Part I- Hoarding Disorder- The Current Facts for You and Your Loved Ones

In our interview last week on hoarding disorder with Dr. Elspeth Bell, she referenced the book “Buried in Treasures” (Tolin DF et al. Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding. 2nd ed. USA: Oxford University Press: 2014). We also recommend this book to our clients. Gail Steketee, PhD is a co-author of that book and was featured as an expert in the March 2014 issue of The Carlat Report: Behavioral Health, a monthly report featuring topics for mental health practitioners. The March issue’s focus was hoarding disorder.

Being the most up-to-date and current information available, we wanted to take the time to present to our readers Dr. Steketee’s interview with The Carlat Report: Behavioral Health, as well as some of the information provided on hoarding disorder. Hopefully it will help clarify any questions you may be looking to have answered for yourself, a friend or loved one.

Over the last 15 years, we have received many inquiries from people who describe themselves as hoarders who need help. We offer hands-on help to reduce clutter and our professional organizers are able to work with individuals who are currently in therapy for hoarding disorder. If you have any questions, please call our Maryland office, 410-329-3300 or our New Jersey office, 973-668-5666 for a free confidential phone consultation.

The following information if an excerpt from:

Coburn, Jay. “Psychosocial Interventions for Hoarding Disorder.” The Carlat Report: Behavioral Health 3.2 (2014):1-5. Print.

In Summary:

* The central symptoms of hoarding disorder are difficulty discarding objects, urges to save, excessive acquisition of possessions, and cluttered living spaces

* Hoarding disorder is a distinct diagnosis separate from hoarding behavior related to obsessive compulsive disorder (OCD) and obsessive compulsive personality disorder (OCPD)

* The most promising therapy is a cognitive-behavioral model specialized to treat hoarding

Demographics and Prevalence:

* Hoarding disorder is almost three times more prevalent in older adults (ages 55-94) than those 34 to 44

* Hoarding afflicts men more than women

* Women with hoarding disorder tend to engage in more excessive acquisition of possessions

* Onset is usually by age 15, with clinically significant impairment by the mid-30s; hoarding is chronic and progressive, with severity increasing with age

Part I of Dr. Steketee’s Interview:

TCRBH (The Carlat Report Behavioral Health): How do people with hoarding disorder typically come to the attention of a clinician?

Dr. Steketee: Most people with hoarding disorder are embarrassed and do not come to seek help from clinicians. Others do not recognize it as a problem. These individuals are more likely to be discovered by service providers such as the public health department and housing authorities.

TCRBH: Do they come for the hoarding or do they come for a co-occurring disorder?

Dr. Steketee: Both. Since hoarding has become more visible in popular culture, people have started seeking help specifically for this. We also see people who are seeking treatment for depression or anxiety.

TCRBH: Are there factors that can complicate diagnosis?

Dr. Steketee: Clutter does not equal hoarding. Hoarding must include the symptoms of difficulty discarding, excessive attachment to objects, excessive acquisition, and difficulty using the living areas of the home in standard ways. A common example of nonhoarding clutter is seen in the anhedonia of major depression: When the mail comes in, someone might leave it on the counter, not because they can’t make the decision on how to dispose of it, but because they have no energy and just don’t want to deal with it. That is a depression problem, not necessarily a hoarding problem. Then there is accumulation that can look like hoarding but is caused by something like contamination fears. For example, someone can be obsessed with not picking things up after they touch the floor because they are “dirty.” It is not that they can’t part with the object, but they have agonizing obsessions and compulsions related to disposing of things.

TCRBH: What is involved in psychotherapy for hoarding?

Dr. Steketee: There is a cognitive behavioral therapy (CBT)-based individual treatment. As part of this, we do motivational interviewing and other motivational strategies. This is so important, because people are ambivalent about parting with things that they have had for a long time. It is the same sort of strategy you would use if you were working on addiction, and in many ways it has similar features of strong positive emotions that are in the mix along with the negative. We also use skills training strategies-training people to make choices, like whether to keep something or throw it away, more rapidly.

TCRBH: Then there is an exposure component?

Dr. Steketee: People have to practice being exposed to situations where they make the choice to throw something away and then follow through. We also expose clients to situations where they commonly accumulate things and help them learn to resist those urges to do that. This is a gradual process. We do not ask people to do things they are not prepared to do, although we do encourage them to push their own limits.

(We will continue with this article next week.)

Jenny PowerAbsolutely Organized, LLC

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