The Effect of Hoarding Behavior on Health
Monday August 31, 2009
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The patient could be suffering from compulsive hoarding syndrome, according to Gail Steketee, PhD, professor in the school of social work at Boston University: “Compulsive hoarders save objects that most people would consider useless. They have difficulty getting rid of things.”
Holding Onto the Facts
Compulsive hoarding includes three key features, according to Sanjaya Saxena, MD, director of the Obsessive Compulsive Disorders Program at the University of California, San Diego School of Medicine: Failure to discard objects most people consider inconsequential; excessive acquisition; and excessive clutter interfering with the use of home and work spaces.
More research is needed on many aspects of this problem, however. It may be a variation of obsessive-compulsive disorder or a related, separate disorder. Attention deficit disorder and depression are often associated with hoarding, but it isn’t clear whether these conditions contribute to the problem or are caused by it.
A recent study suggests that about 5% of the U.S. population exhibits compulsive hoarding tendencies, according to Randy Frost, PhD, professor of psychology at Smith College in Northampton, Mass. “It may be more prevalent now than in the past. In our culture, so many objects are available at relatively low cost, and people can find things they couldn’t find before.” Hoarding is more common in the elderly, particularly those who are isolated, Frost says, but whether isolation contributes to the hoarding or vice versa isn’t clear.
People may develop the problem later in life or it may worsen with age, Steketee adds: “As people age, they have trouble processing information effectively and so are more likely, for example, to leave papers lying around because they don’t know what to do with them.”
People with the disorder tend to have at least one relative who could be described as a “pack rat,” notes Stephen Whiteside, PhD, clinical psychologist at the Mayo Clinic in Rochester, Minn.
Signs of Clutter
Because many compulsive hoarders are elderly and living alone, OTs serving this population should be aware of the signs and related concerns. “A lot of physical disabilities are associated with people who hoard,” Steketee says. “We don’t know if those are causal or just side by side. But an OT is likely to see the difficulties associated with hoarding.” A home may have paths through it that are too narrow for a person to navigate using a walker, or bedrooms may be so cluttered that it is difficult to stretch out in the bed. In severe cases, a person may end up sleeping on the floor.
Other warning signs at home or in the office include poor personal hygiene, often because the person can’t easily access the bathroom. “People with hoarding problems tend to carry more things with them,” Frost says, “So a person might be carrying bags and even picking things up along the way.” Hoarders tend to fill whatever space is available, including the bathtub and shower stall; cars might be filled with clutter too.
An OT should report hoarding signs to the referring physician. Social workers...visiting nurses, and physical therapists may have additional resources to deal with the problem, Steketee suggests. “Work with the care team to figure out the appropriate caregiver to [give] help.”
Patients with hoarding disorder are likely to resist help, so Whiteside suggests OTs discuss their ability to function in the home, rather than what they should throw out. “That conversation won’t go anywhere,” he advises. “Focus on how they are unable to do things that they should be doing, such as home exercises, and how they can change the environment to do them.”
Clearing a Space
Treatment begins with careful assessment of the extent of the problem. “We look at specific problems such as difficulty sorting, or clutter so extensive they need physical help clearing it,” Steketee says. Individuals may need help creating a filing system, or learning to make decisions. Cognitive behavioral therapy can help change unhelpful and unrealistic beliefs about saving things, but dealing with new objects coming into the home immediately and appropriately is important to prevent relapse.
Whiteside stresses that effective treatments don’t focus on forcing people to throw things away, but rather on improving decision making. “Just going in and throwing everything away can, at the very least, be damaging to relationships and causes the person a lot of stress. It’s important to realize this is a mental health problem with a lot of negative consequences.” Involving family in treatment can help, provided family members understand the nature of the problem. “It is easy to blame the person who hoards,” Steketee says. “Yes, they can’t throw things away, but that doesn’t mean they wanted this problem.”
Some research has suggested that serotonin re-uptake inhibitors are effective in treating compulsive hoarding, although Steketee says they haven’t worked as well as for patients with OCD. Saxena’s research has revealed visible and measurable brain abnormalities in compulsive hoarders, often showing mild brain atrophy or an unusual shape to the frontal lobes that are associated with decision making. But research has yet to definitively identify which medications and strategies work best for this complex problem. Until then, OTs should watch for warning signs of hoarding, alert team members when problems arise, and help patients clear functional spaces within the home to promote safe participation in the rehabilitation process. •
Melissa Gaskill is a medical writer for the Gannett Healthcare Group.
Resources
> Mayo Clinic, Hoarding: www.mayoclinic.com/health/hoarding/DS00966
> Obsessive Compulsive Foundation, Compulsive Hoarding: www.ocfoundation.org/hoarding
> Resources for compulsive hoarding syndrome: www.helpinghoarders.com
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