March 2012 Satwant Singh 1 Hoarding Satwant Singh MSc RN Nurse Consultant in CBT & Mental Health Wordsworth Health Centre, London 1

March 2012 Satwant Singh 2 Aims  To have an understanding about hoarding and the psychological aspects and impact of hoarding on the individual and others  Appreciate the need to develop a joint strategy and the involvement of all agencies 2

March 2012 Satwant Singh 3 Hoarding symptoms and features  A common behaviour with the collection of food among rodents, small animals and birds (Honig, 1991)  Normal part of life cycle (Anderson, 1983, Kolb, 1974)  Relationship between hoarding in non humans and humans is less understood but may have some similarities  Hoarding in humans can be seen in a variety of disorders- anorexia nervosa Frankenburg, 1984), organic disorders (Greenberg, et al1990), psychotic disorders (Lichins et al, 1992), OCD, OCPD (APA, 1994) and mental retardation (van Houten & Rolider, 1988) 3

March 2012 Satwant Singh 4 Definition of hoarding  Although widely recognised as symptom of OCD, the DSM IV describes it in the context of OCPD  However DSM V (2013) hoarding will be classified as a disorder in its own right  Frost & Gross (1993)- the acquisition and failure to discard possessions which appear to be useless or of limited value  The clutter is so severe that it prevents or precludes the use of living spaces for what they were designed for  The clutter, acquiring or difficulty discarding cause significant distress or impairment for the individual and family members 4

March 2012 Satwant Singh 5 How common is hoarding?  Frost el al (1996) found with the OCD outpatients 31% had hoarding compulsions and 26% had hoarding tendencies  It is estimated that less than 1% of population hoard the true figure is higher (6-8%). Estimated in the UK 1 in 200  Hoarding does not discriminate between age, gender socio economic groups 5

March 2012 Satwant Singh 6 10/12/2014 Continuum Minimalist Normal saving Clutt e r Hoarding 6

March 2012 Satwant Singh 7 Why is it a problem?  Impairment and distress to the individual  Impairment to social functioning and relationship issues, social isolation  Health and safety- fire hazard, infestation, poor living conditions (lack of heating etc), hazard to the environment e.g. building with the lack of poor maintenance  Mental health issues e.g. depression, psychosis etc 7

March 2012 Satwant Singh 8 Reasons for hoarding  Usually begins in childhood, more common in males  Family history of hoarding and OCD  Often linked to some sort of trauma e.g. loss, abuse, divorce etc  Material deprivation  Severe and enduring mental illness and other mental health problems 8

March 2012 Satwant Singh /12/2014 Similarities and Differences Hoarders and non hoarders save the same things but the differences are: -Quantity - Emotional attachments (sentimental) -Perceived use of object (instrumental) - Over valued beliefs -The object as an extension of self

March 2012 Satwant Singh 10 10/12/2014 Manifestations cont…. 2 subtypes:  Compulsive acquisition- bringing items e.g. buy 1 get 3 free, good value  Non compulsive acquisition- unable to get rid of things e.g. rubbish

March 2012 Satwant Singh 11 10/12/2014 Understanding of condition Different from OCD and other conditions as:  Do not view their behaviour as unusual  Less insight into their behaviour  Have reasons why they need to “save ” “I need this just in case” “It reminds me of marriage, good times in my life”

March 2012 Satwant Singh 12 Satwant Singh 12 10/12/2014 Manifestation of hoarding  Usually begins in childhood- long standing  Compulsive acquisition  Lack of organisation  Saving behaviours and inability to discard  Avoidance- dealing with the problem, others  Trust issues- letting others help  Lack of insight/acceptance of problem e.g. the place is too small, I don’t have time to organise

March 2012 Satwant Singh 13 10/12/2014 Why is hoarding an issue?  It impacts on families and neighbours  Health and safety issues- fire risk, injury, infestation, structural damage  Inside housing (May 2009) 87% out of 40 home improvement agencies have dealt with individuals with issues of hoarding  It is not an isolated problem and has implications for housing providers and landlords

March 2012 Satwant Singh 14 10/12/2014 Consequences of legislation  Homelessness  Distress and trauma- Environment Health  Stigma and vulnerability (exposed)  Harassment by neighbours/others and victimisation  Feelings of being punished  Social exclusion and isolation

March 2012 Satwant Singh 15 10/12/2014 Next steps  Hoarding will become a major issue post the new diagnostic categorisation- recognition and identification  Local authority (EH, SS, police, fire services), health, statutory and non statutory organisations, housing associations to work together to deal a joint strategy  Development of services to deal with this issue of hoarding- dealing and supporting individuals

March 2012 Satwant Singh 16 10/12/2014 Next steps  Need joint working of these services and have a single point of contact/access  Training in recognising, engaging and working with individuals with issues of hoarding  In the long term development of specialist services in dealing with this issue

March 2012 Satwant Singh 17 10/12/2014 References  Chartered Institute of Environmental Health: Professional Practice Note: Hoarding and how to approach it  Frost R.O. & Gross, R. C. (1993) The hoarding of possessions. Behaviour Research and Therapy, 31,  Frost, R.O. & Hartl, T. L. (1996) A Cognitive Behavioural Model of Compulsive Hoarding. Behaviour Research and Therapy, 33,  Furby, L. (1978) Possessions: Towards a theory of their meaning and function throughout the life cycle. In Bates, P.B. Life span development and behaviour (Vol 1) NY: Academic Press.

March 2012 Satwant Singh 18 10/12/2014 References  Hunter, C. & Nixon, J. (2007) Special Issue- Hoarding and mental health Editorial. People, Place & Policy2/1: 1-3. DOI: /ppp  Inside Housing (May, 2009) It’s a hoard life. =  Obsessive Compulsive Cognitions Working Group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35,  Slatter M. (2007) Treasures, trash and tenure: hoarding and housing risk. People, Place & Policy Online: 2/

March 2012 Satwant Singh 19 10/12/2014 Treatment Group in London National Hoarding Treatment group meets once a month- the last Wednesday of each month from pm at: The Wordsworth Health Centre 19 Wordsworth Ave London, E12 6SU More details can be obtained from the website: