Got a Client with a Hoarding Problem? Assess for Safety!
How do you assess whether an individual has a hoarding problem? What questions do you ask to ascertain whether the person’s clutter is a safety/health concern?
Individuals with compulsive hoarding disorder typically lack awareness of the severity of their behavior and may even deny that they have a problem; however, they may be placing themselves and/or their family members health at risk.
Tools Used to Assess Hoarding:
- The clutter image scale shown above in which individuals indicate which room image best represents the clutter they have in each room in their home (there are three different clutter images available to represent a typical living room, kitchen and bedroom).
- In general, individuals with clutter that reaches the level of picture # 4 or higher have sufficient clutter to impinge on their lives and would be encouraged to seek help for hoarding.
- The saving inventory-revised shown below is a questionnaire designed to measure the three features of hoarding: excessive acquisition, difficulty discarding and clutter.
- Scoring instructions are located at the end of the questionnaire together with a table of average scores of people who do not suffer from hoarding, as well as cutoffs for what indicates a probable hoarding problem.
The Saving Inventory-Revised (Frost, Steketee, & Grisham, 2004)
Safety Checklist
- Is there an immediate health & safety threat to the individual(s) living in the home? (can he/she use refrigerator/stove/toilet/bathtub?)
- If there is a child, how is he/she being impacted by parent’s hoarding behavior?
- Is there any structural damage to the home? (high levels of clutter sometimes lead to this type of damage)
- Are there some fire and/or safety hazards for the occupants of the home as a result of piles of stuff blocking exits/doors/windows (i.e., is the clutter raising the risk of injury and/or blocking accessibility in case of a fire or emergency)?
- How is the home being maintained in terms of adequate cleanliness (getting rid of dust, dirt, cobwebs, etc.)?
- Are there tall/unsafe piles of objects and items?
- Are there rodents, bugs, or feces and garbage in the home creating unpleasant and dangerous odors? Can you smell these odors from the neighbors’ homes?
Hoarding refers to:
- the accumulation of things that have little or no value
- and the inability to dispose of things
Collecting Is Very Different from Hoarding
Collecting is more of a hobby in which you are:
- locating, purchasing, organizing, cataloging, displaying and taking care of the items you are collecting
Hoarders often:
Collect too many items
- 3/4 shop too much
- 1/4 report that they collect too many “free” things
Have difficulties getting rid of things
- even objects of seemingly limited value
- due to strong needs to save and/or distress with thought of discarding
Are disorganized
- valuable and worthless items tend to be stored together, making clean-up more complicated
Experience some emotional distress and/or functional impairment
Until the release of the new Manual of Mental Disorders (DSM-5), hoarding had been considered to be part of the obsessive-compulsive disorder. However, in the new DSM-5, the need to compulsively collect things without value has been given its own diagnosis.
Below is a wonderful webinar on the topic of hoarding that the UNC-Chapel Hill School of Social Work put together. You may also download a copy of the deck/handout to follow along with the webinar. It appears down below.
How Prevalent Is Hoarding?
- Up to 5% of the world population suffer from hoarding
Causes of Hoarding
People who hoard report experiencing high levels of stressful and traumatic life events:
- Traumatic events including abuse and neglect
- Stressful life events such as: death of spouse, divorce, separation, jail term and death of close family member
- Hoarding is also believed to be associated with individuals experiencing the following 4 underlying characteristics:
- Certain core vulnerabilities including emotional dysregulation in the form of depression or anxiety along with family histories of hoarding and generally high levels of perfectionism.
- Difficulties in processing information. In particular, these difficulties appear as problems in attention (including ADHD-like symptoms), memory, categorization, and decision-making.
- Form intense emotional attachments to a wider variety of objects than do people who don’t hoard. These attachments take the form of attaching human-like qualities to inanimate objects, feeling grief at the prospect of getting rid of objects, and deriving a sense of safety from being surrounded by possessions.
- Often hold beliefs about the necessity of not wasting objects or losing opportunities that are represented by objects. Saving things out of the need to remember events/people etc. or because of the aesthetic beauty of objects further contribute to the problem.
What Are Some of the Consequences of Hoarding?
- Severe clutter can lead to health/safety hazards (the health and safety of those living in or near the home may be threatened; structural damage from clutter, fire, and even death may result)
- Possible evictions, hospitalizations and homelessness
- High expenses and debt as a result of excessive buying and storage unit fees
- Social isolation
- Conflict with family members and friends who are frustrated and concerned about the state of the home and/or excessive acquiring (see What Is Hoarding? for a glimpse of some of the difficulties in living with a hoarder)
What Kinds of Things Do People Hoard?
- Most often, people hoard common items, such as paper (e.g., mail, newspapers), books, clothing and containers (e.g., boxes, paper and plastic bags).
- Some people hoard garbage or rotten food.
- More rarely, people hoard animals or human waste products.
- Often the items collected are valuable but far in excess of what can reasonably be used.
How Can You Engage a Person Who Has a Problem with Hoarding?
- Acknowledge your own feelings
- The work with your client is about safety and harm reduction and not about your (or someone else’s) standards of a neat home.
- Understand your client’s motivations for hoarding
- What types of items are saved
- What are the reasons for each type of item saved
- Where are the items kept
- Are family members involved
- Focus on reducing safety hazards vs. getting rid of things/clutter
- Family members (or others) may help the hoarder sort and go through his/her things (no one should be going through the items without full knowledge and agreement of the hoarder)
Hoarding Webinar Presentation/Handout
Strategies to Treat Hoarding Include:
- Challenging thoughts and beliefs about the need to keep items and about collecting new things
- Curbing acquisitions – going out without buying or picking up new items
- Getting rid of and recycling clutter: practicing the removal of clutter, first with the help of a clinician or coach and then independently
- Finding and joining a support group or teaming up with a coach to sort and reduce clutter
- Understanding that relapses can occur
- Developing a plan to prevent future clutter
What You Can Do When You Have a Friend/Family Member Who Seems Willing to Talk About a Hoarding Problem:
- Show respect. Acknowledge that he/she has a right to make their own decisions at their own pace.
- Express sympathy. Understand that everyone has some attachment to the things they own. Try to understand the importance of their items to them.
- Express encouragement. Suggest ideas to make their home safer, such as moving clutter from doorways and halls.
- Work with them. Don’t argue about whether to keep or discard an item; instead, find out what will help motivate the person to discard or organize.
- Reflect. Help the person to recognize that hoarding interferes with the goals or values the person may hold. For example, by de-cluttering the home, a person may be able to reconnect with family and friends and have a richer social life.
- Ask permission. To develop trust, never throw anything away without asking permission
Hoarding is a very difficult problem to address. Please stay tuned for a future post that will provide some specific strategies that you may employ when working with a client who is suffering from compulsive hoarding.
Have you worked with someone with a hoarding problem? What advice would you provide to either family members trying to help hoarders or professionals working with hoarders?
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References:
The International OCD Foundation (IOCDF). (2009). Hoarding fact sheet.
Lambert et al. (2013). Risk and protective factors related to hoarding. UNC – Chapel Hill School of Social Work.
Steketee, G. & Ayers, C. (n.d.). Challenges in treating hoarding in midlife and older adults. Anxiety and Depression Association of America.
The International OCD Foundation (IOCDF). (2009). Hoarding fact sheet.
Lambert et al. (2013). Risk and protective factors related to hoarding. UNC – Chapel Hill School of Social Work.
Steketee, G. & Ayers, C. (n.d.). Challenges in treating hoarding in midlife and older adults. Anxiety and Depression Association of America.
Thank you very much for sharing “Hoarding, Causes, Hazards and Strategies!!” I think it contains invaluable information and resources with which we can provide extremely important assistance to our clients! It seems clear that it can be a very serious problem for some, potentially impair activities of daily life and functioning and in some cases, can even jeopardize the life of an individual. You’ve provided us with information with which we can assess an individual/family, evaluate the hazards that hoarding may pose to them, and then work on developing and implementing strategies to reduce/eliminate the risks of hoarding behavior. Thank you very much Dorlee, for gathering and sharing this crucial information about hoarding, which one doesn’t come across very frequently!! Ernest A. Wahrburg, MSW, LCSW.
Ernest,
Thanks so much for your kind feedback!
Hoarding is often a hidden problem that can take a toll on both the hoarder and family even in milder cases… try to imagine what it is like to want to watch TV in a room in stage 4… someone (typically the non-hoarder) has to move things away (or clear some things out) in order to have any hope of sitting down (or stage 4 will grow to stage 5 in no time at all)…
Best,
Dorlee