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Hoarding
Satwant Singh MSc RNNurse Consultant in CBT & Mental HealthWordsworth Health Centre, [email protected]
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AimsTo have an understanding about hoarding and the
psychological aspects and impact of hoarding on the individual and others
Appreciate the need to develop a joint strategy and the involvement of all agencies
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Hoarding symptoms and features
A common behaviour with the collection of food among rodents, small animals and birds (Honig, 1991)
Normal part of life cycle (Anderson, 1983, Kolb, 1974)
Relationship between hoarding in non humans and humans is less understood but may have some similarities
Hoarding in humans can be seen in a variety of disorders- anorexia nervosa Frankenburg, 1984), organic disorders (Greenberg, et al1990), psychotic disorders (Lichins et al, 1992), OCD, OCPD (APA, 1994) and mental retardation (van Houten & Rolider, 1988)
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Definition of hoardingAlthough widely recognised as symptom of OCD, the DSM
IV describes it in the context of OCPDHowever DSM V (2013) hoarding will be classified as a
disorder in its own rightFrost & Gross (1993)- the acquisition and failure to discard
possessions which appear to be useless or of limited value
The clutter is so severe that it prevents or precludes the use of living spaces for what they were designed for
The clutter, acquiring or difficulty discarding cause significant distress or impairment for the individual and family members
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How common is hoarding?Frost el al (1996) found with the OCD
outpatients 31% had hoarding compulsions and 26% had hoarding tendencies
It is estimated that less than 1% of population hoard the true figure is higher (6-8%). Estimated in the UK 1 in 200
Hoarding does not discriminate between age, gender socio economic groups
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Continuum
Minimalist Normal saving Clutter Hoarding
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Why is it a problem?Impairment and distress to the individual
Impairment to social functioning and relationship issues, social isolation
Health and safety- fire hazard, infestation, poor living conditions (lack of heating etc), hazard to the environment e.g. building with the lack of poor maintenance
Mental health issues e.g. depression, psychosis etc
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Reasons for hoardingUsually begins in childhood, more common in
malesFamily history of hoarding and OCDOften linked to some sort of trauma e.g. loss,
abuse, divorce etcMaterial deprivation Severe and enduring mental illness and other
mental health problems
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Similarities and Differences
Hoarders and non hoarders save the same
things but the differences are:
- Quantity
- Emotional attachments (sentimental)
- Perceived use of object (instrumental)
- Over valued beliefs
- The object as an extension of self
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Manifestations cont….
2 subtypes:
Compulsive acquisition- bringing items e.g. buy 1 get 3 free, good value
Non compulsive acquisition- unable to get rid of things e.g. rubbish
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Understanding of condition
Different from OCD and other conditions as:
Do not view their behaviour as unusual
Less insight into their behaviour
Have reasons why they need to “save” “I need this just in case” “It reminds me of marriage, good times in my life”
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Manifestation of hoardingUsually begins in childhood- long standing
Compulsive acquisition
Lack of organisation
Saving behaviours and inability to discard
Avoidance- dealing with the problem, others
Trust issues- letting others help
Lack of insight/acceptance of problem e.g. the place is too small, I don’t have time to organise
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Why is hoarding an issue?It impacts on families and neighbours
Health and safety issues- fire risk, injury, infestation, structural damage
Inside housing (May 2009) 87% out of 40 home improvement agencies have dealt with individuals with issues of hoarding
It is not an isolated problem and has implications for housing providers and landlords
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Consequences of legislationHomelessness
Distress and trauma- Environment Health
Stigma and vulnerability (exposed)
Harassment by neighbours/others and victimisation
Feelings of being punished
Social exclusion and isolation
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Next stepsHoarding will become a major issue post the
new diagnostic categorisation- recognition and identification
Local authority (EH, SS, police, fire services), health, statutory and non statutory organisations, housing associations to work together to deal a joint strategy
Development of services to deal with this issue of hoarding- dealing and supporting individuals
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Next stepsNeed joint working of these services and
have a single point of contact/access
Training in recognising, engaging and working with individuals with issues of hoarding
In the long term development of specialist services in dealing with this issue
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ReferencesChartered Institute of Environmental Health:
Professional Practice Note: Hoarding and how to approach it
Frost R.O. & Gross, R. C. (1993) The hoarding of possessions. Behaviour Research and Therapy, 31, 367-381
Frost, R.O. & Hartl, T. L. (1996) A Cognitive Behavioural Model of Compulsive Hoarding. Behaviour Research and Therapy, 33, 897-902
Furby, L. (1978) Possessions: Towards a theory of their meaning and function throughout the life cycle. In Bates, P.B. Life span development and behaviour (Vol 1) NY: Academic Press.
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References
Hunter, C. & Nixon, J. (2007) Special Issue- Hoarding and mental health Editorial. People, Place & Policy2/1: 1-3. DOI:10.3351/ppp.0002.0001.0001
Inside Housing (May, 2009) It’s a hoard life. http://www.insidehousing.co.uk/story.aspx?storycode=6504818
Obsessive Compulsive Cognitions Working Group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667-681
Slatter M. (2007) Treasures, trash and tenure: hoarding and housing risk. People, Place & Policy Online: 2/1 28-36
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Treatment Group in LondonNational Hoarding Treatment group
meets once a month- the last Wednesday of
each month from 6.00-8.00 pm at:
The Wordsworth Health Centre
19 Wordsworth Ave
London, E12 6SU
More details can be obtained from the website:
www.ocdaction.org.uk