Hoarding Behaviors Among the SPMI Population

Transcription

1 Hoarding Behaviors Among the SPMI Population Presented by: Cindy Melander, MA Definitions of Hoarding Randy Frost, PhD, 1996 Clinical Compulsive Hoarding Acquisition and failure to discard large amount of possessions that appear to be useless or of limited value. Living space is so cluttered that they preclude normal use and/or what the room was intended for. Significant distress or impairment in functioning due to hoarding. Definitions of Hoarding Anxiety & Stress Disorders Institute of Maryland Subtype of Obsessive Compulsive Disorder Like other compulsive behaviors, hoarding is an effort to manage the anxiety raised by obsessive doubts. 1

2 Definitions of Hoarding Saxena & Maidment Compulsive Hoarding Syndrome More than just volume of possessions saved, clutter is extremely disorganized-valuable objects, sometimes money is commonly mixed in with trash. Even when volume of possessions isn t t large, considerable dysfunction can result from gross disorganization. Definitions of Hoarding David Tolin,, PhD Compulsive hoarding is thought by many to be a subtype of Obsessive Compulsive Disorder. Definitions of Hoarding David Tolin,, PhD (continued) People are thought to have a compulsive hoarding problem when they meet all three of these criteria (similar to that of Dr. Frost): They regularly keep a large number of possessions that most people would not consider to be very useful or valuable. Their home, or parts of their home, are so cluttered that they can no longer use them for their intended purpose. The clutter is so bad that it causes significant distress or impairment. 2

3 Four Deficit Areas of Someone Who Hoards Randy Frost, PhD 1. Information Processing Deficits Four Deficit Areas of Someone Who Hoards Randy Frost, PhD 2. Emotional Attachment Problems to Possessions Two Types of Saving Pure Sentimentality Value as a safety signal-possession comes to acquire an association with safety and comfort. Four Deficit Areas of Someone Who Hoards Randy Frost, PhD 3. Behavioral Avoidance 3

4 Four Deficit Areas of Someone Who Hoards Randy Frost, PhD 4. Erroneous Beliefs About the Nature of Possessions Other Characteristics Lack insight Delayed recognition Disorganized Indecisive Perfectionist Causes/Theories Saxena Pet scan findings that raise the question of whether compulsive hoarders also have structure brain abnormalities and neurocognitive deficits that differ from those seen in non-hoarding OCD patients. 4

5 Starting the Process Making the connection/relationship. Assure your number one goal is NOT to get them to throw things out. Be up front and honest. What your intentions are: *Is there a time frame forcing change? *Is there just a concern? Guess What? People are allowed to live in their homes and apartments that are full of belongings that we might consider garbage AS LONG as Leases are followed City ordinances are followed,.ie. in Duluth, you have to have running water and electricity to be able to live in your home. 5

6 Conduct an Assessment Can be formal or informal Take photos if necessary Interview Saving inventory Hoarding Assessment Tool Clutter Screening Questionaire Educate Person on Hoarding Explain Symptoms Inform them that is a problem even if they don t t see it that way-family/friends/housing inspectors Motivational factors to consider- Discuss deficit areas/see if they can identify Is the clutter preventing them from doing something they want? Do they want to change that? Develop an Intervention Plan Stop acquisition Homework Contracts Decide where to start Be creative 6

7 Stop Acquisition Must be first goal in therapy How to Stop Acquisition of Items Thorough assessment What do they acquire? How do they acquire it? Where do they acquire it? Why do they acquire it? Is there anyone else involved in the acquisition? Stopping Acquisition (cont.) Develop a written contract Client decides what they can stop acquiring Review barriers to maintaining contract Acquisition Exercises (handout) May need shadowing, check-ins 7

8 Goals and Strategies Goal #1 Stop Acquisition Goal #2 Create a useable space and use it as intended Goal #3 Maintain the useable space Goals and Strategies Goal #4 Start discarding unneeded items Goal #5 Create another useable space Goal #6 Prevent future acquisition Goals and Strategies Teach decision-making, organizing, and categorizing Organize: recycle, discard, save, store for later review, filing system-be creative-use photos, maps 8

9 Goals and Strategies Exposure to discarding Use photos to structure the organizing and discarding Use photos to show progress Once a space is maintained, choose another space or particular objects to work on next Helping people who hoard overcome barriers to meet their goals Suggested visits is several times a week, two hours at a time. Suggested two workers Gail Steketee likened those who hoard to those with ADD. Work in small increments of time- take breaks Helping people who hoard overcome barriers to meet their goals HOMEWORK must be assigned-be creative with this-allow them to assign themselves. People who hoard tend to view hoarding as reasonable so there are few intrinsic motivations to change try to find what their motivator is. 9

10 Crisis Situations/Time Limits Hoarding is a symptom of OCD and OCPD- could possibly be used used for reasonable accommodation, extensions w/ landlords. Teaming the situation (good staff/bad staff) with a written contract-client client in charge Crisis Situations/Time Limits Be AWARE if you clean it up without client, it will just happen all over again if you don t have support in place. Once a few rooms are useable, consider in- home services to help maintain the space. My Mother s s Garden 10

11 Crisis Situations/Time Limits Crisis Situations/Time Limits 2011 is the proposed year when the new revised DSM will be coming out Consider transferring case to new worker when clean up is done Hoarding Resources Use of photographs (w/person s s permission) to help gain insight of situation Family members, friends, church organizations can help Find alternate housing for person and clean out home with permission with professionals- EXTREME CASES. Dr.Tolin s Referral Guide and Resource List Dr. Sanjaya Saxena psychiatry.ucsd.edu/faculty/ssaxena.html Animal Hoarding Saving Inventory-Revised dresden.de/i2/klinische/mitarbeiter/materialien/si-r.pdf r.pdf 11

12 Hoarding Resources Compulsive Hoarding and Acquiring, Therapist Guide,, 2007 Gail Steketee and Randy O. Frost Compulsive Hoarding and Acquiring Workbook, 2007 Gail Steketee and Randy O. Frost The companion Web site for this series: Treatments That Work is Highlighted areas are ones I recommend reading first as it can get overwhelming with all this information. Hoarding Resources continued Hoarding Assessment Tool pdf Clutter Screening Questionnaire _conference_trade_show/archives/doc/2005/309_1.pdf Obsessive Compulsive Inventory Screening Form y/ Buried in Treasures: Help for Compulsive Acquiring, Saving and Hoarding, 2007 David Tolin,, Randy Frost, Gail Steketee Questions? Very quick overview today. I am not an expert, I share information by experience, research and by others sharing with me-both providers and those who hoard. THANK YOU for giving me this opportunity today. 12