hoarding

Introduction

The excessive collection & retention of things or animals until they interfere with day-to-day function (home, health, family, social life, work)

Epidemiology

• < 1% of population
• occurs in 1/3 of patients with obsessive compulsive disorder (OCD)
• female > male
• tend to live alone & have never married
• tend to be older

Clinical manifestations

• obsesses over belongings
  • items perceived as valuable
  • items provide a source of security
  • fear of forgetting or losing items
• constant need to collect and keep things
• finds it difficult to discard belongings without professional help
• may experience extreme distress if attempt is made to discard items
• obtaining love not found from people
• fear others will obtain their personal information
• contributing factors in the elderly
  • physical limitations & frailty
  • inability to organize
  • self neglect
  • stressful life events

Complications

• collected items may cause a health hazzard

Management

• do not remove the clutter immediately
  • carefully assess the individual situation
• if possible, involve the hoarder in decisions
  • intervention without the cooperation of the hoarder can lead to poor outcome
• cognitive behavioral therapy (1st line)
• involve family members & other agencies
  • Dept of Mental Health
  • Adult Protective Services
    • unlikely that adult protective services will become involved unless the patient is cognitively impaired or has a mental health disorder beyond hoarding
  • Building & Safety & Code Enforcement
• things to DO with elderly hoaders
  • contact the patient face to face
  • use a soft, gentle approach & let the patient tell his/her story
  • respect the meaning & attachment to possessions by the patient, which may be as intense as human attachment
  • be calm & factual, but caring & supportive
  • evaluate for safety
  • refer for mental health evaluation
  • go slowly & expect gradual change
  • reassure the older adult that others will try to help & work with him/her
  • involve the patient in seeking solutions
  • work with other agencies to maximize resources
• things NOT to DO with elderly hoaders
  • do NOT hospitalize unless there is a clear plan on what will be accomplished
  • do NOT force interventions
  • do NOT be critical or judgmental about the patient's environment
  • do NOT press the patient for information that appears to make him/her uncomfortable
  • d NOT make negative, teasing or sarcastic statements

More general terms

• psychiatric disease; behavioral disorder
• chronic mental disorder

Additional terms

• cluttering