¶ Understanding Hoarding Disorder and Treatment Interventions
Hello everyone and welcome to our Licensure Exams podcast . I'm Stacey Frost .
And I'm Dr Hutchinson , and we're so glad that you could join us today .
In this episode of our Demystifying Disorders series , we'll be exploring Horting Disorder what it is , how it develops and treatment interventions that you need to know about as you study for your exam . And take note here , linton , if you have trouble throwing things away , then you've met at least one of the criteria for Horting Disorder .
Oh gosh , if that's true , I might be in trouble here , stacey , luckily for me , horting is much more complicated than just simply having a messy house . It's a legitimate mental disorder that you can find in the DSM-5 , tr that causes significant distress and impairment in daily functioning .
The diagnostic criteria have evolved over the years , but the core attributes of persistent difficulty discharging possessions , acquiring unneeded items and clutter that interferes with living spaces have remained constant .
Believe it or not , hoarding behavior often begins in adolescence , beginning to interfere with daily functioning by the mid-20s , and starts to cause clinically significant issues by the mid-30s . The severity of the hoarding behavior again , the severity of hoarding behavior increases with age .
And there are some misconceptions common misconceptions about hoarding disorder that I'd like to address right off the bat . One myth is that a habitually messy or disorganized individual will inevitably progress to full-blown hoarding later in life . Well , the reality is that the compulsive hoarding behaviors really stem from underlying psychological mechanisms .
These mechanisms make it extremely challenging for those suffering from hoarding disorder to discard possessions that most people would consider worthless and unnecessary . So while messiness can accompany hoarding , the two do not have a correlative relationship .
The difficulty in getting rid of items seen in hoarding disorder arises from deeper psychological factors that are driving the hoarding behavior .
Yeah , but it seems that whenever I throw something away , within a week I'll need it for a new project that I'm working on . Or if I have a file that I've spent hours and I dump it in the trash because I don't think I'll need it anymore , guess what ? That's the one that I'll need .
You mean like all the information I sent to you for this podcast Lint . Well , luckily I kept a backup .
Okay , okay , and I'm giving you my unending gratitude , stacy , for pulling my bacon out of the fire on more than one occasion . I'm still on the fence about this one , though you know I'm afraid Beck would definitely agree with you about that . She's positive that I'm a hoarder just because my office looks like someone has again .
But I'm afraid Beck would definitely agree with you , stacy , because on this one let's try it again . But I'm afraid that Beck would definitely agree with you again . But I'm afraid Beck would definitely agree with you on this one . She's positive that I'm a hoarder Just because my office looks like it's been ransacked by thieves looking for my antique toolbox .
I hid behind the mounds of toilet paper which I wisely collected from publics when the pandemic hit a few years ago .
Yeah , lint , I think Beck might have a point , but let's explore a little bit more before we draw any conclusions . Okay so , hoarding disorder can be caused by traumatic historical events like , let's say , for example , the Great Depression , or a pandemic or scarcity .
While such experiences may contribute to hoarding behaviors in some individuals , hoarding is a complex mental health condition with many contributing factors , and these include genetic vulnerabilities , differences in brain function , as well as cognitive and emotional regulation issues .
There's no clear scientific evidence that traumatic historical events or scarcity alone directly costs someone to develop a hoarding disorder later in life . The development of hoarding is influenced by a combination of biological , psychological and environmental factors over one's lifetime .
Wait a minute here , stacy . Some of us like to collect things to preserve them for future generations , like my Rook collection , or my Santa collection , or the light bulb collection , or the Susanbott Poe again or the Susanbott Poe again or the Susanbott Pottery collection .
Well , you forgot to mention your meteor collection , that Shirley Temple collection . I remember you getting the Nativity's collection or the 45 records from the 50s downstairs , not to mention all that stuff you've got in the attic lint and like all those outdated computers that you saved .
I think the last time I was up there I think I even saw an Apple computer from 1984 .
Well , I'll have you know that that antique 1984 Mac computer should be worth something by now .
Well , sure , if it worked .
Well , yeah , but but still , I'm sure that I can fix it if I just spend a little more time again . Yeah , well , sure Again . Well , we had sure if I can fix it if I just spent a little less time doing podcasts .
I think I've made my point here .
Well , moving on , let's talk about the diagnostic features of hoarding disorder and not just someone's opinion . At its core , hoarding disorder involves persistent difficulty of discharging or discarding parts , or I'm going to do that again .
Again , at its core , hoarding disorder involves the persistent difficulty of discarding or parting with possessions regardless of their actual value . This leads to an accumulation of unneeded items .
Again , this leads to an accumulation of unneeded items , even free things , like junk mail or grocery bags grocery bags excluding , of course , those cute little Thanksgiving salt and pepper shakers shaped like turkeys that I had to add to my collection this year . Shopaholic , again . Shopaholic behaviors
¶ Understanding Hoarding Disorder and Treatment Interventions
are common . Beyond what can reasonably be used or enjoyed , clutter piles up throughout the client's home , on beds , floors , tables , chairs , countertops , the attic and the number one closet .
Exactly how many closets do you'd have their lunch in , if you have to start numbering them . Hmm , this is starting to sound like my house minimalist . I am not . I've got a lot of collections , and just like you shells , rocks , feathers , tea cups , fabric gnomes , oh yeah , not to mention a lot of glitter .
Really , your glitter collection is beyond belief .
Yes , I'm leaving trails of it in the house and really I barely touch the surface here and I'm not planning on parting with any of this stuff anytime soon . How is that different than hoarding ?
Well , that's where the next key criteria comes into play . Can you still use the areas in your house the way they were intended to be used ? Can you sit in your chairs , cook meals in your kitchen , use your bathroom or leave your house quickly if it was needed ?
Yes .
Okay , that rules that hoarding again . Okay that rules that hoarding disorder . For both of us . We're clear . Okay , a client with this disorder accumulates so much stuff that it congests their living areas and prevents everyday use of that space , and it's not just limited to the house .
Their possessions might spill way over into the yard , garage cars or other family members' homes , and I bet you keep your collections all very clean , neat and orderly , like your background picture there , right , stacey ?
Actually I do . There's a place for everything .
Yeah , all over the place . Well , you're lucky . You moved out of the dollhouse in Florida and now living a mansion up there in the frozen tundra so you can store again , so you can store all of your prized possessions and still have a pathway open to your bedroom .
Well , pretty soon we're going to need to convert the attic so we can make room for all the holiday decorations I'm planning on for students around the house .
That'll be fun . Well , as long as you keep them all neat , clean and tidy , you've got nothing to worry about . Stacey , one of the notable features of hoarding disorder is a high level of disorganization , putting things in places where they don't belong and mixing items that don't go together . It's not about collecting or displaying possessions in an orderly way .
Clients with hoarding disorders struggle to categorize , file , sort or keep track of possessions .
Well , I definitely don't have a problem with that one . Growing up with a mother from Germany taught me early on to keep things in order . When I was a kid , Linton , I don't know if I ever told you this , but I even arranged my beanie babies by species .
No , come on , All the bears in one pack .
I'm not joking the sea creatures were in their own little pod , the exotic birds you know , together in a flock .
Uh-huh yeah .
Well , here's a question for you , linton what happens when a family member puts their foot down and says enough is enough , it's time for some spring cleaning .
Well , I'd ask . A client with hoarding disorder will often become very highly distressed and emotional when faced with discarding or letting go of possessions . You've heard comments like I can't throw that out , I might need it someday . I say that all the time , really . Or get rid of those newspapers feels like I'm a racing part of my history from my memory .
What if I need to refer back to an article someday ? Obviously it becomes a logic free zone .
Right , and that's a common misunderstanding that friends and family have , thinking that their loved one is just being illogical or stubborn about letting things go . But , as you explained , their distress and attachment stems from real psychological issues . Family involvement is essential , but forcing cleanup rarely works long term if the client's core issues go unaddressed .
And remember that elders may display more severe hoarding as they acquire and save more over their lifetimes .
Watch it . Stacy Hoarding does not spontaneously resolve on its own without treatment . It is considered a dysfunctional across situations and all life stages . Some individuals in their early 30s are just as susceptible as someone in their golden years .
Very nice .
Which brings us to treatment interventions . Clients cling to possessions based on exaggerated fears of losing information , memories or resources tied to those objects and your favorite Stacy . Cognitive behavioral therapy is specifically tailored to treat hoarding and consider the first line treatment to employ .
Cbt helps challenge beliefs that drive acquiring and saving behaviors , which teach organization and decision making skills .
And exposure and response prevention is another approach that involves gradually exposing the person to the anxiety of discarding items and resisting the urge to acquire and save . This helps the person to learn how to tolerate discomfort and make progress in decluttering .
And motivational interviewing techniques can help build insight , willingness to change and commitment to treatment goals . This client centered approach explores ambivalence around letting items go .
Gotcha . So you know how much I love specifiers , right Linton .
Well is the queen British . Is rain wet ? Of course I did .
Well , you just reminded me , when you mentioned using motivational interviewing to build insight , that there are some diagnostic specifiers for hoarding disorder .
And I guess you're going to tell us all about them , aren't you ?
Well , I think telling our test takers about them is really important . The specifiers for hoarding disorder that I want to mention here concern the client's level of insight .
Okay , I think I know where you're going with this . For example , a low level of insight can be a treatment barrier , right ?
Exactly so . The specifiers for hoarding disorder that deal with level of insight are With good or fair insight , where the client recognizes that their beliefs and behavior are problematic . With poor insight , where the client is mostly convinced that their beliefs and behavior are not problematic .
And with absent insight , slash delusional beliefs this is where the client is 100% convinced that their beliefs and behaviors are not problematic . There's nothing to see here , no problems .
So what about the with excessive acquisitions ? Specifier ?
Oh , tricky , tricky . Well the excessive acquisition specifier indicates that the client has difficulty discarding possessions accompanied by excessive acquisition of items that are not needed or for which there's no available space .
So how would your treatment plan look for a client who has good insight versus a client who has absence of any insight ?
Good question . So for a client with good insight , you can move more quickly into interventions like cognitive restructuring to challenge unhelpful thoughts or exposure therapy to reduce the saving behaviors and the client really , you know , recognizes the problem and they're on board with treatment goals .
But for a client with absent insight or delusional beliefs about their hoarding , the first priority really needs to be on developing that insight and you could consider taking a motivational interviewing approach to first work on building trust , express empathy , raise awareness and stimulate ambivalence about their beliefs .
Only once you've made some progress there can you start to explore any skill building strategies .
Yeah , that makes sense . You know you have to first meet the client where they're at . Forcing change with the client who lacks insight will likely damage any therapeutic relationship you've dealt with them . So slow progress is better than no progress .
Exactly , remember , the hoarding behaviors have developed over time , so it's going to take some time and patience to really work on reversing all of that .
That's a good point . And one final thought before we wrap up medications like SSRIs are sometimes used as an adjunct treatment to help manage associated symptoms like depression or anxiety . Many people with hoarding disorder have a comid comid , say it .
Comorbid .
Again , many people with hoarding disorder have a comed comorbid . Again , many people with hoarding disorder have a comorbid disorder like major depressive disorder , social anxiety again social anxiety disorder or generalized anxiety disorder . And as a therapist , making medication recommend again , as a therapist , making medication recommendations is beyond your scope of practice .
Still , you can provide the client with a referral to a psychiatric evaluation to determine if medication would be helpful .
All right . So here's a quick recap of what we covered in this episode on hoarding disorder and what you need to remember in your noggin for the exam .
¶ Understanding Hoarding Disorder
Hoarding disorder is a legitimate mental disorder and it's not just about being messy or disorganized . It causes significant distress and impairment in daily function . Psychological factors like genetic vulnerabilities , differences in brain function and emotional regulation issues tend to drive hoarding behaviors .
Diagnostic criteria involve persistent difficulty discarding possessions , acquiring unneeded items and clutter that interferes with living spaces . Clutter accumulates throughout the home and possessions are disorganized , preventing the normal use of spaces . Individuals become very distressed when forced to discard items .
Attachments are based on exaggerated fears of losing information or resources . Treatment often involves CVT to challenge acquiring and saving beliefs , exposure and response prevention , motivational interviewing to build insight and medications for comorbid disorders .
Diagnostic specifiers indicate the individual's level of insight into their condition as problematic or not , and this impacts the treatment approach .
Well , until next time , remember less stuff , more happiness .
It's in there .
It's in there Anything we need to do over before we get at with this .
I think it's good .
Okay , I got it .