Help for Hoarding:
It Takes a Village
Regina F. Lark, Ph.D., CPO®
Professional Fiduciary Association of California
June 2, 2016
Learning Outcomes and Goals
Identify when disorganization becomes chronic disorganization, & chronic
disorganization becomes hoarding
Understand the history and nature of the hoarding disorder
Become familiar with the “Do No Harm” model for helping people who
hoard
To identify the 5 levels of hoarding on the ICD “Clutter-Hoarding Scale”
How to create support system for people who hoard
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What are we dealing with?
Collecting vs. “Regular clutter” vs. Chronic Disorganization vs. Hoarding
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30,000 - 300,000
• We all have stuff
• Some of us have a bunch of stuff
• Others of us have a lot of stuff
• Still others seem to have waaaay too much stuff
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What Does Chronic Look Like?
Hidden Clutter
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Hoarding
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Chronic Disorganization
• A lá Judith Kolberg…
• Persistence of severe disorganization over a long period of time
• A daily undermining of one’s quality of life by disorganization
• A history of failed self help efforts
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Chronic Disorganization Continuum
Left Brained
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Right
Level 1-2
Brained
C.H. Scale
Chronically Organized
ADHD/ADD
Level 3-4 C.H.
Scale
Level 5
Hoarding
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An Integrated View
Chronic Disorganization
Challenging
Disorganization
Hoarding Disorder
Situational
Disorganization
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A Very Short History of Hoarding
-1500s: Dante's Inferno
-1800s: Dickens' characters
-1940s: Collyer Brothers
-1980: DSM-III (1 of 9 diagnostic criteria for OCD)
-1996: Frost/Hartl publish 1st theoretical account on limited data
-2003: NSGCD/ICD Clutter-Hoarding Scale
-2013: DSM-V: Hoarding Disorder
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Clinical Definition of Hoarding
Disorder
1) The acquiring of and failure to discard a large number of
possessions that appear to be useless or of limited value;
2) Living spaces sufficiently cluttered so that the clutter precludes
activities for which the spaces were designed;
3) Significant impairment in functioning or distress caused by the
hoarding.
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Or, in a sound-byte, hoarding is a
psychological disorder where we will see:
• Excessive acquiring
• Difficulty discarding
• Living in cluttered spaces
• Causing significant distress or impairment
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Some Statistics
Age of onset
• 30%: 6-10 years
• 70%: before age 20
Hoarding and the Elderly
• 45% could not use refrigerator
• 42% could not use a sink
• 42% could not use a bathtub
• 10% could not use a toilet
(Steketee, et al., 2001; Tolin, 2013)
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Clinical & Social Significance(1)
• 77% report one or more severe health conditions
• 80% who self-report hoarding acquire excessively
• Comorbid Disorders:
- Major Depressive Disorder: 50%
-General Anxiety Disorder: 30%
- Social Anxiety Disorder: 30%
- ADHD: 30%
- OCD: 16%
(Chabaud, 2013; Tolin, 2013)
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Clinical & Social Significance (2)
 Hoarding is found in approximately 5% of the US population

An equal opportunity disorder

Tends toward higher education.
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At almost 4 times the rate of bipolar disorder and schizophrenia.
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On par with psychosis in terms of level of impairment
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Fire hazard: 8x more damage; less likely to contain to one room
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Rare for someone to admit: If you want to know, you have to as
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Average hoarding cleanout: $9,000 to $12,000, up to $60,000
(Chabaud, 2013; Tolin, 2013)
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Challenges for the Elderly
• 15% nursing home residents
• 25% attend community day care
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Legal problems
Social Isolation
Increase risk for homelessness
Compromised self care, nutrition
Safety concerns
(Tolin 2013)
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Why Do People Hoard?
Biological: Hypo/hyper activity of the frontal cortex and anterior cingulate
Cognitive and Behavioral:
 Problems with attachments
 Avoidance of emotional pain
 Beliefs about possessions (anthropomorphize)
 Information processing deficits
 Decision-making difficulty
 Motivational problems
 Inattentiveness (ADHD/ADHD-like symptoms)
 Very poor insight
 Perfectionist (but everything imperfect and incomplete)
 Feelings of preparedness (need and safety)
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“I found some more acorns today.”
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Why Objects?
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Valuable, loss of them creates fear, discomfort.
As an extension of self: should be protected
As a protector or friend; they never leave.
Holders of meaning, information.
Useful; never have to be without
Provide a sense of purpose, reflect choice, a life lived.
Provide something else to think about.
Provide volumes of opportunity
(Chabaud, 2013)
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Types of Hoarding
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Animal Hoarding
Bibliomania (hoarding of books)/ Information Hoarder
Syllogomania (hoarding of trash/garbage)
Larder Hoarding (hoarding of food)
Recyclers
Collectors
Shopaholics
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=398
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POTENTIAL WARNING SIGNS
•
Endless talk about “the stuff;”
• Rooms/closets no longer being used as designed;
• Major difficulty throwing things away;
• Acquiring too much too often;
• Difficulty sorting, organizing, deciding about possessions;
• Loss of function of major appliances/living spaces;
• Cannot move safely and comfortably in the home.
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WHAT IS HARM REDUCTION?
• A holistic and humane public health approach
• First developed as a way to minimize the risk of intravenous drug
use
• Focus is not on the problem per se but on safety and health
• Identify areas where harm can occur
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THE PRINCIPLES OF HARM REDUCTION AS
APPLIED TO HOARDING DISORDER
• Do no harm
• It’s not necessary that the person stop all hoarding behavior
• No two hoarding situations are identical
• The person who hoards is an essential member of the team
• Change is slow
• Failures don’t mean the harm reduction approach is failing
• The person who hoards may have other, more pressing problems
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It Takes a Village:
The Harm Reduction Model
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Person Who Hoards
Team Player/Professional Organizer
Therapist
Project Manager
Family/Friend
Cheerleader
Repair Person
Tomkins, et.al., Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive
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Acquiring (2009)
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Creating the Plan
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Form the Team
Set The Goals
Create a System for Monitoring Progress
Home Visits
Red Tape Zoning
Container Inventory / Trash Bins
Photos
List Strategies (assigned to each team member)
Specific Assignments
Contract (spells out each goal, strategy and agreement)
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L.E.A.R.N.
Clearing toward harm reduction targets
•
Listen
•
Empathize
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Affirm
•
Redirect
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Negotiate
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Clutter Hoarding Scale
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http://www.ocfoundation.org/hoarding/cir.pdf
Uh Oh…
SIX COMMON REASONS FOR BACKSLIDING
1. The Contract Wasn’t Set Collaboratively
2. The Contract was Unrealistic
3. Problems with Rewards
4. Other Mental Health Conditions Get in The Way
5. Members of the Team are Over-involved
6. Lack of Monitoring
ACP
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ACP
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Suggested Reading
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Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding David F. Tolin,
Randy O. Frost, and Gail Steketee, Oxford University Press, 2007
Children of Hoarders on Leaving the Cluttered Nest, Steven Kurtz New York Times, May 12,
2011
Conquering Chronic Disorganization Judith Kolberg Squall Press, Inc., 1999
Homer and Langley: A Novel E. L. Doctorow Random House, 2010
Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring
Michael Tompkins and Tamara Hartl New Harbinger Publications, 2009
Psychic Debris, Crowded Closets: The Relationship Between the Stuff in Your Head and
What’s Under Your Bed Regina F. Lark, Ph.D., CPO® Purple Books Publishing 2013
Stuff: Compulsive Hoarding and the Meaning of Things Randy O. Frost and Gail Steketee,
Houghton Mifflin Harcourt, 2010
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Your care and concern is essential for everyone’s success!
Regina F. Lark, Ph.D, CPO
[email protected]
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