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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?