1. health and fitness
2. disorders

Hoarding and Developmental Disabilities:
Coping and Prevention
June 3, 2015
Mission
To offer specialized programs and services that
are accessible to older Manitobans that support
and enhance their social, emotional, physical,
intellectual and spiritual lives and promote active
participation in all aspects of community life.
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Vision
To develop and deliver innovative programs and
services that improve the quality of later life.
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The Agency
• A not-for-profit organization that provides
programs and services to older adults 55+
• Established in 1957 in response to the need
from older adults and their caregivers
• Governed by a Board of Directors
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3 Pillars of Innovative Programs
& Services:
• Safety & Security
• Social Engagement
• Counselling
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Overview
• This Full House
• What is Hoarding?
• Assessment
• Best Practices
• Resources
• Questions
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‘This Full House’
• Voluntary program for older adults (55+) that
addresses hoarding and squalor
• Client participation is essential
• Uses cognitive rehabilitation and exposure
therapy with the goal of harm-reduction
• Involves counseling, sorting/cleaning services,
follow-up, and referral
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Getting Help
Referrals come from a variety of sources:
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Self-referrals
Family/Other Supports
Community/Government Agencies
Housing
Contact A & O and request to speak with Intake
*In order for referral to be made, consent must be given
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Funders
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Problem
behavior?
Mental
Illness?
Symptom of
something else?
OCD?
“Hoarding”
Collecting?
Excuse for
being
lazy?
Only on TV?
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Compulsive Hoarding
• The acquisition of, and failure to discard a large
number of possessions that appear to be of
useless or of limited value;
• Living spaces sufficiently cluttered so as to
preclude activities for which the spaces were
designed; and
• Significant distress or impairment caused by the
hoarding.
(Frost & Hartl, 1996)
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Hoarding Disorder
Diagnostic criteria for DSM-5 (Obsessive-Compulsive & Related Disorders
category):
A.
B.
C.
D.
E.
Persistent difficulty discarding or parting with personal possessions, even those of
apparently useless or limited value, due to strong urges to save items, distress,
and/or indecision associated with discarding.
The symptoms result in the accumulation of a large number of possessions that fill
up and clutter the active living areas of the home, workplace, or other personal
surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all
living areas are uncluttered, it is only because of others’ efforts (e.g., family
members, authorities) to keep these areas free of possessions.
The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning (including maintaining a safe
environment for self and others).
The hoarding symptoms are not due to a general medical condition (e.g. brain injury,
cerebrovascular disease).
The hoarding symptoms are not restricted to the symptoms of another mental
disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, lack
of motivation in Major Depressive Disorder, delusions in Schizophrenia or another
Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autistic
Disorder, food storing in Prader-Willi Syndrome).
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Collecting vs. Hoarding
Collecting:
Hoarding:
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•
•
•
• Usually disorganized
• Takes over areas of
home
• Cause of distress
• Risk to health
• Safety concerns
Organization
Mint condition
Kept in specific areas
Quality of life not
compromised
• Pride
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Squalor
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Squalor
• The state of living in unsanitary conditions which
may include human or animal feces, rotting food,
and infestations of rodents/insects
• May or not involve hoarding behaviors
• Like hoarding, squalor can pose a myriad of
health and safety concerns
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Hoarding Profile
Who?
• Often begins in adolescence, severity increases with
age
• Might occur alongside other conditions (e.g.
depression, anxiety)
• Often single
• Treatment sought in 50’s – women more than men
• Range of education, income
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What?
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•
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•
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•
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Clothing
Written information/material
Food
Craft items
Containers, bags
Used wrappers, bottles, tissues
_______________________
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Where?
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Own home
Multiple properties
Storage
Vehicle
Friends/parents
Acreage
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Why?
• Other illnesses/diagnoses
• Family History of Hoarding
– Genetics, environment
• Beliefs about Possessions
– Sentimental value, utility, beauty
• Cognition
– Differences in brain function and thought processes
• Avoidance
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•
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Object has emotional significance
Losing important information
Wasting useful objects
Object is beautiful or unique
It “doesn’t feel right” to get rid of it
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How?
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•
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•
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Shopping
Online shopping
Garage sales, free weekends
Relatives, friends
Trash, recycling bins
Workshops, fairs
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Assessing Risks
• Physical Health & Safety
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Falls, tripping over clutter
Unable to use bed, eat at table, navigate stairs
Food poisoning
Infestations
Services may not be available (e.g. plumbing,
electrical, Home Care)
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Assessing Risks
• Emotional/Social
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Shame, embarrassment
Anxiety
Depression
Feel overwhelmed
Family/marital discord
Reluctant to have visitors
Stress from family, landlords, etc.
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Assessing Risks
• Financial
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Cost of accumulating belongings
Moving due to eviction
Complying with City orders
Fines
Damage to home/property
Losing bills/important documents
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Assessing Risks
• Home Safety
- falls, fire hazards, rotting food, animals,
infestations, structure, other parties
• Personal Safety
- coping, social support, self-care, distress, risk
of homelessness, overall health
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Best Practices
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•
•
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Basic Strategies
Curiosity over Criticism
Reducing Acquiring
Treatment
– Harm Reduction
– Cognitive Rehabilitation
– Sorting/Discarding
*Aim for client participation wherever possible – goal is
sustainable change that involves client
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Basic Strategies
• Establish trust and
respect
• Don’t touch
• Share concerns about
safety
• Ask questions
• Respect each
individual’s process
• Allow the individual to
•
•
•
•
•
•
take control
Provide resources
Respect decision(s)
Encourage any
progress
Be patient
Family – take a step
back
Pick your battles
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Avoid:
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•
•
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•
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Judgmental language
Touching / removing items
Forced clean ups
Arguing
Overwhelming demands / unrealistic expectations
Manipulation
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Challenges
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Lack of trust
Past attempts
Physical barriers
Mental health concerns
Dementia
Lack of motivation
Time/Deadlines
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Curiosity over Criticism
• Why are you keeping this item / Can you tell me
about this item?
• What might happen if this was lost or was thrown
away?
• How do you feel about your bedroom/home/space?
• How were you feeling / what were you thinking
about before buying this item?
• How did you feel after buying it?
*Match the language used by the individual
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Reducing Acquiring
• Determine the source
• Redirect – replace with other pleasurable
activities
• Positive reinforcement – rules/rewards
• Find a safer (or smaller) item to collect
• Limit access (space, locks, funds)
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Treatment
Harm Reduction
• Target most concerning areas without requiring
hoarding behaviors to stop completely
– Create safer living environment by working on one
goal at a time (i.e. pathway to front door)
– Reduce collecting by setting limit (i.e. 1 item/week,
cannot exceed shoebox)
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Treatment
Cognitive Rehabilitation
• Approach designed for older adults
• Targets executive functioning skills (memory,
attention, problem solving)
– Calendar Use, To Do List, Goal Setting
– Problem Solving Model – DBESTE
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Treatment
Sorting/Discarding
• Strategies based on exposure therapy
• Repeated exposure to decision-making about
belongings (sorting/discarding) which, over time,
leads to a decrease in distress
• Client involvement required for long-term
change
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Treatment
Sorting/Discarding
• Tracking distress: emotion
faces, numbers, etc.
• Hierarchy – least to most
distressing
• Prepare – supplies etc.
• One area at a time
• Make a list ahead of
time/visualization
• Rule Lists
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Rewards
Limit time spent sorting
Space/numerical limits
Categorizing: looks like?
Choose between items
Social stories
Multi-disciplinary approach
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Resources
• A & O – This Full House
• OCD Centre Manitoba
Other Helpful Services:
• Employment & Income Assistance
• City of Winnipeg (Bylaws & Community Services)
• Contracted professional services
– Professional Organizers
– Cleaning Services
– Hauling Services
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Questions?
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References
Ayers, C., Twamley, E., Espejo, E., Saxena, S., and Wetherell, J. (2011). CREST: Cognitive
Rehabilitation and Exposure/Sorting Therapy for Compulsive Hoarding. VA San
Diego Healthcare System, University of California.
Berry C. and Schell, R.M. (2006). Reducing Hoarding Behavior with Individualized
Reinforcement and Item Return. Behavioral Interventions 21, 123-135.
Gallo, K., Wilson, L., and Comer, J. (2012). Treating hoarding disorder in childhood: A case
study. Journal of Obsessive-Compulsive and Related Disorders 2, 62-69.
Tompkins, M. and Hartl, T. (2009). Digging Out. New Harbinger Productions, Oakland CA.
Steketee, G. and Frost, R. O. (2000). Compulsive Hoarding and Acquiring: Therapist Guide.
Oxford English Press.
Storch, E., Rahman, E., Park, J., Reid, J., Murphy., and Lewin, A. (2011). Compulsive
Hoarding in Children. Journal of Clinical Psychology Vol. 67 (5).
Tolin, D., Frost, R., and Steketee, G. (2014). Buried in Treasures: Help for Compulsive
Acquiring, Saving, and Hoarding. Oxford University Press.
www.iocdf.com
https://www.autismspeaks.org/blog/2015/02/06/autism-hoarding-adult-son-fearsparent%E2%80%99s-help-overflowing-room
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A & O Services
Safety & Security
Social Engagement Counselling
• Elder Abuse
Prevention Services
• Safe Suite Program
• Older Victim
Services
• SafetyAid
• This Full House
• Senior Centre
Without Walls
• Connect Program
• Entry Program for
Older Adult
Immigrants
• Centres/Meals
Programs
• Information &
Referral
• Intake
• Counselling
• Housing
• Legal Clinics
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Thank you!
Contact info:
A & O: Support Services for Older Adults
200-280 Smith St.
Winnipeg, MB R3C 1K2
Phone: 204-956-6440
Toll-free: 1-888-333-3121
Fax: 204-946-5667
e-mail: [email protected]
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