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HOARDINGHOARDING

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DEFINITIONS OF HOARDINGDEFINITIONS OF HOARDING

• Acquisition of and failure to discard useless or limited value 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.

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COMPULSIVE HOARDINGCOMPULSIVE HOARDING

Hoarding is the compulsive acquisition or saving Hoarding is the compulsive acquisition or saving of items that are perceived by the individual to of items that are perceived by the individual to have intrinsic value or importance. Hoarding have intrinsic value or importance. Hoarding can be a symptom associated with either can be a symptom associated with either another disorder such as depression, or can another disorder such as depression, or can occur all by itself. Individuals who hoard may occur all by itself. Individuals who hoard may experience obsessions, cognitive distortions, experience obsessions, cognitive distortions, and or compulsions about their possessions.and or compulsions about their possessions.

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HOARDING DATAHOARDING DATA

Hoarders make up approximately 2 to 5% of the general Hoarders make up approximately 2 to 5% of the general population, in APS hoarding occurs in 12% of our cases. population, in APS hoarding occurs in 12% of our cases.

According to Frost & Hartl, l996, 18% to 42% of people According to Frost & Hartl, l996, 18% to 42% of people diagnosed with OCD are hoardersdiagnosed with OCD are hoarders

There are other mental disorders in which Hoarding There are other mental disorders in which Hoarding Behavior is seen, Anorexia Nervosa, Dementia and Behavior is seen, Anorexia Nervosa, Dementia and sometimes Psychotic Disorders as well as Depressionsometimes Psychotic Disorders as well as Depression

Between one in four to one in five people with dementia Between one in four to one in five people with dementia are also hoardersare also hoarders

20% of schizophrenics become hoarder20% of schizophrenics become hoarder 5% of general population would account for 5% of general population would account for

approximately 15 million in the USapproximately 15 million in the US

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WARNING SIGNS OF HOARDINGWARNING SIGNS OF HOARDING

Extreme collection and storage of items in the home and in the Extreme collection and storage of items in the home and in the outside areasoutside areas

Accumulation of combustible materials (newspapers, magazines Accumulation of combustible materials (newspapers, magazines and rubbish as well as paint, solvents and multiple examples of and rubbish as well as paint, solvents and multiple examples of cleaning products)cleaning products)

Blocked exits (doors/windows)Blocked exits (doors/windows) All windows covered with diverse materials including piled objects All windows covered with diverse materials including piled objects

(books, newspapers, boxes and occasionally sheets and tarp)(books, newspapers, boxes and occasionally sheets and tarp) Narrow pathways in the homeNarrow pathways in the home Rat and/or insect infestations also including maggots, bed bugs, Rat and/or insect infestations also including maggots, bed bugs,

fleas and even reptiles.fleas and even reptiles. Rotting food and/or used food containersRotting food and/or used food containers Human and/or animal wasteHuman and/or animal waste Long-term neglect of home maintenanceLong-term neglect of home maintenance Non-working utilities, such as heat, running water, sewer, Non-working utilities, such as heat, running water, sewer,

refrigeration refrigeration

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DANGERS OF HOARDINGDANGERS OF HOARDING The collection of newspapers, magazines, old clothes, paint and The collection of newspapers, magazines, old clothes, paint and

chemical products may cause fire and exacerbate the fire once it chemical products may cause fire and exacerbate the fire once it begins.begins.

Animal hoarding can spread contagious diseasesAnimal hoarding can spread contagious diseases EMTs’ often are unable to find people during fires until it is too lateEMTs’ often are unable to find people during fires until it is too late Large piles of items can fall upon the hoarder and helpers, both injuring Large piles of items can fall upon the hoarder and helpers, both injuring

and in some instances killing the people. and in some instances killing the people. Adjacent property owners are also at risk primarily of fire, insect Adjacent property owners are also at risk primarily of fire, insect

infestation and the risk of the hoarders’ property falling on the infestation and the risk of the hoarders’ property falling on the neighbor’s propertyneighbor’s property

The amount of heat released from the contents (BTU’s) often exceed The amount of heat released from the contents (BTU’s) often exceed the design of fire protection systems and fire wall ratings. the design of fire protection systems and fire wall ratings.

Affects ability to escape for those in the house and for those who have Affects ability to escape for those in the house and for those who have gone in to help rescue the residents.gone in to help rescue the residents.

Rapid fire spread/high heat decreases time of failure for fire resistant Rapid fire spread/high heat decreases time of failure for fire resistant materials (collapse).materials (collapse).

Substantial weight increase can exceed the structural design. Weight Substantial weight increase can exceed the structural design. Weight can be from materials themselves or from absorbing water. can be from materials themselves or from absorbing water.

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CLUTTERING VS. HOARDING CLUTTERING VS. HOARDING

Where are the THINGS?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 can’t 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 don’t have the energy or the room to place another thing. They don’t 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.

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What is a hoarder?What is a hoarder? Now let us look at the picture of hoarders. They might also have Now let us look at the picture of hoarders. They might also have

moved into a smaller abode. They might receive groceries from moved into a smaller abode. They might receive groceries from friends, shoppers or get them themselves. However, they might friends, shoppers or get them themselves. However, they might “borrow from the McDonald’s when they go there. They take “borrow from the McDonald’s when they go there. They take packets of sugar, packets of salt, pepper, ketchup and, of course, packets of sugar, packets of salt, pepper, ketchup and, of course, they will keep the container in which the McDonald’s came from. they will keep the container in which the McDonald’s came from. They might ask for an extra container every time they go to a They might ask for an extra container every time they go to a restaurant. They might wash out the containers, but more than restaurant. They might wash out the containers, but more than likely, they will just leave it in a pile which is co-mingled with other likely, they will just leave it in a pile which is co-mingled with other piles. They might even go to trash bins next to groceries and bring piles. They might even go to trash bins next to groceries and bring back some of that bread that “someone threw out by accident”. back some of that bread that “someone threw out by accident”. After all, who would dream of throwing away “good” bread. It might After all, who would dream of throwing away “good” bread. It might come in handy if someone is hungry. The hoarder goes out and come in handy if someone is hungry. The hoarder goes out and gets magazines sometimes from the next door neighbor’s stoop or gets magazines sometimes from the next door neighbor’s stoop or more than likely from another “valuable” trash bin. Their piles of more than likely from another “valuable” trash bin. Their piles of newspapers date back years and years. They might, in fact, sleep newspapers date back years and years. They might, in fact, sleep on the newspapers. Their beds are piled too high to get to the top. on the newspapers. Their beds are piled too high to get to the top.

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COMMON HOARDING COMMON HOARDING COMPULSIONS INCLUDECOMPULSIONS INCLUDE

Inspecting possessionsInspecting possessions Purchasing more itemsPurchasing more items Counting itemsCounting items Checking garbage (own and others) for objectsChecking garbage (own and others) for objects Looking through circulars for salesLooking through circulars for sales Maintaining clutterMaintaining clutter Making piles/clutter visibleMaking piles/clutter visible Making “discard piles” without actually discardingMaking “discard piles” without actually discarding Calling others to check on itemsCalling others to check on items Perspective on objects differs from others who do Perspective on objects differs from others who do

not see the “something special in specific items”.not see the “something special in specific items”.

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COMMON HOARDING COMMON HOARDING BEHAVIORSBEHAVIORS

Difficulty Organizing TasksDifficulty Organizing Tasks PerfectionismPerfectionism Poor Attention (ADHD 15% – 20% )Poor Attention (ADHD 15% – 20% ) Excessive AcquisitionExcessive Acquisition InefficiencyInefficiency IndecisivenessIndecisiveness ImpulsivityImpulsivity Impaired or “special” SensitivityImpaired or “special” Sensitivity

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COMMON HOARDING OBSESSIONS AND COMMON HOARDING OBSESSIONS AND

COGNITIVE DISTORTIONSCOGNITIVE DISTORTIONS

Thoughts about the importance and/or necessity of Thoughts about the importance and/or necessity of objectsobjects

Fear of running out of objectsFear of running out of objects Fear of discarding an object and then needing itFear of discarding an object and then needing it Fear of losing control of saved objectsFear of losing control of saved objects Fear of discarding items with emotional valueFear of discarding items with emotional value Fear of losing sight of an itemFear of losing sight of an item Fear of being irresponsible Fear of being irresponsible Fear of making a mistake regarding a choice of Fear of making a mistake regarding a choice of

discarding or saving an itemdiscarding or saving an item

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WHY DO OLDER PEOPLE WHY DO OLDER PEOPLE HOARDHOARD

Items are perceived as valuableItems are perceived as valuable Items provide a source of securityItems provide a source of security Fear of forgetting or losing itemsFear of forgetting or losing items Constant need to collect and keep thingsConstant need to collect and keep things Obtaining love not found from peopleObtaining love not found from people Fear others will obtain their personal informationFear others will obtain their personal information Physical limitations and frailtyPhysical limitations and frailty Inability to make changesInability to make changes Lack of motivationLack of motivation The hoarder does not recognize a problem with his/her The hoarder does not recognize a problem with his/her

life stylelife style Hoarding is a successful compulsionHoarding is a successful compulsion

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NEUROBIOLOGICAL ASPECTS NEUROBIOLOGICAL ASPECTS OF HOARDINGOF HOARDING

OCD and HoardingOCD and Hoarding Compulsive Hoarders and Brain Glucose Compulsive Hoarders and Brain Glucose

MetabolismMetabolism Anterior cingulated gyrusAnterior cingulated gyrus Posterior Cingulated gyrusPosterior Cingulated gyrus Anxiety Disorders Anxiety Disorders DementiaDementia

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TREATMENT STRATEGIESTREATMENT STRATEGIES

Medication: SRI’s vs. RitalinMedication: SRI’s vs. Ritalin CBT (Cognitive Behavior Therapy)CBT (Cognitive Behavior Therapy) Multiple approaches simultaneouslyMultiple approaches simultaneously

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PsychotherapyPsychotherapy

Why does the person hoard?Why does the person hoard? Group therapy is a good starting pointGroup therapy is a good starting point Small goals, small gains – very BIG Small goals, small gains – very BIG

accomplishmentaccomplishment Learning to organizeLearning to organize Learning to give something upLearning to give something up Continue therapy as a means to prevent Continue therapy as a means to prevent

relapse.relapse.

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TREATMENT FOR COMPULSIVE TREATMENT FOR COMPULSIVE HOARDINGHOARDING

Education about the problem and the treatmentEducation about the problem and the treatment The hoarder and the therapist establish goals related to The hoarder and the therapist establish goals related to

basic organization and de-cluttering.basic organization and de-cluttering. With gentle challenges, the need to collect is devaluedWith gentle challenges, the need to collect is devalued The pace is as slow as the hoarder requiresThe pace is as slow as the hoarder requires Only a small area of the hoarders living area is worked Only a small area of the hoarders living area is worked

upon at any one timeupon at any one time The hoarder, with the therapist’s help, make decisions The hoarder, with the therapist’s help, make decisions

togethertogether ““Things” can be thrown out, kept or donated. Things” can be thrown out, kept or donated. Before and after pictures are taken in order to help the Before and after pictures are taken in order to help the

hoarder see the accomplishmentshoarder see the accomplishments Maintenance and the prevention of relapse continues for Maintenance and the prevention of relapse continues for

a lengthy period a lengthy period


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