PowerPoint Presentation · 2018. 9. 13. · •Once cleaned recidivism is high Supporting Personal...
Transcript of PowerPoint Presentation · 2018. 9. 13. · •Once cleaned recidivism is high Supporting Personal...
9102018
1
Marilyn A Halpern
MSW
HoardingDigging to the Bottom of the Problem
bull Professional Guardian
bull ClientPatient Advocate
bull Medical Social Worker
bull End-of-Life Doula
Marilyn Halpern LSW
Hoarding Is Not A Messy Desk
9102018
2
History of Hoarding
DSM 5 Criteria for
Hoarding Disorder - 2013
A Persistent difficulty discarding or
parting with possessions regardless of
their actual value
B This difficulty is due to the perceived
need to save the items and to distress
associated with associated with
discarding them
DSM 5 Criteria
C The difficulty discarding possessions
results in the accumulation of
possessions that congest and clutter
active living areas and substantially
compromise their intended use If living
areas are uncluttered it is only
because of the interventions of third
parties (eg family members
cleaners authorities)
9102018
3
DSM 5 Criteria
D The hoarding causes clinically
significant distress or impairment in
social occupational or other important
areas of functioning (including
maintaining a safe environment for self
and others)
The DSM-V also calls for the clinician to
specify whether the individual is also
experiencing ldquoexcessive acquisitionrdquo (eg
do they acquire items that they donrsquot need
and for which they donrsquot have space in
their home) and to specify the personrsquos
level of insight (good fair poor or
absentdelusional)
Predisposition of a Hoarder
bull History
bull Vulnerability
bull Cognitive deficits
bull Beliefs about possessions
bull Emotions
bull Reinforcements
9102018
4
AcquiringSaving amp
Accumulating
OrganizingSorting
Removal
(Insight amp Executive Functioning)
(Excess)
Halpern 2018
Acquiring
bull Dollar Store
bull Home Shopping
bull Thrift stores
bull Tree lawns
bull Free samples
bull Senior fairs (pens clips sanitizers)
bull Trash
Emotional $hopping
Positive Emotions
bull Pleasure
bull Excitement
bull Pride
bull Joy
bull Fondness
bull Satisfaction
Negative Emotions
bull Griefloss
bull Anxiety
bull Sadness
bull Guilt
bull Anger
bull Frustration
9102018
5
Managing Possessions
Hoarding Collecting
Clutter Minimalist
Possessions
Organization
low high
Halpern 2018
Reasons for Saving
ldquoThrowing things away is wastefulrdquo
ldquoI may need itrdquo
ldquoI can fix thisrdquo
ldquoSomeone will value itrdquo
ldquoThis is beautifulrdquo
ldquoThese are my memoriesrdquo
ldquoI have to see it or I will lose itrdquo
ldquoThese items are my identityrdquo
9102018
6
An Extension of Self
HOARDING
Executive Functioning
Perfectionism
Lack of Insight
Procrastination
Churning
Disorientation
Trauma
Vulnerabilities
bull Family History
bull Losses
bull Depression
bull Social isolation
bull Health limitations
bull Acquiring inherited possessions
bull Downsizing
bull A lifetime to collect items
9102018
7
Profile for Elders
bull Problem solving
bull Executive functioning
bull Memory
bull Decision-making
Special Considerations
bull Diminished health and wellness
bull Chronic medical conditions
bull Lack of access to medical treatment
bull Complex family relationships
bull Limitedfixed income
bull Victimization
bull Low rate of overall happiness
9102018
8
Co-Morbidity
bull 60 Major Depression
bull 30 Social Phobia
bull 25 Anxiety Disorder
bull Dementia
bull Post Traumatic Stress
Disorder (PSTD)
bull Prolonged Grief Disorder
bull Onset childhood adolescence
bull Hoarding increases with each decade
bull Generally people do not receive
treatment
bull Older adults with hoarding are
socially isolated and live alone
Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149
Age at onset and clinical features
of late life compulsive hoarding
Onset
bull Onset can start in childhood or early
adolescence
bull Severity increases over time (30s 50s)
bull Progressive and Chronic
bull Negative life event (death divorce)
bull Psychiatric or Physical illness
Ayers et al 2009 Grisham et al 2006 Samuels et al 2002
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
2
History of Hoarding
DSM 5 Criteria for
Hoarding Disorder - 2013
A Persistent difficulty discarding or
parting with possessions regardless of
their actual value
B This difficulty is due to the perceived
need to save the items and to distress
associated with associated with
discarding them
DSM 5 Criteria
C The difficulty discarding possessions
results in the accumulation of
possessions that congest and clutter
active living areas and substantially
compromise their intended use If living
areas are uncluttered it is only
because of the interventions of third
parties (eg family members
cleaners authorities)
9102018
3
DSM 5 Criteria
D The hoarding causes clinically
significant distress or impairment in
social occupational or other important
areas of functioning (including
maintaining a safe environment for self
and others)
The DSM-V also calls for the clinician to
specify whether the individual is also
experiencing ldquoexcessive acquisitionrdquo (eg
do they acquire items that they donrsquot need
and for which they donrsquot have space in
their home) and to specify the personrsquos
level of insight (good fair poor or
absentdelusional)
Predisposition of a Hoarder
bull History
bull Vulnerability
bull Cognitive deficits
bull Beliefs about possessions
bull Emotions
bull Reinforcements
9102018
4
AcquiringSaving amp
Accumulating
OrganizingSorting
Removal
(Insight amp Executive Functioning)
(Excess)
Halpern 2018
Acquiring
bull Dollar Store
bull Home Shopping
bull Thrift stores
bull Tree lawns
bull Free samples
bull Senior fairs (pens clips sanitizers)
bull Trash
Emotional $hopping
Positive Emotions
bull Pleasure
bull Excitement
bull Pride
bull Joy
bull Fondness
bull Satisfaction
Negative Emotions
bull Griefloss
bull Anxiety
bull Sadness
bull Guilt
bull Anger
bull Frustration
9102018
5
Managing Possessions
Hoarding Collecting
Clutter Minimalist
Possessions
Organization
low high
Halpern 2018
Reasons for Saving
ldquoThrowing things away is wastefulrdquo
ldquoI may need itrdquo
ldquoI can fix thisrdquo
ldquoSomeone will value itrdquo
ldquoThis is beautifulrdquo
ldquoThese are my memoriesrdquo
ldquoI have to see it or I will lose itrdquo
ldquoThese items are my identityrdquo
9102018
6
An Extension of Self
HOARDING
Executive Functioning
Perfectionism
Lack of Insight
Procrastination
Churning
Disorientation
Trauma
Vulnerabilities
bull Family History
bull Losses
bull Depression
bull Social isolation
bull Health limitations
bull Acquiring inherited possessions
bull Downsizing
bull A lifetime to collect items
9102018
7
Profile for Elders
bull Problem solving
bull Executive functioning
bull Memory
bull Decision-making
Special Considerations
bull Diminished health and wellness
bull Chronic medical conditions
bull Lack of access to medical treatment
bull Complex family relationships
bull Limitedfixed income
bull Victimization
bull Low rate of overall happiness
9102018
8
Co-Morbidity
bull 60 Major Depression
bull 30 Social Phobia
bull 25 Anxiety Disorder
bull Dementia
bull Post Traumatic Stress
Disorder (PSTD)
bull Prolonged Grief Disorder
bull Onset childhood adolescence
bull Hoarding increases with each decade
bull Generally people do not receive
treatment
bull Older adults with hoarding are
socially isolated and live alone
Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149
Age at onset and clinical features
of late life compulsive hoarding
Onset
bull Onset can start in childhood or early
adolescence
bull Severity increases over time (30s 50s)
bull Progressive and Chronic
bull Negative life event (death divorce)
bull Psychiatric or Physical illness
Ayers et al 2009 Grisham et al 2006 Samuels et al 2002
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
3
DSM 5 Criteria
D The hoarding causes clinically
significant distress or impairment in
social occupational or other important
areas of functioning (including
maintaining a safe environment for self
and others)
The DSM-V also calls for the clinician to
specify whether the individual is also
experiencing ldquoexcessive acquisitionrdquo (eg
do they acquire items that they donrsquot need
and for which they donrsquot have space in
their home) and to specify the personrsquos
level of insight (good fair poor or
absentdelusional)
Predisposition of a Hoarder
bull History
bull Vulnerability
bull Cognitive deficits
bull Beliefs about possessions
bull Emotions
bull Reinforcements
9102018
4
AcquiringSaving amp
Accumulating
OrganizingSorting
Removal
(Insight amp Executive Functioning)
(Excess)
Halpern 2018
Acquiring
bull Dollar Store
bull Home Shopping
bull Thrift stores
bull Tree lawns
bull Free samples
bull Senior fairs (pens clips sanitizers)
bull Trash
Emotional $hopping
Positive Emotions
bull Pleasure
bull Excitement
bull Pride
bull Joy
bull Fondness
bull Satisfaction
Negative Emotions
bull Griefloss
bull Anxiety
bull Sadness
bull Guilt
bull Anger
bull Frustration
9102018
5
Managing Possessions
Hoarding Collecting
Clutter Minimalist
Possessions
Organization
low high
Halpern 2018
Reasons for Saving
ldquoThrowing things away is wastefulrdquo
ldquoI may need itrdquo
ldquoI can fix thisrdquo
ldquoSomeone will value itrdquo
ldquoThis is beautifulrdquo
ldquoThese are my memoriesrdquo
ldquoI have to see it or I will lose itrdquo
ldquoThese items are my identityrdquo
9102018
6
An Extension of Self
HOARDING
Executive Functioning
Perfectionism
Lack of Insight
Procrastination
Churning
Disorientation
Trauma
Vulnerabilities
bull Family History
bull Losses
bull Depression
bull Social isolation
bull Health limitations
bull Acquiring inherited possessions
bull Downsizing
bull A lifetime to collect items
9102018
7
Profile for Elders
bull Problem solving
bull Executive functioning
bull Memory
bull Decision-making
Special Considerations
bull Diminished health and wellness
bull Chronic medical conditions
bull Lack of access to medical treatment
bull Complex family relationships
bull Limitedfixed income
bull Victimization
bull Low rate of overall happiness
9102018
8
Co-Morbidity
bull 60 Major Depression
bull 30 Social Phobia
bull 25 Anxiety Disorder
bull Dementia
bull Post Traumatic Stress
Disorder (PSTD)
bull Prolonged Grief Disorder
bull Onset childhood adolescence
bull Hoarding increases with each decade
bull Generally people do not receive
treatment
bull Older adults with hoarding are
socially isolated and live alone
Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149
Age at onset and clinical features
of late life compulsive hoarding
Onset
bull Onset can start in childhood or early
adolescence
bull Severity increases over time (30s 50s)
bull Progressive and Chronic
bull Negative life event (death divorce)
bull Psychiatric or Physical illness
Ayers et al 2009 Grisham et al 2006 Samuels et al 2002
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
4
AcquiringSaving amp
Accumulating
OrganizingSorting
Removal
(Insight amp Executive Functioning)
(Excess)
Halpern 2018
Acquiring
bull Dollar Store
bull Home Shopping
bull Thrift stores
bull Tree lawns
bull Free samples
bull Senior fairs (pens clips sanitizers)
bull Trash
Emotional $hopping
Positive Emotions
bull Pleasure
bull Excitement
bull Pride
bull Joy
bull Fondness
bull Satisfaction
Negative Emotions
bull Griefloss
bull Anxiety
bull Sadness
bull Guilt
bull Anger
bull Frustration
9102018
5
Managing Possessions
Hoarding Collecting
Clutter Minimalist
Possessions
Organization
low high
Halpern 2018
Reasons for Saving
ldquoThrowing things away is wastefulrdquo
ldquoI may need itrdquo
ldquoI can fix thisrdquo
ldquoSomeone will value itrdquo
ldquoThis is beautifulrdquo
ldquoThese are my memoriesrdquo
ldquoI have to see it or I will lose itrdquo
ldquoThese items are my identityrdquo
9102018
6
An Extension of Self
HOARDING
Executive Functioning
Perfectionism
Lack of Insight
Procrastination
Churning
Disorientation
Trauma
Vulnerabilities
bull Family History
bull Losses
bull Depression
bull Social isolation
bull Health limitations
bull Acquiring inherited possessions
bull Downsizing
bull A lifetime to collect items
9102018
7
Profile for Elders
bull Problem solving
bull Executive functioning
bull Memory
bull Decision-making
Special Considerations
bull Diminished health and wellness
bull Chronic medical conditions
bull Lack of access to medical treatment
bull Complex family relationships
bull Limitedfixed income
bull Victimization
bull Low rate of overall happiness
9102018
8
Co-Morbidity
bull 60 Major Depression
bull 30 Social Phobia
bull 25 Anxiety Disorder
bull Dementia
bull Post Traumatic Stress
Disorder (PSTD)
bull Prolonged Grief Disorder
bull Onset childhood adolescence
bull Hoarding increases with each decade
bull Generally people do not receive
treatment
bull Older adults with hoarding are
socially isolated and live alone
Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149
Age at onset and clinical features
of late life compulsive hoarding
Onset
bull Onset can start in childhood or early
adolescence
bull Severity increases over time (30s 50s)
bull Progressive and Chronic
bull Negative life event (death divorce)
bull Psychiatric or Physical illness
Ayers et al 2009 Grisham et al 2006 Samuels et al 2002
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
5
Managing Possessions
Hoarding Collecting
Clutter Minimalist
Possessions
Organization
low high
Halpern 2018
Reasons for Saving
ldquoThrowing things away is wastefulrdquo
ldquoI may need itrdquo
ldquoI can fix thisrdquo
ldquoSomeone will value itrdquo
ldquoThis is beautifulrdquo
ldquoThese are my memoriesrdquo
ldquoI have to see it or I will lose itrdquo
ldquoThese items are my identityrdquo
9102018
6
An Extension of Self
HOARDING
Executive Functioning
Perfectionism
Lack of Insight
Procrastination
Churning
Disorientation
Trauma
Vulnerabilities
bull Family History
bull Losses
bull Depression
bull Social isolation
bull Health limitations
bull Acquiring inherited possessions
bull Downsizing
bull A lifetime to collect items
9102018
7
Profile for Elders
bull Problem solving
bull Executive functioning
bull Memory
bull Decision-making
Special Considerations
bull Diminished health and wellness
bull Chronic medical conditions
bull Lack of access to medical treatment
bull Complex family relationships
bull Limitedfixed income
bull Victimization
bull Low rate of overall happiness
9102018
8
Co-Morbidity
bull 60 Major Depression
bull 30 Social Phobia
bull 25 Anxiety Disorder
bull Dementia
bull Post Traumatic Stress
Disorder (PSTD)
bull Prolonged Grief Disorder
bull Onset childhood adolescence
bull Hoarding increases with each decade
bull Generally people do not receive
treatment
bull Older adults with hoarding are
socially isolated and live alone
Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149
Age at onset and clinical features
of late life compulsive hoarding
Onset
bull Onset can start in childhood or early
adolescence
bull Severity increases over time (30s 50s)
bull Progressive and Chronic
bull Negative life event (death divorce)
bull Psychiatric or Physical illness
Ayers et al 2009 Grisham et al 2006 Samuels et al 2002
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
6
An Extension of Self
HOARDING
Executive Functioning
Perfectionism
Lack of Insight
Procrastination
Churning
Disorientation
Trauma
Vulnerabilities
bull Family History
bull Losses
bull Depression
bull Social isolation
bull Health limitations
bull Acquiring inherited possessions
bull Downsizing
bull A lifetime to collect items
9102018
7
Profile for Elders
bull Problem solving
bull Executive functioning
bull Memory
bull Decision-making
Special Considerations
bull Diminished health and wellness
bull Chronic medical conditions
bull Lack of access to medical treatment
bull Complex family relationships
bull Limitedfixed income
bull Victimization
bull Low rate of overall happiness
9102018
8
Co-Morbidity
bull 60 Major Depression
bull 30 Social Phobia
bull 25 Anxiety Disorder
bull Dementia
bull Post Traumatic Stress
Disorder (PSTD)
bull Prolonged Grief Disorder
bull Onset childhood adolescence
bull Hoarding increases with each decade
bull Generally people do not receive
treatment
bull Older adults with hoarding are
socially isolated and live alone
Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149
Age at onset and clinical features
of late life compulsive hoarding
Onset
bull Onset can start in childhood or early
adolescence
bull Severity increases over time (30s 50s)
bull Progressive and Chronic
bull Negative life event (death divorce)
bull Psychiatric or Physical illness
Ayers et al 2009 Grisham et al 2006 Samuels et al 2002
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
7
Profile for Elders
bull Problem solving
bull Executive functioning
bull Memory
bull Decision-making
Special Considerations
bull Diminished health and wellness
bull Chronic medical conditions
bull Lack of access to medical treatment
bull Complex family relationships
bull Limitedfixed income
bull Victimization
bull Low rate of overall happiness
9102018
8
Co-Morbidity
bull 60 Major Depression
bull 30 Social Phobia
bull 25 Anxiety Disorder
bull Dementia
bull Post Traumatic Stress
Disorder (PSTD)
bull Prolonged Grief Disorder
bull Onset childhood adolescence
bull Hoarding increases with each decade
bull Generally people do not receive
treatment
bull Older adults with hoarding are
socially isolated and live alone
Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149
Age at onset and clinical features
of late life compulsive hoarding
Onset
bull Onset can start in childhood or early
adolescence
bull Severity increases over time (30s 50s)
bull Progressive and Chronic
bull Negative life event (death divorce)
bull Psychiatric or Physical illness
Ayers et al 2009 Grisham et al 2006 Samuels et al 2002
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
8
Co-Morbidity
bull 60 Major Depression
bull 30 Social Phobia
bull 25 Anxiety Disorder
bull Dementia
bull Post Traumatic Stress
Disorder (PSTD)
bull Prolonged Grief Disorder
bull Onset childhood adolescence
bull Hoarding increases with each decade
bull Generally people do not receive
treatment
bull Older adults with hoarding are
socially isolated and live alone
Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149
Age at onset and clinical features
of late life compulsive hoarding
Onset
bull Onset can start in childhood or early
adolescence
bull Severity increases over time (30s 50s)
bull Progressive and Chronic
bull Negative life event (death divorce)
bull Psychiatric or Physical illness
Ayers et al 2009 Grisham et al 2006 Samuels et al 2002
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
9
Collected Items
bull Paper
bull NewspaperMagazines
bull Clothing
bull Food
bull Books
bull Trash
bull Animals (rare)
bull Alcohol bottles
bull Cat hair
Kim et al 2001
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
10
The Impacts of Hoarding
bull 45 could not use their refrigerators
bull 42 could not use the kitchen sink
bull 42 could not use their bathtub
bull 20 could not use the bathroom sink
bull 10 could not use the toilet
Am J Geriatr Psychiatry - January 2014
Hoarding Disorder in Older Adulthood
Problems and Safety Issues
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
11
General Risks of Hoarding
bull Fire
bull Blocked egress
bull Food poisoningcontamination
bull Infestations (rats fleas bed bugs)
bull Poorinadequate diet
bull Hygiene issues
bull Finesevictions
Geriatric Risks
bull Chronic illness
bull Problems with medication
bull Poorinadequate diet
bull Increased fall risk
bull ADL problematic
bull Social isolation
bull Eviction
bull Family conflicts
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
12
Assessment
Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)
Hoarding rating scale(Tolin et al 2010)
Clutter image rating(Frost et al 2006)
Bedroom Livingroom Kitchen
Saving
Inventory
Revised (2014)
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
13
Hoarding
Rating Scale (Tolin et al 2008)
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
14
bull Improve the personrsquos quality of life
bull Improve functionality of target areas
bull Create living space and free use of space
bull Improve organizational skills
bull Make possessions more accessible
bull Improve decision making skills
bull Improve family relations
bull Reduce acquiring through substituting alternative
satisfying behaviors
bull Learn problem solving skills
Treatment Goals
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
15
bull Touch nothing without permission
bull Person makes all decisions about
possessions
bull Treatment should be systematic following a
plan but leaving room for flexibility
bull Person must think aloud while
bull OHIO principle (Only Handle It Once)
bullKeep ndash Discard ndash Donate ndash Display (sorting)
bullSorting criteria
Treatment Rules
What Helps - Trust
bull Emphasis on modeling
bull Teach skills
bull Homework and compliance
Get organized
Use calendar
Make a ldquoTo Dordquo list
Work on problems
Skills training
ldquoGood enoughrdquo
Tolerate distress of discarding
Treatment
bull Building trust
bull Home Visits Important
bull Education
bull Organization
bull Decision-makingExecutive functioning
bull Exposure to non-acquiring and
discarding
bull Cognitive Behavior Therapy
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
16
Cleaning Up
bull The person must be involved in
the decision-making
bull Hoarders are reluctant to part
with anything
bull Can cause anxietydistress
sense of loss
bull Clearing out is not always the
best approach
bull Once cleaned recidivism is
high
Supporting Personal Goals
bull Encouraging incremental efforts
bull Talk through the process
bull Articulate ambivalence
bull By expressing empathy
bull Rolling with resistance
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
17
Case Studies
Case 1 - Betty
Case 2 - John
Case 3 - Lou
Keep in Mind
bull A mental health disorder not a decision
bull Not a moral issue Not caused by laziness
lack of standards lack of responsibility
bull Clutter is only a symptom of the problem
bull Others are usually more aware ofbothered
by the clutter than the individual
bull 92 of individuals have 1 or more mental
health issues (depression anxiety OCD
social phobias)
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000
9102018
18
Resources
Bostonrsquos Center for Hoarding Intervention
httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention
Children of Hoarders
httpchildrenofhoarderscomwordpress
Hoarding On-line Support Group (Free and National)
httpshoardingcleanupcomhoarding_support_group
Institute for Challenging Disorganization
httpsicdorgmemberclicksnet
International OCD Foundation
httpshoardingiocdforg
State and City Hoarding Task Force
San Diego
httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf
San Diego ndash Hoarding in Older Adults Study
httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-
adultsaspx
Marilyn Halpern LSW
mhalpernsecuredallianceorg
7207240000