Compulsive Hoarding

Barbara J. Chromy

Definition of Hoarding

• No consistent definition of hoarding

• The term is used in different clinical and non-clinical contexts to describe a broad spectrum of behavioral abnormities

(Maier, 2004)

Commonly Accepted Definition

1. The acquisition of, and failure to discard, a large number of possessions that appear to be of useless or limited value

Definition (continued)

2. Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed

Definition (continued)

3. Significant distress or impairment in functioning cause by the hoarding

(Frost, Hartl, & Gross)

Types of Hoarding

• Scarcity Mentality Hoarder– “What if the depression returns?”

• Frugality Mentality Hoarder– Nothing should be wasted

• Frozen Indecision Hoarder– Finds no decision easy

(NSGCD, 2003)

Types of Hoarding (continued)

• Ordinary Hoarders– Primarily objects

• Animal Hoarders– Can have in excess of 300 animals in a

home

• Trash Hoarders– Syllogomania

Types of Hoarding (continued)

• Animal Hoarding

Animal Hoarding Defined

• HSUS defines an animal hoarder as a person who has more animals than he or she can properly care for

• A defining characteristic of animal hoarders is their refusal to acknowledge their inability to care for the number of animals they have accumulated

(Simmons, 2006)

Causes

• Little is known about onset and course of compulsive hoarding

Grisham, Frost, Steketee,

Kim and Hood (2006)

Prevalence

• 1.4 to 2 million people in the United States have compulsive hoarding syndrome

(Maidment, 2005; Collingwood, 2006).

• Hoarding accompanies OCD in 25% to 40% of individuals diagnosed

(Understanding Hoarding, 2005; Seedat and Stein, 2002).

• 2-3% of the general population has OCD and up to one-third of those diagnosed with OCD exhibit hoarding behavior

(Cohen, 2004; Haggerty, 2006).

Co-morbidity

• Anorexia nervosa• Bipolar disorder• Dementia• Depression• Impulse control

disorders– Such as compulsive

buying or gambling

• Social phobia

• Obsessive-compulsive disorder

• Personality disorders• Schizophrenia• Diogenes syndrome• Prader-Willi syndrome• Head injury• Autism

Hoarding Dangers

• Health hazards• Injury• Isolation

Impact on Elderly

• Compulsive hoarding is known to co-exist with both dementia and Diogenes syndrome; two conditions that are correlated with age

• Compulsive hoarders are more likely to be socially isolated, live alone, and to be female

Impact on Elderly (continued)

• Hoarding medications is not uncommon among the elderly who have many ways to obtain drugs

(MacIsaac & Bartus Adamson, 1989)

Treatment

• No known ‘cure’ for compulsive hoarding

(Understanding Hoarding, 2005)

• Traditional treatments for OCD have not proven to be effective with compulsive hoarders

(Saxena and Maidment, 2004)

Treatment (continued)

• Intensive multimodal treatment found effective in pilot studies following a course of up to one year

• This treatment focused on the following areas 1) discarding; 2) organizing; 3) preventing incoming clutter; and 4) introducing alternative behaviors

•

(Saxena & Maidment, 2004)

Applications

• Educators need to bring educational programs about hoarding to their communities

• Need to spearhead or gain access to community hoarding task forces to protect the interest of older adults

• Research how hoarding manifest itself in the elderly, the special concerns of elderly hoarders, and effective treatment protocols for older hoarders

Conclusion

• Compulsive hoarding is a devastating disorder that is not well understood and is difficult to treat

• Prevalence rates are unclear and the causes have not been identified

• Early intervention is essential

References• Maier, T. (2004). On phenomenology and classification of hoarding:

A review. Acta Psychiatr Scand, 110, 323-337.• Frost, R.O., & Gross, R.C. (1993). The hoarding of possessions.

Behavioral Research and Therapy, 31, 367-381.• Frost, R.O., & Hartl, T. (1996). A cognitive-behavioral model of

compulsive hoarding. • Behavioral Research and Therapy, 34(4), 341-350.• National Study Group on Chronic Disorganizations (NSGCD).

(2003). Types of hoarding: Different perspective [fact Sheet 02 3-03], 1-2. Retrieved from www.nsgcd.org.

• Simmons, R. (2006). Behind closed doors: The horrors of animal hoarding. The Humane Society of the United States. Retrieved 11.27/06 from http://www.hsus.org/pets/issues_affecting_our_pets/behind_closed_doors_the_horrors_of_animal_hoarding.html.

References (continued)

• Grisham, J.R., Frost, R.O., Steketee, G., Kim, H. & Hood, S. (2006). Age of onset of compulsive hoarding. Journal of Anxiety Disorders, 20, 675-686.

• Cohen, J. (2004). The danger of hoarding. USA Today; 2/19/04 [Electronic version].

• Haggerty, J. (2006). The impact of obsessive-compulsive disorder. Psychcentral.com, retrieved 11/27/06 from http://psychcentral.com/lib/2006/02/the-impact-of-obsessive-compulsive-disorder/.

• MacIsaac, A.M., & Bartus Adamson, C. (1989). Multiple Medications: Is your elderly patient caught in the storm? Nursing, July, 60-64.

• Saxena, S. & Maidment, M. (2004). Treatment of compulsive hoarding. JCLP/In Session, 60, 1143-1154.