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Examining Hoarding and Cluttering Behavior. Matthew Soderquist, MSW Adult Services Supervisor/CRC Otsego/Crawford/Oscoda DHS. Overview. Diagnosing Hoarding Disorder Underlying Beliefs and Impacts of Hoarding Assessments Interventions Rules of Interventions Goals of Interventions

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examining hoarding and cluttering behavior

Examining Hoarding and Cluttering Behavior

Matthew Soderquist, MSW

Adult Services Supervisor/CRC

Otsego/Crawford/Oscoda DHS

overview
Overview
  • Diagnosing Hoarding Disorder
  • Underlying Beliefs and Impacts of Hoarding
  • Assessments
  • Interventions
      • Rules of Interventions
      • Goals of Interventions
  • Measuring Success
  • 3 Case examples
diagnosing hoarding disorder
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.
diagnosing hoarding disorder1
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
underlying beliefs
Underlying Beliefs
  • Overestimation of Catastrophe or Loss
  • Perfectionism
  • Responsibility
  • Need for control
  • Emotional Comfort
      • Sentimental
      • Security Based
      • Connections, Social Ties
impacts of i ndividuals with hoarding and cluttering disorder
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”
impacts of children of hoarding and cluttering behavior
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
impacts of adult children of hoarding and cluttering behavior
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
assessments
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
interventions
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
interventions1
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?
interventions2
Interventions
  • Education
    • Buried in Treasures
    • BIT Workshop
    • Support Groups
    • Children of Hoarders
    • Adult Children of Hoarders
interventions3
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
rules for intervention
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
goals of intervention
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
measuring success
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
references
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.