Hoarding Behavior in Elders

Presented by: Emily B. Saltz, LICSW Elder Resources www.eldres.com

NAPGCM Webinar January 11, 2012 Definition of Hoarding*

1) The acquisition of, and failure to discard a large number of possessions that appear to be useless or of limited value.

2) The living spaces in the home are sufficiently cluttered so as to preclude activities for which those spaces were designed.

3) There is generally significant distress or impairment in functioning caused by hoarding.

(Adapted from “A Cognitive-Behavioral Model of Compulsive Hoarding” by Randy Frost) DIAGNOSTIC CRITERIA

Current:

 Subset of OCPD in DSMIV

 DSM-IV lists hoarding of “worn out or worthless objects even when they have no sentimental value” as a symptom of obsessive-compulsive personality disorder (OCPD). DIAGNOSTIC CRITERIA

Proposed:  Accumulation of clutter  Difficulty discarding/parting with objects  Compulsive acquiring of free or purchased items  Distress or interference  Duration at least 6 months  Not better accounted for by other conditions (OCD, major , , psychosis, bipolar disorder)

(Frost, Steketee, Tolin & Brown, 2006) Hoarding vs. Collecting

 Collecting is a normal and common phenomenon in children.  Collecting in adulthood can be a pleasurable activity that does not necessarily include an unwillingness to part with items.  Clinically significant hoarding is associated with distress and functional impairment in daily life.  Collectors acquires and discards. Hoarders just acquire and rarely discard. Prevalence and Demographics of Hoarding

 Prevalence in general population – 3-5%  Underreported problem –only five percent of cases come to attention of authorities.  Prevalence among patients with obsessive compulsive disorder is approximately 20-30 percent.  Prevalence among patients with dementia is approximately 20 percent.  Education – ranged widely  Typical age of onset was during childhood or adolescence.  Strong familial link – 80 percent of hoarders grew up in house with someone who had hoarded. Profile of Hoarders

•Female, unmarried, lives alone •Social Isolation •, depression and/or personality disorder •Poor insight – denies problem Co-Morbid Problems Associated With Hoarding

Hoarding is associated with several disorders including:  Dementia  OCD  ADHD  Depression  Anxiety (PTSD, general)  Schizophrenia /psychotic disorders  Substance abuse  Personality Disorders

Frost & Steketee; Cognitive-Behavioral Model of Compulsive Hoarding; Frost & Steketee; 1998 WHY PEOPLE HOARD

 Vulnerabilities  Information processing deficits  Meaning of possessions  Emotional Reactions  Reinforcement Symptoms of Hoarding

 Nearly always accompanied by excessive buying or acquisition of possessions  Hoarders can collect things or animals – “Specialty Hoarders”  Many hoarders experience significant depression, social phobia, and isolation. Hoarders show poor insight into problems and have poor treatment motivation

Frost & Steketee; Cognitive-Behavioral Model of Compulsive Hoarding; Frost & Steketee; 1998 Symptoms of Hoarding

Hoarding is characterized by problems with:  Acquisition  Discarding  Organization  Beliefs about possessions  Decision-making

Frost & Steketee; Cognitive-Behavioral Model of Compulsive Hoarding; Frost & Steketee; 1998 Deficits Associated With Hoarding

Hoarding Stems from Four Types of Deficits  Information-processing – decision making; categorization/organization; memory.  Problems with emotional attachments to possessions – objects as extensions of oneself.  Behavioral avoidance – excessive concern over mistakes.  Erroneous or distorted beliefs about nature and importance of p