1. Examining Hoarding and Cluttering Behavior Matthew Soderquist, MSW Adult Services Supervisor/CRC Otsego/Crawford/Oscoda DHS

2. Overview  Diagnosing Hoarding Disorder  Underlying Beliefs and Impacts of Hoarding  Assessments  Interventions  Rules of Interventions  Goals of Interventions  Measuring Success  3 Case examples

3. Diagnosing Hoarding Disorder  Persistent difficulty discarding or parting with possessions, regardless of their actual value.  This difficulty is due to a perceived need to save the items and distress associated with discarding them.  The symptoms result in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use.  The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. Diagnosing Hoarding Disorder  In addition the DSM-5 lists two “specifiers” (features that may or may not be present):  Excessive acquiring  Level of Awareness  Good or fair Insight  Poor insight  Absent insight  *Medical condition  *Another mental disorder

5. Underlying Beliefs  Overestimation of Catastrophe or Loss  Perfectionism  Responsibility  Need for control  Emotional Comfort  Sentimental  Security Based  Connections, Social Ties

6. Impacts of Individuals with Hoarding and Cluttering Disorder  Isolation  Impedes development of relationships  Safety issues in their homes  Fear of eviction  Problems in their family relationships, loss of contact, divorce, and custody.  “My wife left, My children don’t visit”  “I lost custody of my daughter because of hoarding”  “My family has completely abandoned me”  “My husband hurt himself while walking through the house…he has no place to relax”

7. Impacts of Children of Hoarding and Cluttering Behavior  Loss of space  Developmental delays  Hygiene problems (access to bathrooms, loss of utilities)  “Doorbell Dread”  One child of a hoarder would strategically arrange for her friends to visit while she was visiting her fathers home  Financial strain  Poor eating habits  Physical and Mental Health Issues  Impact on social lives  CPS involvement, Divorce and Housing Instability

8. Impacts of Adult Children of Hoarding and Cluttering Behavior  Strained familial relationships  Resistant to allowing grandchildren to visit  Grandparents become isolated from grandchildren  Adult children are ashamed to bring significant others to visit parents.  Limited ability to determine the proper value in objects  “Abandon all hope that the parent will reform

9. Assessments  Hoarding Assessment Tool  HOMES- Health, Obstacles, Mental health, Endangerment, Structure and Safety.  Hoarding Rating Scale  Savings Inventory Revised  Savings Cognitions Inventory  Clutter Image Rating Scale  TACC- Tufts Animal Care and Condition

10. Interventions  What doesn’t work  Quick Cleanouts  Throwing things away in secret or lying about what you will do with an object  Forced discarding often increases distrust of others and increases attachment of the object  May cause increase of collecting as fear of losing is increased

11. Interventions  Professional Counseling or Therapy  Cognitive Behavioral Therapy  Exposure Therapy  Themes of CBT for Hoarding  Building a legacy of trash?  Everything goes to the dumpster eventually  Build relationships with people not things  Things are here to serve us not the other way around  How does this item add to my life?

12. Interventions  Education  Buried in Treasures  BIT Workshop  Support Groups  Children of Hoarders  Adult Children of Hoarders

13. Interventions  Practical Methods  Cut of paper flow  Fowl the trash and avoid dumpsters  Involve family members  Non-shopping trips  Practice getting rid of objects  Develop guidelines for Keep vs. Toss  Safe vs. Unsafe  Rotten Wood  Pest infestation

14. Rules for Intervention  May not touch or throw anything out without explicit permission  All decisions regarding saving, discarding and organizing are made by client  O.H.I.O- Only Handle It Once  Focus on client goals and standards NOT ours

15. Goals of Intervention  Client safety by uncluttering living space  Harm Reduction Model  Increase appropriate use of space  Improve decision making skills and develop organizational plan  Reduce accumulations of new possessions  Clean, Cull and Connect

16. Measuring Success  Small Steps  Safe, healthier environment for the client to live in  Housing secured  Client’s motivation increases  Creation of a system for managing items that client can manage on their own  Use of photos, CIR, HOMES

17. References  Bratiotis, C., & Schmalisch, C. S. (2011). The hoarding handbook: a guide for human service professionals. Oxford: Oxford University Press.  Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.  Frost, R. O., & Steketee, G. (2010). Stuff: compulsive hoarding and the meaning of things. Boston: Houghton Mifflin Harcourt.  Lokers, L. M. (2013). Identifying and treating hoarding behaviors. University of Michigan. Anxiety Disorders Program  Steketee, G., & Frost, R. O. (2013). Treatment for Hoarding Disorder Workbook. (2nd ed.). Oxford: Oxford University Press, USA.  Tolin. D.F. (2014). Buried in treasures help for compulsive acquiring, saving, and hoarding (Second ed.). Oxford: Oxford University Press.