1 Hoarding Satwant Singh MSc RN Nurse Consultant

1 Hoarding Satwant Singh MSc RN Nurse Consultant in CBT & Mental Health Wordsworth Health Centre, London hoarding. satwant@gmail. com March 2012 Satwant Singh

2 Aims ¡ To 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 March 2012 Satwant Singh

3 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 al 1990), psychotic disorders (Lichins et al, 1992), OCD, OCPD (APA, 1994) and mental retardation (van Houten & Rolider, 1988) March 2012 Satwant Singh

4 Definition of hoarding ¡ Although widely recognised as symptom of OCD, the DSM IV describes it in the context of OCPD ¡ However DSM V (2013) hoarding will be classified as a disorder in its own right ¡ Frost & 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 March 2012 Satwant Singh

5 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 March 2012 Satwant Singh

6 Continuum Minimalist March 2012 Satwant Singh Normal saving Clutter Hoarding 3/18/2018

7 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 March 2012 Satwant Singh

8 Reasons for hoarding ¡ Usually begins in childhood, more common in males ¡ Family history of hoarding and OCD ¡ Often linked to some sort of trauma e. g. loss, abuse, divorce etc ¡ Material deprivation ¡ Severe and enduring mental illness and other mental health problems March 2012 Satwant Singh

9 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 March 2012 Satwant Singh 3/18/2018

10 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 March 2012 Satwant Singh 3/18/2018

11 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” March 2012 Satwant Singh 3/18/2018

12 Manifestation of hoarding ¡ Usually 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 Satwant Singh 3/18/2018

13 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 March 2012 Satwant Singh 3/18/2018

14 Consequences of legislation ¡ Homelessness ¡ Distress and trauma- Environment Health ¡ Stigma and vulnerability (exposed) ¡ Harassment by neighbours/others and victimisation ¡ Feelings of being punished ¡ Social exclusion and isolation March 2012 Satwant Singh 3/18/2018

15 Next steps ¡ Hoarding will become a major issue post the new diagnostic categorisationrecognition 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 March 2012 Satwant Singh 3/18/2018

16 Next steps ¡ Need 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 March 2012 Satwant Singh 3/18/2018

17 References ¡ Chartered 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. March 2012 Satwant Singh 3/18/2018

18 References ¡ Hunter, C. & Nixon, J. (2007) Special Issue- Hoarding and mental health Editorial. People, Place & Policy 2/1: 1 -3. DOI: 10. 3351/ppp. 0002. 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 2836 March 2012 Satwant Singh 3/18/2018

19 Treatment Group in London National 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, E 12 6 SU More details can be obtained from the website: www. ocdaction. org. uk March 2012 Satwant Singh 3/18/2018