Who Gets Buried:
The Long Lasting Impact of
Hoarding
Terri L. Hamrick, BA MNM LSW
[email protected]
717-805-5373
Copyright 2012 Terri L. Hamrick
Learning ObjectivesParticipants will be able to:
O Define hoarding and understand how it is
currently defined, current research and studies,
as well as the likely changes in the DSM 5
O Develop a better understanding of the ‘hoard’ as
a symptom of underlying issues for the person
who hoards
O Identify the coping mechanisms and perception
of the person who engages in hoarding
O Identify potentially hoarded homes verses
‘normal clutter’
Copyright 2012 Terri L. Hamrick
Learning Objectives (continued)Participants will be able to:
O Identify the impact of hoarding on the family of
the person who compulsively hoards
O Identify and develop ways to support children
who still reside in the hoarded home
O Understand the reasons that the adult children
of those who hoard may be angry and/or
disengaged from their parent(s)
O Develop strength based and client centered
strategies to work with children who are being
raised in hoarded homes or have been raised in
a hoarded home
Copyright 2012 Terri L. Hamrick
Quote from a Child of the Hoard
“It wasn’t the mess, it was only
being blamed or made to feel
responsible for it. My mother was
difficult to be around, alternating
emotional absence with temper
tantrums…”
Anonymous participant of Dr. Suzanne Chabaud’s/Obsessive-Compulsive Disorder
Institute of Greater New Orleans unpublished study (2011-2012)
Copyright 2012 Terri L. Hamrick
Hoarding… What is it?
O The DSM-IV-TR defines hoarding as (300.3):
O Either obsessions or compulsions
O Obsessions/compulsions are excessive or
unreasonable
O Cause marked distress, are time consuming,
significantly interfere with the person’s normal
routine or relationships
O Not due to the direct physiological effects of a
substance or medical condition
O Poor insight- the person may not recognize how
excessive or unreasonable
Copyright 2012 Terri L. Hamrick
Copyright 2012 Terri L. Hamrick
How prevalent is Hoarding?
O In July of 2011, there were over 6,500
families who had reached out to the A&E
Hoarders show
O Over 2,300+ Children of Hoarders seeking
support on the COH Yahoo Group
O CDC released that there is one diagnosis of
Alzheimer's for every 10 to 12 persons.
Now- the CDC further believes that for each
person with Alzheimer's, there are 3 people
who compulsively hoard.
Copyright 2012 Terri L. Hamrick
How prevalent is Hoarding?
Continued
O Is a worldwide issue
O Originally thought that more men hoard than
women, but more women that seek help are
caught in a situation where they are ‘outed’
O Onset of hoarding seems to be the middle
teens but those who seek help often do not
do so until the 50’s
O Statistics and estimates vary, but it is
believed that between 1.4 million and 3
million compulsively hoard
Copyright 2012 Terri L. Hamrick
It is a right of self determination… Or is it?
The real risks of Hoarding.
O A hoarded house is over 4 times more likely to
burn. And when the hoarded home burns, there
is a higher likelihood of fatalities.
http://www.abc27.com/story/17060192/crewshoarding-made-fatal-adams-co-fire-hard-to-battle
O Public health issue:
O Falls (both dry/clean and wet/dirty hoards)
O Asthma, allergies (both wet and dry)
O Infections such as staph, MRSA (both clean and
dry)
O Mold (both clean and dry hoards)
O Sewage and other biologicals in a wet/dirty hoard
Copyright 2012 Terri L. Hamrick
Quote from a Child of the Hoard
From an anonymous participant of Dr. Suzanne Chabaud’s
in-process research study:
“The physical conditions were
pretty horrific. The shame was
overwhelming. The conflict
with my parents was
exhausting.”
Copyright 2012 Terri L. Hamrick
It is a right of self determination… Or is it?
The real risks of Hoarding- Continued
Hoarding has long been ill-defined as a
character trait or as an eccentricity.
Many still look at it as the person’s business
and do not understand the potential harm to
the person who hoards and to others.
Self-determination can cut both ways.
Copyright 2012 Terri L. Hamrick
It is a right of self determination… Or is it?
The real risks of Hoarding- Continued
O Oddly- many who hoard seem to biologically
acclimate to their toxic surroundings
O This does not mean they are unaffected, long
term damage is being done to both him or her and
his or her family and pets
O The emotional damage that is done
O Neglect of children and their needs
O Children of Hoarders have similar experiences to
those surviving addicted parents
O Power and control/oppression/interpersonal
violence cycle
Copyright 2012 Terri L. Hamrick
It is a right of self determination… Or is it?
The real risks of Hoarding- Continued
Effects on Seniors…
O Basic functioning in the home is impaired.
One investigation found that:
O 45% could not use their refrigerators
O 42% could not use the kitchen sink
O 42% could not use the bathtub
O 20% could not use the bathroom basin
O 10% could not use their toliet
Copyright 2012 Terri L. Hamrick
Copyright 2012 Terri L. Hamrick
Those who hoard will often:
O Enjoy significantly powerful positive feelings
that reinforce hoarding
O Avoid the extreme, anxiety producing
negative feelings discarding [items] causes
Stuff: Complusive Hoarding and the Meaning of Things by
Gail Steketee and Randy O. Frost, 2011)
Copyright 2012 Terri L. Hamrick
How the person that hoards
exerts their influence
Often, behind ever-closed doors and blinds, the
person that hoards will:
O Live in the circle of shame of guilt
O Lack empathy for COH, but ‘wonderful strangers’
get all the empathy in the world
O The COH comes last; passive aggressive
behavior at special events, birthdays, etc.
O Be self-depreciating yet guilt issuing
O See the COH as merely an extension of
themselves
O Claim the COH needs too much, is too emotional
Copyright 2012 Terri L. Hamrick
How the person that hoards exerts his
or her influence- Continued
O Does not know how to interact with a child,
grandchild, etc. as a separate person
O Lack of ‘Otherization’ – seeing someone as a
separate
O Depersonalization of children, others, and
especially those who attempt to intervene
O The ‘with us or against us’ mentality and utter
betrayal if a child varies from their wishes,
behavior or thought expectations
O It is all about them… Narcissism and selfcenteredness in parenting and in most if not all
interpersonal interactions
Copyright 2012 Terri L. Hamrick
How the person that hoards exerts his
or her influence- Continued
O Jealous of achievements that take the focus off
of the person who hoards…
O Success sets the child apart from the family
O Minimizes the child’s achievements to the
COH- brags to others
O The hoard may reflect failure to some
O If it is not completed perfectly it will not be
started at all
O Power and control exerted …
Copyright 2012 Terri L. Hamrick
How the person that hoards exerts his
or her influence- Continued
O Message from person who hoards
O You are harming me
O You do not care about me
O Split personality… one way to the kids and family,
and another to everyone else (or to whom the person
who hoards deems important) ‘Wonderful Strangers’
O You are incompetent
O You are sneaky (stealing, etc.)
O You are spoiled rotten because…
O You are the baby
O We never made you do anything- you have it easy
O You have never ‘wanted’ for anything (material items)
O You have an inappropriate sense of entitlement
Copyright 2012 Terri L. Hamrick
How the person that hoards exerts his
or her influence- Continued
Passive Aggressive behavior- is so harmful because it is deniable.
The person that hoards often denies the COH reality…
O Which is supremely invalidating.
O It is particularly destructive.
O May be utilized by the person when they are conflicted, and
they may not be comfortable expressing their behavior in an
authentic way.
O It is a purposeful behavior, and it feels mean.
O It is conscious and intentional behavior to punish a perceived
injustice, yet for whatever reason they cannot express those
feelings directly.
O It is often modeled and becomes a way to relate within families
and is learned.
Copyright 2012 Terri L. Hamrick
How the person that hoards exerts his
or her influence- Continued
The person that hoards has enough insight to
know hoarding is something that should be
hidden, and trains their children from birth
onward to focus on the needs and desires of
the hoarder.
The children get a clear, clear message.
Everything, EVERYTHING is more important than
people or relationships. As a COH, you are
expected to ‘keep the secret’.
Copyright 2012 Terri L. Hamrick
Is it a Hoard?
Or are they just messy?
O 2011 Clutter – Hoarding Scale©
http://createthespace.com/wordpress/wpcontent/uploads/2011/08/ICD_CHS_Trifold_b
order_Release_062911.pdf
O Clutter Image Rating
http://www.ocfoundation.org/hoarding/cir.pdf
Copyright 2012 Terri L. Hamrick
Copyright 2012 Terri L. Hamrick
Collection? Or Hoard?
Collectors will:
O Seek specific items
or genres of items,
sometimes
purchasing
frequently, other
times going long
periods of time
without purchasing
Copyright 2012 Terri L. Hamrick
Those who hoard will:
O Seek specific items
but will buy
additional items,
often
indiscriminately
Collection? Or Hoard? Cont.
Collectors will:
O Store and/or display
items in a careful,
methodical manner
O Proudly share their
collected items with
others
O Have very specific
knowledge of value
Those who hoard will:
O Store items
carelessly and
haphazardly, often
resulting in damage
O Will not share
‘treasured items’
O Damage does not
disqualify value
(Adapted from Hoarding vs. Collecting- Geralin Thomas)
Copyright 2012 Terri L. Hamrick
Copyright 2012 Terri L. Hamrick
What We Are Learning…
O DSM 5 will likely address:
O Removing Hoarding from OCD
O It will be a ‘Syndrome’ rather than Compulsive
Hoarding
O Own diagnosis rather than V-code
O Axis I
O Acknowledging co-morbidity such as:
O
O
O
O
Trauma, loss
Narcissism
Power and control
Possibly subset of OCD
Copyright 2012 Terri L. Hamrick
Emerging from additional
research…
O In the nearly 800 participants in Dr. Suzanne Chabaud’s
2012 study, over 80% of the parents who hoard were
identified as female
O Often with depression and social anxiety … hoarding
manifests before the other is grossly evident.
O There are two components of hoarding:
O One is pleasure seeking… acquisition or the comfort
gained.
O Second- avoidance behavior in the inability to get rid of it.
The letting go phase is what causes the most issues.
O Most folks with OCD do not get pleasure from their
obsessions as those who hoard often do. Many
hoarders do not have OCD… the counting, the order, and
the perfectionism.
Copyright 2012 Terri L. Hamrick
Emerging from additional
research…
O There is also an expansion of the definition that
insight of the person who hoards is not required.
O External identifiers such as –
O acquiring AND/OR inability to let go…
O Too much of or of limited value items.
O It must limit their ability to use the home in the
manner intended, regardless of distress by the
hoarder.
O This appears to be more in line with some
participants experience that hoarding is like
addiction. There is pleasure at acquisition and
discomfort at thought of discarding an item(s).
Copyright 2012 Terri L. Hamrick
Copyright 2012 Terri L. Hamrick
Current Research
Beginning in 2011, Dr. Suzanne Chabaud and
her team of researchers began a multilayered
research project that focuses on the Children
of Hoarders.
As of April 2012 the project continues… nearly
800 adult children of the hoard have
participated in the study at some level to date.
Copyright 2012 Terri L. Hamrick
It is NOT just the Stuff- Growing up in
the shadow of the Hoard
The pain of the family of those who hoard is
not about the amount of belongings the parent
has, it is about the emotional unavailability of
the parent who hoards as well as the
emotional abuse, manipulation, the use of
power/control, the use of guilt, etc.
Children growing up in a hoarded home suffer
the loss of being able to benefit in the healthy
relationships garnered by the non-Hoarding
parent due to the isolation.
Copyright 2012 Terri L. Hamrick
Copyright 2012 Terri L. Hamrick
Commonalities of the COH
Experience
O Choosing the geographical solution- (the people that
*poof* disappear after high school and do not return
often, if at all)
O Those who continue to try to please the person that
hoards, and everyone else (codependency)
O Feeling like a fake and a failure (feeling reactive)
O ‘Cherry picking’ details of their lives that are presented
to others
O The struggle of integration of self and experience
O Feeling ‘not quite as’ ________. Worthy, good, etc.
O When a person feels pervasively and continually
devalued, how does that person value himself or
herself
Copyright 2012 Terri L. Hamrick
Commonalities of the COH
Experience
Continued
O Those who dream of getting old enough to do it their own way
O Double edged sword… as a child they are forced by necessity to
lie and manipulate, and it exacerbates the wall that is being
built
O Learned helplessness because of all the inability to clean the
hoard
O Will distort memories to protect themselves or pass through
the filter of their experience
O Frustration – asking what they (the child) can do, and advised
to do a duty that does not address the condition of the home
(dusting the chandelier for example)
O Using school or outside opportunities as a way to escapesuper achieving … or the flip side of the same coin, rebelling
Copyright 2012 Terri L. Hamrick
Commonalities of the COH
Experience
Continued
O Waiting for something, a light to go on so to speak…
O Realizing that what is needed, deserved, from a
hoarding parent will never be. Grieving the loss of
what should have been. (Zombie analogy)
O The desire to be a good person and a good parent
DESPITE the hoarder, to treat people in a healthy way
O Many COHs seemed to agree they were made to feel
like ‘bad children’ or inappropriately entitled for the
basics in which they WERE entitled, and it is a double
edged sword.
O Shaming, guilt, and manipulation are used to ensure
that the children, even as adults… KEEP THE SECRET
Copyright 2012 Terri L. Hamrick
Copyright 2012 Terri L. Hamrick
Working with and supporting
Children of Hoarders
O Adult Children
In work with those that compulsively hoard, the
family is often viewed as contributing to the stress
of the person. (Viewed often as the ‘angry
children’ or refusing to help a vulnerable/aging
parent). It is critical to the Social Worker to realize
the impact on the environment on the family.
Relatives, professionals, neighbors, the media…
often unwittingly victimize the COH again.
Copyright 2012 Terri L. Hamrick
Working with and supporting
Children of Hoarders
O Adult Children- Continued
The family should be treated by the
professional as the expert… and as
SURVIVORS. Confidentiality and boundaries
should apply, but no one-size-fits-all treatment
(such as cognitive behavioral therapy).
Long term treatment success for those who
hoard is currently bleak.
Copyright 2012 Terri L. Hamrick
Working with and supporting
Children of Hoarders
O Adult Children- Continued
Interventions have to be tailored to the family
experience, and should include:
1. Dealing with unresolved trauma
2. Finding core issues
3. Finding trigger issues
4. Discovering how the Hoard impacts the
individual family members and their
development, coping, safety and insight
Copyright 2012 Terri L. Hamrick
Working with and supporting
Children of Hoarders
O Adult Children and Interventions- Continued
An understanding of the isolation that the COH
felt, and still feels
6. Commonalities of the COH experience
7. Understanding of the shame and
embarrassment and how that evolves through
the COH’s life
8. Dissociation and other coping mechanisms are
present because COH’s have been in survival
mode their entire lives
5.
Copyright 2012 Terri L. Hamrick
Working with and supporting
Children of Hoarders- Cont.
O Minor children still residing in the Hoard
Identifying the real environmental risks as well
as the abusive behavior that many children
who live in a hoarded home experience.
Advocacy is critical in creating meaningful
change in a system that is not sufficiently
prepared or has few appropriate resources.
Copyright 2012 Terri L. Hamrick
Working with and supporting
Children of Hoarders- Cont.
Minor children still residing in the Hoard
Some safety questions and/or safety planning
O Is your home condition a secret?
O Are you blamed for things? What is that like?
O Can you define your own personal space?
O Can you bring someone home?
O Do you have bug bites?
O Do you get teased because of how you smell?
O Can you get out in a fire? How?
Copyright 2012 Terri L. Hamrick
Copyright 2012 Terri L. Hamrick
Blaming the Victim…
(Yes, it happens with COHs as well)
There is a perception that Children of Hoarders are
dysfunctional, angry people.
Families of addicts and alcoholics are not treated as COHs
are. COHs upset the professionals sometimes, and like
with the addiction models the family was considered part
of the addicts problem from the early stages. (Especially
adult) children are pigeon holed negatively for moving
through behavior that was survival-focused (enabling) and
as in addiction they are in a different space.
The adult child has worked around the person who hoards
from the beginning, and put their and others’ needs ahead
their own for often their entire lives.
Copyright 2012 Terri L. Hamrick
Blaming the Victim…
(Yes, it happens with COHs as well)
Continued
O Appalachian and rural culture often values
the parental relationship above all others…
No matter what.
O “But it is your mother!”
O “You will feel guilty when he is gone… I wish I
still had my father…”
O At what level of abuse does a person (child)
have the right to protect themselves by
disengaging emotionally and/or physically?
Copyright 2012 Terri L. Hamrick
Blaming the Victim…
(Yes, it happens with COHs as well)
Continued
O Adult children are faced with, “How do you help
someone who will not help themselves, and
worse, will work against you and manipulate
potential allies against you?”
O Emotional (and sometimes physical) abuse
escalation occurs at time of interventions…
O Children of the Hoard know that ‘clean outs’ do
not work, and are physically harmful to them,
and even more emotionally damaging… and
polarizing…
Copyright 2012 Terri L. Hamrick
Hoarding and Mandated Reportingwhen is it abuse or neglect?
O What is the definition of Abuse in your state?
http://www.childwelfare.gov/systemwide/laws
_policies/state/
Copyright 2012 Terri L. Hamrick
Physical Abuse in WV
Physical Abuse
Citation: Ann. Code § 49-1-3
'Abused child' means a child whose health or welfare is harmed or threatened by:
A parent, guardian, or custodian who knowingly or intentionally inflicts, attempts to inflict, or knowingly allows
another person to inflict, physical injury or mental or emotional injury upon the child or another child in the home
O
Sexual abuse or sexual exploitation
O
The sale or attempted sale of a child by a parent, guardian, or custodian in violation of the law
O
Domestic violence, as defined by § 48-27-202
O
Physical injury as a result of excessive corporal punishment
O
'Child abuse and neglect' or 'child abuse or neglect' means physical injury of a child by a parent, guardian,
or custodian who is responsible for the child's welfare under circumstances that harm or threaten the
health and welfare of the child.
O
'Imminent danger to the physical well-being of the child' means an emergency situation in which the welfare
or the life of the child is threatened. Such emergency situations may include:
O
Nonaccidental trauma inflicted by a parent, guardian, custodian, sibling, or a babysitter or other caregiver
O
A combination of physical and other signs indicating a pattern of abuse that may be medically diagnosed as
battered child syndrome
O
Sale or attempted sale of the child by the parent, guardian, or custodian
O
'Serious physical abuse' means bodily injury that creates a substantial risk of death or causes serious or
prolonged disfigurement, prolonged impairment of health, or prolonged loss or impairment of the function
of any bodily organ.
Copyright 2012 Terri L. Hamrick
Neglect in WV
Neglect
Citation: Ann. Code § 49-1-3
'Neglected child' means a child:
O Whose physical or mental health is harmed or threatened by a present refusal,
failure, or inability of the child's parent, guardian, or custodian to supply the child
with necessary food, clothing, shelter, supervision, medical care, or education
O Who is presently without necessary food, clothing, shelter, medical care,
education, or supervision because of the disappearance or absence of the child's
parent or custodian
O 'Child abuse and neglect' or 'child abuse or neglect' means negligent treatment or
maltreatment of a child by a parent, guardian, or custodian who is responsible for
the child's welfare under circumstances that harm or threaten the health and
welfare of the child.
O 'Imminent danger to the physical well-being of the child' means an emergency
situation in which the welfare or the life of the child is threatened. Such emergency
situations may include:
O Nutritional deprivation
O Inadequate treatment of serious illness or disease
Copyright 2012 Terri L. Hamrick
Emotional Abuse in WV
O Emotional Abuse
Citation: Ann. Code § 49-1-3
The terms 'child abuse and neglect' or 'child
abuse or neglect' include mental or emotional
injury of a child by a parent, guardian, or
custodian who is responsible for the child's
welfare, under circumstances that harm or
threaten the health and welfare of the child.
'Imminent danger to the physical well-being of
the child' includes substantial emotional injury
inflicted by a parent, guardian, or custodian.
Copyright 2012 Terri L. Hamrick
Reporting Child Abuse in WV
Standards for Reporting
Citation: Ann. Code § 49-6A-2
A report is required when there is reasonable cause to suspect that a child is
neglected or abused.
Persons Responsible for the Child
Citation: Ann. Code § 49-1-3
Responsible persons include the child's parent, guardian, or custodian.
Exceptions
Citation: Ann. Code § 49-1-3
A child is not considered neglected when:
O The lack of necessary food, clothing, shelter, or medical care is due primarily to a
lack of financial means on the part of the parent.
O The child's education is conducted within the provisions of § 18-8-1 [which
provides exemption from the State compulsory education requirement for private
school enrollment or homeschooling].
Copyright 2012 Terri L. Hamrick
Community Collaboration and
a Paradigm Shift
O Who can assist?
O Child Protective Services?
O Animal Control Officers?
O Fire Marshal?
O Codes Office?
O Adult Protective Services?
O MH/MR Services?
O Local Area Housing Option Team (LHOT)?
O Emergency Responders?
O Homeowner’s and Renter’s Insurance Carriers?
Copyright 2012 Terri L. Hamrick
Community Collaboration
One of the challenges in maintaining a viable
task force is that there is not a clear cut
definition of hoarding and a clear role for task
forces.
All areas are different as the coordinating
entities are different. Fairfax County has a
temporary housing situation and they are now
jammed up.
Copyright 2012 Terri L. Hamrick
Community Collaboration
Furthermore:
Some areas (in reference to Task Forces) there are
grant driven initiatives, some are governmental
positions.
It has been found that if there is a paid position (think
SHiP cooperative) then the task force will survive.
Some areas such as Spokane – if the postal carrier
sees mail is not picked up that is an automatic referral
to Adult Protect Services.
Copyright 2012 Terri L. Hamrick
References
O Chabaud, Suzanne, unpublished study, 2011O
O
O
O
2012
http://psychiatryonline.org/content.aspx?bookid
=28&sectionid=1678180#149244
http://createthespace.com/wordpress/wpcontent/uploads/2011/08/ICD_CHS_Trifold_bor
der_Release_062911.pdf
http://www.ocfoundation.org/hoarding/cir.pdf
http://www.childwelfare.gov/systemwide/laws_p
olicies/state/
Copyright 2012 Terri L. Hamrick
References- Continued
O http://www.childwelfare.gov/systemwide/la
ws_policies/state/index.cfm?event=stateSta
tutes.processSearch
O Stuff: Complusive Hoarding and the
Meaning of Things by Gail Steketee and
Randy O. Frost, 2011)
O Kim, H., Steketee, G., & Frost, R.O., (2001).
Hoarding by elderly people. Health and
Social Work, 26, 176-184.
Copyright 2012 Terri L. Hamrick
References- Continued
O Frost and Hartl, 1996
Copyright 2012 Terri L. Hamrick
Resources for Children of the Hoard
O http://www.psychiatrictimes.com/ocd/conte
nt/article/10168/1989161http://www.milfo
rddailynews.com/archive/x770710252/-N
O http://childrenofhoarders.com/wordpress/
O http://www.childrenofhoarders.com/COHBro
chure-081811.pdf
O http://www.challengingdisorganization.org/
Copyright 2012 Terri L. Hamrick
Resources for Children of the Hoard
O http://www.andersoncooper.com/episodes/
hoarders-and-how-to-free-your-life-fromclutter/
O http://www.wwltv.com/news/health/Groupreaches-out-to-children-of-hoarders126219988.html
O http://abcnews.go.com/blogs/health/2012
/03/10/nearly-half-of-children-of-hoardersfight-guilt-depression/?fb_ref=.T11ctJ4rpk.like&fb_source=profile_multiline
Copyright 2012 Terri L. Hamrick
Resources for Children of the Hoard
O My Mother’s Garden- A film by Cynthia
Lester, daughter of a hoarding mother
O Dirty Secret- Memoir by Jessie Sholl,
daughter of a hoarding mother
O Dirty Little Secrets- Young adult novel about
the daughter of a hoarding mother, by C.J.
Omololu
O Toxic Parents: Overcoming Their Hurtful
Legacy and Reclaiming your Life- Craig Buck
and Susan Forward
Copyright 2012 Terri L. Hamrick
A special thank you to:
O Dr. Suzanne Chabaud of the Obsessive-
Compulsive Disorder Institute of Greater
New Orleans and her dedicated research
team
O Ceci Garrett- Advocate for Hoarding and
Family Related Issues, Spokane WA
O A. Lamping for all home photos used in this
presentation
O The leadership of Children of Hoarders, Inc.
Copyright 2012 Terri L. Hamrick