the hoarding disorder.
• Have a conversation about safety hazards such as access for emergency services.
• Discuss the consequences of not meeting safety standards (ex: BOH involvement, eviction, court proceedings.)
• Offer assistance in creating a safe environment (this may not include discarding items) The primary goal is for safety and comfort of the living conditions and living space to be achieved in accordance with the individuals standards and goals.
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Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
Level of Insight Good or fair insight: Recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic. Poor insight: Mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary. Delusional: Completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.
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Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
Work S.M.A.R.T.
Specific
Measurable
Attainable
Relevant
Time-bound
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Seeing it Through
Establish a baseline
Regularly Monitor and Measure Progress
Keep Everyone on Track (and on the same track)
Expect set-backs
Acknowledge progress
Keep communication open
Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
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Not for reproduction or use without the expressed written permission of Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
OZ Vs.
Kansas Not for reproduction or use without the expressed written permission of
Marnie Matthews, MSW, LICSW 978.624.2207 [email protected]
What we want success look like.
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What success really looks like.
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RESOURCES
• www.facebook.com/groups/HoardingTaskForceNetwork
• www.masshousing.com/hoarding
• http://thehoardingproject.org/home/
• www.ocdfoundation.org
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