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hoarding

The excessive collection & retention of things or animals until they interfere with day-to-day function (home, health, family, social life, work) Epidemiology: 1) < 1% of population 2) occurs in 1/3 of patients with obsessive compulsive disorder (OCD) 3) female > male 4) tend to live alone & have never married 5) tend to be older [1] Clinical manifestations: 1) obsesses over belongings a) items perceived as valuable b) items provide a source of security c) fear of forgetting or losing items 2) constant need to collect and keep things 3) finds it difficult to discard belongings without professional help 4) may experience extreme distress if attempt is made to discard items 5) obtaining love not found from people 6) fear others will obtain their personal information 7) contributing factors in the elderly a) physical limitations & frailty b) inability to organize c) self neglect d) stressful life events Complications: - collected items may cause a health hazzard Management: 1) do not remove the clutter immediately - carefully assess the individual situation 2) if possible, involve the hoarder in decisions - intervention without the cooperation of the hoarder can lead to poor outcome 3) cognitive behavioral therapy (1st line) [2] 4) involve family members & other agencies a) Dept of Mental Health b) Adult Protective Services - unlikely that adult protective services will become involved unless the patient is cognitively impaired or has a mental health disorder beyond hoarding d) Building & Safety & Code Enforcement 5) things to DO with elderly hoaders a) contact the patient face to face b) use a soft, gentle approach & let the patient tell his/her story c) respect the meaning & attachment to possessions by the patient, which may be as intense as human attachment d) be calm & factual, but caring & supportive e) evaluate for safety f) refer for mental health evaluation g) go slowly & expect gradual change h) reassure the older adult that others will try to help & work with him/her i) involve the patient in seeking solutions j) work with other agencies to maximize resources 6) things NOT to DO with elderly hoaders a) do NOT hospitalize unless there is a clear plan on what will be accomplished b) do NOT force interventions c) do NOT be critical or judgmental about the patient's environment d) do NOT press the patient for information that appears to make him/her uncomfortable e) d NOT make negative, teasing or sarcastic statements

Related

cluttering

General

psychiatric disease; behavioral disorder chronic mental disorder

References

  1. Nordsletten AE et al Epidemiology of hoarding disorder. Br J Psychiatry 2013 Oct 24 PMID: 24158881
  2. Mataix-Cols D. Hoarding disorder. N Engl J Med. 2014;370:2023-2030 PMID: 2484908
  3. Dept of Mental Health - Access Center (800) 854-7771 information & referral to local mental health system of care, 24 hours/day, 7 days/week
  4. Adult Protective Services (800) 992-1660 investigation & crisis intervention for elder & dependent adult abuse including self-neglect 24 hours/day, 7 days/week
  5. Infoline (800) 339-6994; TDD (800) 660-4026 24-hour information & referral to human services agencies
  6. Self-Help & Recovery (310) 305-8878 (West Los Angeles) Referral to hoarding and other self support groups