March 2012 Satwant Singh 1 Hoarding Satwant Singh MSc RN Nurse Consultant in CBT & Mental Health Wordsworth Health Centre, London [email protected].

March 2012 Satwant Singh

1

Hoarding

Satwant Singh MSc RNNurse Consultant in CBT & Mental HealthWordsworth Health Centre, [email protected]

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AimsTo have an understanding about hoarding and the

psychological aspects and impact of hoarding on the individual and others

Appreciate the need to develop a joint strategy and the involvement of all agencies

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Hoarding symptoms and features

A common behaviour with the collection of food among rodents, small animals and birds (Honig, 1991)

Normal part of life cycle (Anderson, 1983, Kolb, 1974)

Relationship between hoarding in non humans and humans is less understood but may have some similarities

Hoarding in humans can be seen in a variety of disorders- anorexia nervosa Frankenburg, 1984), organic disorders (Greenberg, et al1990), psychotic disorders (Lichins et al, 1992), OCD, OCPD (APA, 1994) and mental retardation (van Houten & Rolider, 1988)

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Definition of hoardingAlthough widely recognised as symptom of OCD, the DSM

IV describes it in the context of OCPDHowever DSM V (2013) hoarding will be classified as a

disorder in its own rightFrost & Gross (1993)- the acquisition and failure to discard

possessions which appear to be useless or of limited value

The clutter is so severe that it prevents or precludes the use of living spaces for what they were designed for

The clutter, acquiring or difficulty discarding cause significant distress or impairment for the individual and family members

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How common is hoarding?Frost el al (1996) found with the OCD

outpatients 31% had hoarding compulsions and 26% had hoarding tendencies

It is estimated that less than 1% of population hoard the true figure is higher (6-8%). Estimated in the UK 1 in 200

Hoarding does not discriminate between age, gender socio economic groups

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Continuum

Minimalist Normal saving Clutter Hoarding

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Why is it a problem?Impairment and distress to the individual

Impairment to social functioning and relationship issues, social isolation

Health and safety- fire hazard, infestation, poor living conditions (lack of heating etc), hazard to the environment e.g. building with the lack of poor maintenance

Mental health issues e.g. depression, psychosis etc

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Reasons for hoardingUsually begins in childhood, more common in

malesFamily history of hoarding and OCDOften linked to some sort of trauma e.g. loss,

abuse, divorce etcMaterial deprivation Severe and enduring mental illness and other

mental health problems

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Similarities and Differences

Hoarders and non hoarders save the same

things but the differences are:

- Quantity

- Emotional attachments (sentimental)

- Perceived use of object (instrumental)

- Over valued beliefs

- The object as an extension of self


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Manifestations cont….

2 subtypes:

Compulsive acquisition- bringing items e.g. buy 1 get 3 free, good value

Non compulsive acquisition- unable to get rid of things e.g. rubbish


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Understanding of condition

Different from OCD and other conditions as:

Do not view their behaviour as unusual

Less insight into their behaviour

Have reasons why they need to “save” “I need this just in case” “It reminds me of marriage, good times in my life”


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Manifestation of hoardingUsually begins in childhood- long standing

Compulsive acquisition

Lack of organisation

Saving behaviours and inability to discard

Avoidance- dealing with the problem, others

Trust issues- letting others help

Lack of insight/acceptance of problem e.g. the place is too small, I don’t have time to organise


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Why is hoarding an issue?It impacts on families and neighbours

Health and safety issues- fire risk, injury, infestation, structural damage

Inside housing (May 2009) 87% out of 40 home improvement agencies have dealt with individuals with issues of hoarding

It is not an isolated problem and has implications for housing providers and landlords


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Consequences of legislationHomelessness

Distress and trauma- Environment Health

Stigma and vulnerability (exposed)

Harassment by neighbours/others and victimisation

Feelings of being punished

Social exclusion and isolation


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Next stepsHoarding will become a major issue post the

new diagnostic categorisation- recognition and identification

Local authority (EH, SS, police, fire services), health, statutory and non statutory organisations, housing associations to work together to deal a joint strategy

Development of services to deal with this issue of hoarding- dealing and supporting individuals


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Next stepsNeed joint working of these services and

have a single point of contact/access

Training in recognising, engaging and working with individuals with issues of hoarding

In the long term development of specialist services in dealing with this issue


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ReferencesChartered Institute of Environmental Health:

Professional Practice Note: Hoarding and how to approach it

Frost R.O. & Gross, R. C. (1993) The hoarding of possessions. Behaviour Research and Therapy, 31, 367-381

Frost, R.O. & Hartl, T. L. (1996) A Cognitive Behavioural Model of Compulsive Hoarding. Behaviour Research and Therapy, 33, 897-902

Furby, L. (1978) Possessions: Towards a theory of their meaning and function throughout the life cycle. In Bates, P.B. Life span development and behaviour (Vol 1) NY: Academic Press.


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References

Hunter, C. & Nixon, J. (2007) Special Issue- Hoarding and mental health Editorial. People, Place & Policy2/1: 1-3. DOI:10.3351/ppp.0002.0001.0001

Inside Housing (May, 2009) It’s a hoard life. http://www.insidehousing.co.uk/story.aspx?storycode=6504818

Obsessive Compulsive Cognitions Working Group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667-681

Slatter M. (2007) Treasures, trash and tenure: hoarding and housing risk. People, Place & Policy Online: 2/1 28-36


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Treatment Group in LondonNational Hoarding Treatment group

meets once a month- the last Wednesday of

each month from 6.00-8.00 pm at:

The Wordsworth Health Centre

19 Wordsworth Ave

London, E12 6SU

More details can be obtained from the website:

www.ocdaction.org.uk

March 2012 Satwant Singh 1 Hoarding Satwant Singh MSc RN Nurse Consultant in CBT & Mental Health Wordsworth Health Centre, London [email protected].

Documents

issue of hoarding

steps hoarding

hoarding symptoms

manifestation of hoarding

impact of hoarding

definition of hoarding

isolation slide

life slide