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 Measuring Success 3 Case examples 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 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 Overestimation of Catastrophe or Loss Perfectionism Responsibility Need for control Emotional Comfort Sentimental Security Based Connections, Social Ties 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 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 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 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 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 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? Interventions Education Buried in Treasures BIT Workshop Support Groups Children of Hoarders Adult Children of Hoarders 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 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 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 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 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.