Hoarding

1. Hoarding Abby Wagner, Marie Sartori, Adam Coleman, David Cotterman, Maryam Noorzad, Lindsey Gamrat, Morgan Lewis, Aaren Hampton, Katie York, Liz Farra

2. What the Research Says... • "Compulsive hoarding is a progressive and chronic condition that begins early in life." • "Left untreated, its severity increases with age." • Most compulsive hoarding symptoms were reported as being in midlife, but results found most cases began in childhood or adolescence (Ayers et al, 2010).

3. What is Hoarding? • Two behaviors associated w/ hoarding: • Excessive collection of items • Inability to discard or rid these items • Common items hoarded: • clothes • newspapers • junk mail • books • craft items (International OCD Foundation, 2010)

4. What is Hoarding? YES..... EVEN ANIMALS!!!! (Mayo Clinic, 2011)

5. What is Hoarding? • Debilitating, chronic disorder • Disorganized clutter that creates chaos in homes leading to: • Cramped living conditions • Unsanitary conditions • Exits being blocked • Rooms unable to be used • Difficulty moving around (International OCD Foundation, 2010) (Mayo Clinic, 2011) (Ayers et al, 2010).

6. Who Hoards? • Hoarding may be a symptom of OCD, but many people who hoard do not have other OCD-related symptoms • Hoarding can affect anyone, regardless of age, sex or economic status. It's not clear, though, how common hoarding is. • People who hoard do not see it as a problem so treatment is difficult • Due to lack of understanding of cause there is no known prevention (Mayo Clinic, 2011)

7. Risk Factors • Little is understood as to what causes hoarding but researchers have identified risk factors: • Age: usually starts in adolescence and gets worse with age • Stressful life events • Family history • Alcohol abuse • Social isolation • Late onset hoarding may be idiopathic or secondary to other conditions (Mayo Clinic, 2011; Ayers et al, 2010).

8. Signs and Symptoms • Cluttered living spaces • Inability to discard items • Keeping stacks of newspapers, magazines or junk mail • Moving items from one pile to another, without discarding anything • Acquiring unneeded or seemingly useless items, including trash or napkins from a restaurant • Difficulty managing daily activities, including procrastination and trouble making decisions • Difficulty organizing items • Shame or embarrassment • Excessive attachment to possessions, including discomfort letting others touch or borrow possessions • Limited or no social interactions (Mayo Clinic, 2011)

9. Focus on age at onset: compulsive hoarding in elderly • Elderly hoarding can be more difficult to diagnose and is not well understood • Study conducted by Ayers et al (2010) interviewed 18 adults over age 60 • Asked patients about major life events and to rate their hoarding symptoms • Used a number of different tools to conduct structured interviews, including Mini International Neuropsychotic Interview (MINI) • Findings: onset actually occurs most often in childhood and adolescence • Compulsive hoarding behaviors increased with each decade of life; it is a progressive, chronic condition • Only 16% of participants met criteria for OCD, but mood and anxiety comorbidities were common • Should be considered a separate disorder from OCD

10. Implications Goal is to stick to treatment; sticking to your goals and treatment plan will ensure the most probable outcome. Examples -Keeping up on personal hygiene/bathing -Proper nutrition -Compliant with medications -Living a healthy, enjoyable life (Mayo Clinic, 2011)

11. Implications Reach out to others -Hoarding lifestyle can cause people to become isolated and have a sense of loneliness which in turn can lead to more hoarding. Nurses should encourage socialization -If people are feeling overwhelmed and don't want people in their house, they should be encouraged to socialize outside the house with friends and family. (Mayo Clinic, 2011)

12. Current Treatments • Therapy • Psychotherapy • Cognitive Behavior Therapy most commonly used. • Medications • SSRIs • Paxil • Not everyone responds to medication (Mayo Clinic, 2011)

13. Prognosis • Initially obtaining treatment may prove difficult in itself • Barriers to treatment may include: • Hiding symptoms/denial • Less public awareness of hoarding and OCD • Lack of training of health professionals (may be misdiagnosed) • Difficulty finding a therapist • Not being able to afford therapy • On average, it takes 14-17 years after the problem starts for someone with an OCD disorder to get the right treatment (International OCD Foundation, 2010)

14. Prognosis (cont.) • Treatment is challenging and often results in mixed success • Cognitive Behavior Therapy is often most successful • Underlying disorders and potential causes of the hoarding need to be treated • Ideally, a combination of treatment options tailored to the specific patient will help them learn to live a normal life and be a productive member of society (Mayo Clinic, 2011)

15. Videoclip CBS News interview with "Hoarding:Buried Alive" women and a psychologist https://www.youtube.com/watch?v=RvlHdx7-M6g

16. Resources • International OCD Foundation (2010). About hoarding. Retrieved from http://www.ocfoundation.org/hoarding/about.aspx • Mayo Clinic (2011). Hoarding. Retrieved from http://www.mayoclinic.com/health/hoarding/DS00966 • Ayers, C., Saxena, S., Golshan, S., & Wetherell, J. (2010). Age at onset and clinical features of late life compulsive hoarding. International Journal OfGeriatricPsychiatry, 25(2), 142-149.doi:10.1002/gps.2310