A COMMUNITY RESPONSE TO

HOARDING DISORDER

Lisa O’Neill, DBH, MPH

Assoc. Director of Research & Education, ACOA

Clinical Assist. Prof, UA COM Division of Geriatrics,

General Internal Medicine, & Palliative Medicine

DISCLOSURE

Lisa O’Neill has no disclosures or conflicts related to this presentation

DEFINITION

• The accumulation of and failure to discard a large number of possessions; impairment in functioning as a result of accumulation

• Significant distress associated with discarding

• The amount of possessions prevents using rooms for intended purpose

PREVALENCE

• Estimated 5-6.2% of U.S. population = 16 million+

• Prevalence is similar for men and women, but women seek treatment more often

– average age in treatment = 50 yrs old

• Average age onset = 11-25 yrs old

• Family history is common – up to 84%

• Occurs in all cultures, income and education levels

HOW

Items can be acquired by:

• Compulsive buying – retail; web shopping

• Compulsive acquiring of free things – giveaways; flyers; dumpster diving

• Passive acquisition – junk mail; food packaging

WHY

Items are saved for two primary reasons

• Sentimental – this is a part of me; represents my life

• Instrumental – I could use this; opportunity is lost if I throw it away; multiple uses for every item

WHAT HAPPENS

Disorganization – clutter builds

• Random piles will include items of mixed importance

• Sometimes there is a fear of putting things out of sight

• Almost always there is a fear of making the wrong decision

EMOTIONS

Severe emotional distress when attempting to discard items

Often lack an awareness of the severity of behavior

May feel angry, defensive or overwhelmed by the burden of their possessions

COMMUNICATION

• Be respectful – nonjudgmental in words and behavior

• Use their language

• Value their belongings

• Initially, use harm reduction approach to ensure safety

• Do not impose your feelings – “you will feel better if…”

• Praise, frequently and genuinely – celebrate the little wins; acknowledge how hard this is for them

BARRIERS TO COMMUNICATION

Keep in mind they might

• Have different solutions in mind – maybe would rather reorganize as first step / not discard

• Be frustrated because we don’t understand how valuable their stuff is

• Be afraid we will throw their stuff away

HEALTH AND SAFETY

• Public Health Issue – extends past person struggling with these behaviors

• Without intervention hoarding situations will continue to deteriorate

• Possible co-occurring mental illness

Major Depressive Disorder; Social Phobias Generalized Anxiety Disorder

HEALTH AND SAFETY

• Increased risk of falls, infections, respiratory problems

• High fire risk – can put first responders at risk

• Pest infestations

• Animal Control Issues

• Eviction

ESTIMATED COSTS

The San Francisco Hoarding Task Force has quantified the costs of compulsive hoarding for their city

• Estimated costs are over $6 million per year

• Organizations reported higher costs for individuals with hoarding behaviors compared to other clients, ranging from $50 - $20,000 per client, with a mean of $3,191 per client

ASSESSMENT TOOLS

Wide selections of assessment tools available

• Clutter Image Rating

• Photos are helpful to get an accurate sense of the situation – can also be used to show improvement

ASSESSMENT TOOLS

Kitchen – 9 photos used to measure degree of clutter

ASSESSMENT TOOLS

ASSESSMENT TOOLS

TREATMENT

Hoarding Disorder is a mental health issue

Counseling must occur

Forced clean ups – not recommended

TREATMENT

Cognitive Behavioral Therapy (CBT)

• CBT focuses upon creating a different relationship with one’s possessions

• The work focuses on organizing, sorting, discarding, decision making, and learning to control the urge to acquire new possessions

CBT can help manage illness; high risk of relapse

COMMUNITY RESPONSE

Multidisciplinary approach

Hoarding Disorder Task Forces - various models with structure variations

Depending on the mission and goals of the taskforce, some services that can be provided are:

public educationagency/community resource informationstaff trainingsfamily support

COMMUNITY RESPONSE

Models include:

• Education – professionals and community

• Coordination – provide expertise and actively connect agencies to close cases

• Intervention – provide direct services for individual cases

COMMUNITY RESPONSE

Southern Arizona Hoarding Task Force

• Educational model – 60 agencies, 100+ members

• HOPE Workshop - Hoarding Disorder education to learn how to Organize, Purge and End the cycle

• Started in 2015; 9th cohort starts August 2019; partner with PCOA

COMMUNITY RESPONSE

HOPE Workshop

• 10 week course, 1 night a week for 90 minutes

• Open to anyone struggling with hoarding behaviors

• Not for clinicians, family members or caregivers

• Based on evidence based program “Buried in Treasures” but restructured for class 4x larger (~ 47)

COMMUNITY RESPONSE

HOPE Workshop

• Each weekly session is structured and interactive focused on specific topic

• Assigned weekly homework that includes readings, emotion journaling, photographing progress, and individual behavior modification strategies

COMMUNITY RESPONSE

Session topics include:

• Identifying unhelpful beliefs and barriers

• Goals (immediate and future)

• Non-acquiring strategies

• Decluttering strategies

• Stress management techniques

COMMUNITY RESPONSE

The Fall 2017 cohort, 30 course participants,

retrospective reporting on hoarding behavior changes

• Prior to the Workshop

COMMUNITY RESPONSE

COMMUNITY RESPONSE

• Demonstrated participants can make substantial progress after learning new behavior modification skills

• A significantly larger class size does not restrict participant ability to learn, participate or share personal thoughts and feelings

• Innovative solution to help address this growing and costly public health concern

COMMUNITY RESPONSE

QUESTIONS?