Friday, October 04, 2013

Catherine Ayers, PhD - Hoarding in Older Adults - Research on Aging

Catherine Ayers, PhD discusses the treatment of hoarding disorder in older adults. Learn about new interventions and how to help those with hoarding behaviors. UC San Diego Health Sciences Series: "Stein Institute for Research on Aging" [10/2013].

Hoarding is generally considered an anxiety disorder, although more honestly it is an obsessive-compulsive disorder (OCD) according to the nation's leading expert in this field, Dr. Randy Frost (Smith College), who, along with Gail Steketee (co-author with Frost on several books), leads the hoarding division of the International OCD Foundation.

Here is the "About Hoarding" section of the above website:

What is hoarding, and how does it differ from collecting?

Two behaviors characterize hoarding: acquiring too many possessions and difficulty discarding or getting rid of them when they are no longer useful or needed.

When these behaviors lead to enough clutter and disorganization to disrupt or threaten a person’s health or safety, or they lead to significant distress, then hoarding becomes a “disorder." Simply collecting or owning lots of things does not qualify as hoarding.

A major feature of hoarding is the large amount of disorganized clutter that creates chaos in the home.  Such as:

  • Rooms can no longer be used as they were intended
  • Moving through the home is difficult
  • Exits are blocked
Collectors typically keep their possessions well-organized, and each item differs from other items to form an interesting and often valuable collection. Further, an important purpose of collecting is to display the special items to others who appreciate them. People who hoard are seldom able to accomplish such goals.

What kinds of things do people who hoard typically save?

It may appear that people who hoard save only trash or things of no real value.  In fact, most people who hoard save almost everything. Often this includes things that have been purchased but never removed from their original wrapper.

The most frequently saved items are:

  • clothes
  • newspapers
Other commonly hoarded items include:

  • containers
  • junk mail
  • books
  • craft items

What contributes to the development of hoarding?

People who hoard often have deficits in the way they process information.  For example, they are often easily distracted and show symptoms of Attention Deficit Hyperactivity Disorder (ADHD). These symptoms make it difficult for them to concentrate on a task without being distracted by other things.

Most of us live our lives in categories. We put our possessions into categories and use organizing systems to store and find them easily. But using categories is hard for people who hoard. Their lives seem to be organized by sight and space.

The electricity bill might go on the 5-foot high pile of papers in the living room to keep it in sight as a reminder to pay the bill. The hoarder tries to keep life organized by remembering where that bill is located. When they need to find it, they search their memory for the location it was last seen. Instead of relying on a system of categories where one only has to remember where the entire group of objects is located, each object seems to have its own category. This makes the process of finding things very difficult once a critical mass of things has been collected.

Do all people who hoard save things for the same reason?

No. But, there are some general themes, such as:

Not Wasting Things

The most frequent reason for hoarding is to avoid wasting things that might have value. Often people who hoard believe that an object may still be useable or of interest or value to someone. Thinking about whether to discard it leads them to feel guilty about wasting it.

”If I save it”, reasons the hoarder, “I might not ever need it but at least I am prepared in case I do.”

Fear of Losing Important Information

The second most frequent reason for saving is a fear of losing important information. Many hoarders describe themselves as "information junkies" who save newspapers, magazines, brochures, and other information-laden papers. They keep large quantities of newspapers and magazines so that when they have time, they will be able to read and digest all the useful information they imagine to be there. Each newspaper contains a wealth of opportunities. Discarding it means losing those opportunities. For such people, having the information at hand seems crucial, whereas knowing that the information exists on the internet or in a library does little to help them get rid of their often out-of-date papers. Hoarders are often intelligent and curious people for whom the physical presence of information is almost an addiction.

Emotional Meaning of Objects

A third reason for saving is that the object has an emotional meaning. This takes many forms, including the sentimental association of things with important persons, places, or events, something most people experience as well, just not to the same degree. Another common form of emotional attachment concerns the incorporation of the item as part of the hoarder’s identity—getting rid of it feels like losing part of one’s self.

Characteristics of Objects

Finally, some people hoard because they appreciate the way objects look, especially their shape, color, and texture. Many people who hoard describe themselves as artists or craftspeople who save things to further their art. In fact, many are very creative with their hands. Unfortunately, having too many supplies gets in the way of living and the art projects never get done.

Why can’t people who hoard control their urges?

Understanding this requires knowing what happens at the moment the person decides to acquire or save something. At the time of acquisition, people who hoard often experience a sort of “high” or very good sensation during which their thoughts center on how wonderful it would be to own the object sitting in front of them. These thoughts are so pleasant that they dominate thinking, crowding out information that might curb the urge to acquire.

For instance, they forget that they don’t have the money or space for the item, or that they already have 3 or 4 of the same thing. When faced with the idea of throwing it away, hoarders have different thoughts than most other people. All their thoughts center on what they will lose (e.g., opportunity, information, identity) or how bad they will feel (e.g., distress, guilt) while none of the thoughts focus on the benefits of getting rid of the item. Saving the item, or putting off the decision, allows them to escape this bad experience. In this way people become conditioned to hoard.

How much truth is there to the common wisdom of hoarding being a response to deprivation?

Although some people attribute their hoarding to living through a period of extreme deprivation, our research has failed to find a link between being deprived of things early in life and later hoarding behavior. We do suspect there is a connection between hoarding and traumatic experiences or chaotic or disruptive living circumstances earlier in life.

Hoarding has been considered to be a kind of obsessive compulsive disorder (OCD), but are there any differences?

Yes. In fact, only about 1 in 5 people with hoarding problems report any significant OCD symptoms like checking or cleaning rituals. There are also some other important differences.

In OCD, obsessions are experienced as intrusive and unwanted, and the symptoms are always accompanied by distress. But in hoarding, owning things often produces pleasant feelings of safety and comfort, and acquiring can even produce euphoric feelings. In fact, the distress we see in hoarding comes from the accumulated clutter as a whole or from thinking about discarding things. There also appear to be differences in the brains of people with hoarding problems compared to those who suffer from OCD.

For these reasons, many scientists who study hoarding have recommended that it be classified as a distinct disorder separate from OCD.

Is it true that depression is a common problem for hoarders?

Yes. In our research we find that more than half of people with hoarding problems are clinically depressed. However, the depression does not seem to cause the hoarding, although it might be a result of hoarding, especially when the clutter interferes with people’s ability to function and they feel embarrassed and ashamed.
Among the useful and interesting books available on this topic, including Stuff: Compulsive Hoarding and the Meaning of Things (2011), probably the best non-clinical overview of hoarding I have seen, and of course it is by Frost and Steketee. They are also the authors of Compulsive Hoarding and Acquiring: Therapist Guide (2006 - new version due in November) and  Compulsive Hoarding and Acquiring: Workbook (2006).

Hoarding in Older Adults - Research on Aging

A hoarding fact sheet:

The Psychology of Hoarding

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