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

We continue this week with sharing information from the March 2014 issue of The Carlat Report: Behavioral Health on hoarding disorder.

At Absolutely Organized, 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):5-8. Print.

Etiology:

* The main self-reported reasons for hoarding include:

* Possible future need for the object

* Sentimental attachment

* Perception of value

* 50% of patients who hoard report hoarding behavior in a first degree relative

* Hoarders often retrospectively report trauma or stressful events, especially abuse or witnessing a crime, prior to start of hoarding or increase in hoarding behavior

* Hoarding is associated with information-processing deficits, including difficulties with memory, categorization, and decision-making

* Hoarders score higher on measures of attention-deficit/hyperactivity disorder (ADHD), and children with ADHD have been found to have hoarding behaviors

 

Part II of Dr. Steketee’s Interview:

TCRBH (The Carlat Report: Behavioral Health): Is this an individual or group therapy?

Dr. Steketee: We are not convinced that individual treatment is the best way to go. It takes at least 26 sessions for most people, and can be very expensive.

TCRBH: How does therapy look in a group setting?

Dr. Steketee: There are two main types of group strategies. The first uses CBT methods developed in individual treatment but applied in a group format. The advantage of the group is that we have a natural motivator built in and people can use each other as resources to advance their own efforts. The second approach is adapted from a self-help book I co-authored called, “Buried in Treasures” (Tolin DF et al.  Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding. 2nd ed. USA: Oxford University Press: 2014). These are groups led by a peer who has a hoarding problem who has learned to deal with it effectively.

TCRBH: Is cleaning out a house to resolve safety issues a traumatic experience for someone with hoarding disorder?

Dr. Steketee: Having a home cleaned out without involving the participant in the decision-making process can be quite disastrous for them. Housing and public health professionals who have experience with hoarding fully understand that they should only remove items that are necessary to ensure health and safety. For instance, you have to have access to windows, a path to get through a room, the ability to get into and use the bathroom, use of the stove, and there cannot be fire hazards. These may require relatively limited interventions, and then the person can settle down and work on the hoarding problem themselves with the help of those who are supporting them.

TCRBH: This sounds like it can be a real challenge for family members.

Dr. Steketee: Family members are often frustrated because they cannot get that person to agree to treatment. The book, Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiringby Michael Thompkins and Tamara Hartl (New Harbinger Publications, 2009) was designed to help family members think about health and safety as the main focus of their conversation with family members. This puts it on a different footing than saying, “You should get rid of all this stuff,” which doesn’t go over very well.

TCRBH: Does hoarding disorder respond well to treatment?

Dr. Steketee: Yes, it does, once people decide to seek help, but that decision is a major challenge for people who hoard-it is hard for them to decide they want treatment. When you have depression or anxiety, you are emotionally very uncomfortable, and you seek to relieve that discomfort. But when you have a houseful of stuff that you don’t want to get rid of and it makes you happy to accumulate new things, only a part of your life is challenged. For instance, people’s worlds become narrower because they can no longer invite friends or family over to visit. The idea of parting with things is so upsetting for people that they don’t necessarily want to stop unless they are convinced that it is dangerous or family members won’t tolerate it anymore.

TCRBH: Where do you see this work going and what future opportunities lie ahead?

Dr. Steketee: I am very interested in seeing how far the peer treatment model can be used to move forward in making treatment more appealing and more effective. The question is, can people develop peer networks that really do move them forward and help them maintain what they are doing? Often people with hoarding, especially as they are older, can be quite isolated, and that is a challenging problem that the peer support systems will be better at than individual clinicians who are with them an hour or two a week.

Jenny PowerAbsolutely Organized, LLC

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