Examining Hoarding and Cluttering Behavior

1. Examining Hoarding and Cluttering Behavior Matthew Soderquist, MSW Adult Services Supervisor/CRC Otsego/Crawford/Oscoda DHS

2. Overview • Diagnosing Hoarding Disorder • Underlying Beliefs and Impacts of Hoarding • Assessments • Interventions • Rules of Interventions • Goals of Interventions • Measuring Success • 3 Case examples

3. Diagnosing Hoarding Disorder • Persistent difficulty discarding or parting with possessions, regardless of their actual value. • This difficulty is due to a perceived need to save the items and distress associated with discarding them. • The symptoms result in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use. • The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. Diagnosing Hoarding Disorder • In addition the DSM-5 lists two “specifiers” (features that may or may not be present): • Excessive acquiring • Level of Awareness • Good or fair Insight • Poor insight • Absent insight • *Medical condition • *Another mental disorder

5. Underlying Beliefs • Overestimation of Catastrophe or Loss • Perfectionism • Responsibility • Need for control • Emotional Comfort • Sentimental • Security Based • Connections, Social Ties

6. Impacts of Individuals with Hoarding and Cluttering Disorder • Isolation • Impedes development of relationships • Safety issues in their homes • Fear of eviction • Problems in their family relationships, loss of contact, divorce, and custody. • “My wife left, My children don’t visit” • “I lost custody of my daughter because of hoarding” • “My family has completely abandoned me” • “My husband hurt himself while walking through the house…he has no place to relax”

7. Impacts of Children of Hoarding and Cluttering Behavior • Loss of space • Developmental delays • Hygiene problems (access to bathrooms, loss of utilities) • “Doorbell Dread” • One child of a hoarder would strategically arrange for her friends to visit while she was visiting her fathers home • Financial strain • Poor eating habits • Physical and Mental Health Issues • Impact on social lives • CPS involvement, Divorce and Housing Instability

8. Impacts of Adult Children of Hoarding and Cluttering Behavior • Strained familial relationships • Resistant to allowing grandchildren to visit • Grandparents become isolated from grandchildren • Adult children are ashamed to bring significant others to visit parents. • Limited ability to determine the proper value in objects • “Abandon all hope that the parent will reform

9. Assessments • Hoarding Assessment Tool • HOMES- Health, Obstacles, Mental health, Endangerment, Structure and Safety. • Hoarding Rating Scale • Savings Inventory Revised • Savings Cognitions Inventory • Clutter Image Rating Scale • TACC- Tufts Animal Care and Condition

10. Interventions • What doesn’t work • Quick Cleanouts • Throwing things away in secret or lying about what you will do with an object • Forced discarding often increases distrust of others and increases attachment of the object • May cause increase of collecting as fear of losing is increased

11. Interventions • Professional Counseling or Therapy • Cognitive Behavioral Therapy • Exposure Therapy • Themes of CBT for Hoarding • Building a legacy of trash? • Everything goes to the dumpster eventually • Build relationships with people not things • Things are here to serve us not the other way around • How does this item add to my life?

12. Interventions • Education • Buried in Treasures • BIT Workshop • Support Groups • Children of Hoarders • Adult Children of Hoarders

13. Interventions • Practical Methods • Cut of paper flow • Fowl the trash and avoid dumpsters • Involve family members • Non-shopping trips • Practice getting rid of objects • Develop guidelines for Keep vs. Toss • Safe vs. Unsafe • Rotten Wood • Pest infestation

14. Rules for Intervention • May not touch or throw anything out without explicit permission • All decisions regarding saving, discarding and organizing are made by client • O.H.I.O- Only Handle It Once • Focus on client goals and standards NOT ours

15. Goals of Intervention • Client safety by uncluttering living space • Harm Reduction Model • Increase appropriate use of space • Improve decision making skills and develop organizational plan • Reduce accumulations of new possessions • Clean, Cull and Connect

16. Measuring Success • Small Steps • Safe, healthier environment for the client to live in • Housing secured • Client’s motivation increases • Creation of a system for managing items that client can manage on their own • Use of photos, CIR, HOMES

17. References • Bratiotis, C., & Schmalisch, C. S. (2011). The hoarding handbook: a guide for human service professionals. Oxford: Oxford University Press. • Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association. • Frost, R. O., & Steketee, G. (2010). Stuff: compulsive hoarding and the meaning of things. Boston: Houghton Mifflin Harcourt. • Lokers, L. M. (2013). Identifying and treating hoarding behaviors. University of Michigan. Anxiety Disorders Program • Steketee, G., & Frost, R. O. (2013). Treatment for Hoarding Disorder Workbook. (2nd ed.). Oxford: Oxford University Press, USA. • Tolin. D.F. (2014). Buried in treasures help for compulsive acquiring, saving, and hoarding (Second ed.). Oxford: Oxford University Press.