Hoarding Behaviors Among
the SPMI Population
Presented by:
Cindy Melander, MA
Definitions of Hoarding
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Randy Frost, PhD, 1996
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Clinical Compulsive Hoarding
Acquisition and failure to discard large amount of
possessions that appear to be useless or of limited value.
„ Living space is so cluttered that they preclude normal
use and/or what the room was intended for.
„ Significant distress or impairment in functioning due to
hoarding.
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Definitions of Hoarding
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Anxiety & Stress Disorders Institute of
Maryland
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Subtype of Obsessive Compulsive Disorder
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Like other compulsive behaviors, hoarding is an effort
to manage the anxiety raised by obsessive doubts.
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Definitions of Hoarding
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Saxena & MaidmentMaidment- 2002
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Compulsive Hoarding Syndrome
More than just volume of possessions saved, clutter is
extremely disorganizeddisorganized-valuable objects, sometimes
money is commonly mixed in with trash.
„ Even when volume of possessions isn’
isn’t large,
considerable dysfunction can result from gross
disorganization.
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Definitions of Hoarding
„
David Tolin,
Tolin, PhD
„
Compulsive hoarding is thought by many to be a
subtype of Obsessive Compulsive Disorder.
Definitions of Hoarding
„
David Tolin,
Tolin, PhD (continued)
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People are thought to have a compulsive hoarding
problem when they meet all three of these criteria
(similar to that of Dr. Frost):
They regularly keep a large number of possessions that
most people would not consider to be very useful or
valuable.
„ Their home, or parts of their home, are so cluttered that
they can no longer use them for their intended purpose.
„ The clutter is so bad that it causes significant distress or
impairment.
„
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Four Deficit Areas of
Someone Who Hoards
Randy Frost, PhD
1. Information Processing Deficits
Four Deficit Areas of
Someone Who Hoards
Randy Frost, PhD
2. Emotional Attachment Problems to
Possessions
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Two Types of Saving
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Pure Sentimentality
Value as a safety signalsignal-possession comes to acquire an
association with safety and comfort.
Four Deficit Areas of
Someone Who Hoards
Randy Frost, PhD
3. Behavioral Avoidance
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Four Deficit Areas of
Someone Who Hoards
Randy Frost, PhD
4. Erroneous Beliefs About the Nature of
Possessions
Other Characteristics
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Lack insight
Delayed recognition
Disorganized
Indecisive
Perfectionist
Causes/Theories
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Saxena
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Pet scan findings that raise the question of
whether compulsive hoarders also have
structure brain abnormalities and
neurocognitive deficits that differ from those
seen in nonnon-hoarding OCD patients.
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Starting the Process
Making the connection/relationship.
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Assure your number one goal is NOT to get
them to throw things out.
Be up front and honest. What your intentions
are:
*Is there a time frame forcing change?
*Is there just a concern?
Guess What?
„
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People are allowed to live in their homes and
apartments that are full of belongings that
“we”
we” might consider garbage AS LONG as…
as…
Leases are followed
City ordinances are followed, .ie
.ie in Duluth,
you have to have running water and electricity
to be able to live in your home.
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Conduct an Assessment
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Can be formal or informal
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Take photos if necessary
Interview
Saving inventory
Hoarding Assessment Tool
Clutter Screening Questionaire
Educate Person on Hoarding
„
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Explain Symptoms
Inform them that is a problem even if they don’
don’t see it
that wayway-family/friends/housing inspectors
Motivational factors to considerconsider„ Discuss deficit areas/See if they can identify
„ Is the clutter preventing them from doing something
they want? Do they want to change that?
Develop an Intervention Plan
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Stop acquisition
Homework
Contracts
Decide where to start
Be creative
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Stop Acquisition
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Must be first
goal in therapy
How to Stop Acquisition of Items
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Thorough assessment
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What do they acquire?
How do they acquire it? Where do they acquire
it?
Why do they acquire it?
Is there anyone else involved in the acquisition?
Stopping Acquisition (cont.)
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Develop a written contract
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Client decides what they can stop acquiring
Review barriers to maintaining contract
Acquisition Exercises (handout)
May need shadowing, checkcheck-ins
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Goals and Strategies
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Goal #1 Stop Acquisition
Goal #2 Create a useable space and use it as
intended
Goal #3 Maintain the useable space
Goals and Strategies
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Goal #4 Start discarding unneeded items
Goal #5 Create another useable space
Goal #6 Prevent future acquisition
Goals and Strategies
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Teach decisiondecision-making, organizing, and
categorizing
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Organize: recycle, discard, save, store for later
review, filing systemsystem-be creativecreative-use photos, maps
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Goals and Strategies
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Exposure to discarding
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Use photos to structure the organizing and
discarding
Use photos to show progress
Once a space is maintained, choose another space
or particular objects to work on next
Helping people who hoard overcome
barriers to meet their goals
„
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Suggested visits is several times a week, two
hours at a time. Suggested two workers
Gail Steketee likened those who hoard to those
with ADD. Work in small increments of timetimetake breaks
Helping people who hoard overcome
barriers to meet their goals
„
„
HOMEWORK must be assignedassigned-be creative
with thisthis-allow them to assign themselves.
People who hoard tend to view hoarding as
reasonable so there are few intrinsic
motivations to change—
change—try to find what their
motivator is.
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Crisis Situations/Time Limits
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Hoarding is a symptom of OCD and OCPDOCPDcould possibly be used used for reasonable
accommodation, extensions w/ landlords.
Teaming the situation (good staff/bad staff)
with a written contractcontract-client in charge
Crisis Situations/Time Limits
„
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Be AWARE if you clean it up without client, it
will just happen all over again if you don’
don’t
have support in place.
Once a few rooms are useable, consider ininhome services to help maintain the space.
My Mother’s Garden
www.seethroughwww.seethrough-films.com/mmg/trailer.html
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Crisis Situations/Time Limits
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Use of photographs (w/person’
(w/person’s permission) to
help gain insight of situation
Family members, friends, church organizations
can help
Find alternate housing for person and clean out
home with permission with professionalsprofessionalsEXTREME CASES.
Crisis Situations/Time Limits
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2011 is the proposed year when the new
revised DSM will be coming out
Consider transferring case to new worker when
clean up is done
Hoarding Resources
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http://www.childrenofhoarders.com
http://www.childrenofhoarders.com
Dr.Tolin’
Dr.Tolin’s Referral Guide and Resource List
http://www.instituteofliving.org/adc/compulsive_hoarding.htm
http://www.instituteofliving.org/adc/compulsive_hoarding.htm
Dr. Sanjaya Saxena
http://psychiatry.ucsd.edu/faculty/ssaxena.html
http://psychiatry.ucsd.edu/faculty/ssaxena.html
http://cluttersanonymous.net
http://cluttersanonymous.net
Animal Hoarding
http://www.tufts.edu/vet/cfa/hoarding/index.html
http://www.tufts.edu/vet/cfa/hoarding/index.html
Saving InventoryInventory-Revised
http://www.psychologie.tuhttp://www.psychologie.tudresden.de/i2/klinische/mitarbeiter/materialien/sidresden.de/i2/klinische/mitarbeiter/materialien/si-r.pdf
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Hoarding Resources
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Compulsive Hoarding and Acquiring, Therapist
Guide,
Guide, 2007
Gail Steketee and Randy O. Frost
Compulsive Hoarding and Acquiring Workbook,
Workbook,
2007
Gail Steketee and Randy O. Frost
The companion Web site for this series:
Treatments That Work is www.oup.com/us/ttw
Highlighted areas are ones I recommend reading first
as it can get overwhelming with all this information.
Hoarding Resources continued
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Hoarding Assessment Tool
http://www.environmentalgeriatrics.com/pdf/assessment_tool.
http://www.environmentalgeriatrics.com/pdf/assessment_tool.
pdf
Clutter Screening Questionnaire
http://www.onpha.on.ca/conference_training_meetings/annual
_conference_trade_show/archives/doc/2005/309_1.pdf
Obsessive Compulsive Inventory Screening Form
http://www.nvo.com/psych_help/obsessivecompulsiveinventor
http://www.nvo.com/psych_help/obsessivecompulsiveinventor
y/
Buried in Treasures: Help for Compulsive Acquiring,
Saving and Hoarding, 2007
David Tolin,
Tolin, Randy Frost, Gail Steketee
Questions?
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Very quick overview today.
I am not an expert, I share information by
experience, research and by others sharing
with meme-both providers and those who hoard.
THANK YOU
for giving me this opportunity today.
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