9102018

1

Marilyn A Halpern

MSW

HoardingDigging to the Bottom of the Problem

bull Professional Guardian

bull ClientPatient Advocate

bull Medical Social Worker

bull End-of-Life Doula

Marilyn Halpern LSW

Hoarding Is Not A Messy Desk

9102018

2

History of Hoarding

DSM 5 Criteria for

Hoarding Disorder - 2013

A Persistent difficulty discarding or

parting with possessions regardless of

their actual value

B This difficulty is due to the perceived

need to save the items and to distress

associated with associated with

discarding them

DSM 5 Criteria

C The difficulty discarding possessions

results in the accumulation of

possessions that congest and clutter

active living areas and substantially

compromise their intended use If living

areas are uncluttered it is only

because of the interventions of third

parties (eg family members

cleaners authorities)

9102018

3

DSM 5 Criteria

D The hoarding causes clinically

significant distress or impairment in

social occupational or other important

areas of functioning (including

maintaining a safe environment for self

and others)

The DSM-V also calls for the clinician to

specify whether the individual is also

experiencing ldquoexcessive acquisitionrdquo (eg

do they acquire items that they donrsquot need

and for which they donrsquot have space in

their home) and to specify the personrsquos

level of insight (good fair poor or

absentdelusional)

Predisposition of a Hoarder

bull History

bull Vulnerability

bull Cognitive deficits

bull Beliefs about possessions

bull Emotions

bull Reinforcements

9102018

4

AcquiringSaving amp

Accumulating

OrganizingSorting

Removal

(Insight amp Executive Functioning)

(Excess)

Halpern 2018

Acquiring

bull Dollar Store

bull Home Shopping

bull Thrift stores

bull Tree lawns

bull Free samples

bull Senior fairs (pens clips sanitizers)

bull Trash

Emotional $hopping

Positive Emotions

bull Pleasure

bull Excitement

bull Pride

bull Joy

bull Fondness

bull Satisfaction

Negative Emotions

bull Griefloss

bull Anxiety

bull Sadness

bull Guilt

bull Anger

bull Frustration

9102018

5

Managing Possessions

Hoarding Collecting

Clutter Minimalist

Possessions

Organization

low high

Halpern 2018

Reasons for Saving

ldquoThrowing things away is wastefulrdquo

ldquoI may need itrdquo

ldquoI can fix thisrdquo

ldquoSomeone will value itrdquo

ldquoThis is beautifulrdquo

ldquoThese are my memoriesrdquo

ldquoI have to see it or I will lose itrdquo

ldquoThese items are my identityrdquo

9102018

6

An Extension of Self

HOARDING

Executive Functioning

Perfectionism

Lack of Insight

Procrastination

Churning

Disorientation

Trauma

Vulnerabilities

bull Family History

bull Losses

bull Depression

bull Social isolation

bull Health limitations

bull Acquiring inherited possessions

bull Downsizing

bull A lifetime to collect items

9102018

7

Profile for Elders

bull Problem solving

bull Executive functioning

bull Memory

bull Decision-making

Special Considerations

bull Diminished health and wellness

bull Chronic medical conditions

bull Lack of access to medical treatment

bull Complex family relationships

bull Limitedfixed income

bull Victimization

bull Low rate of overall happiness

9102018

8

Co-Morbidity

bull 60 Major Depression

bull 30 Social Phobia

bull 25 Anxiety Disorder

bull Dementia

bull Post Traumatic Stress

Disorder (PSTD)

bull Prolonged Grief Disorder

bull Onset childhood adolescence

bull Hoarding increases with each decade

bull Generally people do not receive

treatment

bull Older adults with hoarding are

socially isolated and live alone

Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149

Age at onset and clinical features

of late life compulsive hoarding

Onset

bull Onset can start in childhood or early

adolescence

bull Severity increases over time (30s 50s)

bull Progressive and Chronic

bull Negative life event (death divorce)

bull Psychiatric or Physical illness

Ayers et al 2009 Grisham et al 2006 Samuels et al 2002

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

2

History of Hoarding

DSM 5 Criteria for

Hoarding Disorder - 2013

A Persistent difficulty discarding or

parting with possessions regardless of

their actual value

B This difficulty is due to the perceived

need to save the items and to distress

associated with associated with

discarding them

DSM 5 Criteria

C The difficulty discarding possessions

results in the accumulation of

possessions that congest and clutter

active living areas and substantially

compromise their intended use If living

areas are uncluttered it is only

because of the interventions of third

parties (eg family members

cleaners authorities)

9102018

3

DSM 5 Criteria

D The hoarding causes clinically

significant distress or impairment in

social occupational or other important

areas of functioning (including

maintaining a safe environment for self

and others)

The DSM-V also calls for the clinician to

specify whether the individual is also

experiencing ldquoexcessive acquisitionrdquo (eg

do they acquire items that they donrsquot need

and for which they donrsquot have space in

their home) and to specify the personrsquos

level of insight (good fair poor or

absentdelusional)

Predisposition of a Hoarder

bull History

bull Vulnerability

bull Cognitive deficits

bull Beliefs about possessions

bull Emotions

bull Reinforcements

9102018

4

AcquiringSaving amp

Accumulating

OrganizingSorting

Removal

(Insight amp Executive Functioning)

(Excess)

Halpern 2018

Acquiring

bull Dollar Store

bull Home Shopping

bull Thrift stores

bull Tree lawns

bull Free samples

bull Senior fairs (pens clips sanitizers)

bull Trash

Emotional $hopping

Positive Emotions

bull Pleasure

bull Excitement

bull Pride

bull Joy

bull Fondness

bull Satisfaction

Negative Emotions

bull Griefloss

bull Anxiety

bull Sadness

bull Guilt

bull Anger

bull Frustration

9102018

5

Managing Possessions

Hoarding Collecting

Clutter Minimalist

Possessions

Organization

low high

Halpern 2018

Reasons for Saving

ldquoThrowing things away is wastefulrdquo

ldquoI may need itrdquo

ldquoI can fix thisrdquo

ldquoSomeone will value itrdquo

ldquoThis is beautifulrdquo

ldquoThese are my memoriesrdquo

ldquoI have to see it or I will lose itrdquo

ldquoThese items are my identityrdquo

9102018

6

An Extension of Self

HOARDING

Executive Functioning

Perfectionism

Lack of Insight

Procrastination

Churning

Disorientation

Trauma

Vulnerabilities

bull Family History

bull Losses

bull Depression

bull Social isolation

bull Health limitations

bull Acquiring inherited possessions

bull Downsizing

bull A lifetime to collect items

9102018

7

Profile for Elders

bull Problem solving

bull Executive functioning

bull Memory

bull Decision-making

Special Considerations

bull Diminished health and wellness

bull Chronic medical conditions

bull Lack of access to medical treatment

bull Complex family relationships

bull Limitedfixed income

bull Victimization

bull Low rate of overall happiness

9102018

8

Co-Morbidity

bull 60 Major Depression

bull 30 Social Phobia

bull 25 Anxiety Disorder

bull Dementia

bull Post Traumatic Stress

Disorder (PSTD)

bull Prolonged Grief Disorder

bull Onset childhood adolescence

bull Hoarding increases with each decade

bull Generally people do not receive

treatment

bull Older adults with hoarding are

socially isolated and live alone

Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149

Age at onset and clinical features

of late life compulsive hoarding

Onset

bull Onset can start in childhood or early

adolescence

bull Severity increases over time (30s 50s)

bull Progressive and Chronic

bull Negative life event (death divorce)

bull Psychiatric or Physical illness

Ayers et al 2009 Grisham et al 2006 Samuels et al 2002

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

3

DSM 5 Criteria

D The hoarding causes clinically

significant distress or impairment in

social occupational or other important

areas of functioning (including

maintaining a safe environment for self

and others)

The DSM-V also calls for the clinician to

specify whether the individual is also

experiencing ldquoexcessive acquisitionrdquo (eg

do they acquire items that they donrsquot need

and for which they donrsquot have space in

their home) and to specify the personrsquos

level of insight (good fair poor or

absentdelusional)

Predisposition of a Hoarder

bull History

bull Vulnerability

bull Cognitive deficits

bull Beliefs about possessions

bull Emotions

bull Reinforcements

9102018

4

AcquiringSaving amp

Accumulating

OrganizingSorting

Removal

(Insight amp Executive Functioning)

(Excess)

Halpern 2018

Acquiring

bull Dollar Store

bull Home Shopping

bull Thrift stores

bull Tree lawns

bull Free samples

bull Senior fairs (pens clips sanitizers)

bull Trash

Emotional $hopping

Positive Emotions

bull Pleasure

bull Excitement

bull Pride

bull Joy

bull Fondness

bull Satisfaction

Negative Emotions

bull Griefloss

bull Anxiety

bull Sadness

bull Guilt

bull Anger

bull Frustration

9102018

5

Managing Possessions

Hoarding Collecting

Clutter Minimalist

Possessions

Organization

low high

Halpern 2018

Reasons for Saving

ldquoThrowing things away is wastefulrdquo

ldquoI may need itrdquo

ldquoI can fix thisrdquo

ldquoSomeone will value itrdquo

ldquoThis is beautifulrdquo

ldquoThese are my memoriesrdquo

ldquoI have to see it or I will lose itrdquo

ldquoThese items are my identityrdquo

9102018

6

An Extension of Self

HOARDING

Executive Functioning

Perfectionism

Lack of Insight

Procrastination

Churning

Disorientation

Trauma

Vulnerabilities

bull Family History

bull Losses

bull Depression

bull Social isolation

bull Health limitations

bull Acquiring inherited possessions

bull Downsizing

bull A lifetime to collect items

9102018

7

Profile for Elders

bull Problem solving

bull Executive functioning

bull Memory

bull Decision-making

Special Considerations

bull Diminished health and wellness

bull Chronic medical conditions

bull Lack of access to medical treatment

bull Complex family relationships

bull Limitedfixed income

bull Victimization

bull Low rate of overall happiness

9102018

8

Co-Morbidity

bull 60 Major Depression

bull 30 Social Phobia

bull 25 Anxiety Disorder

bull Dementia

bull Post Traumatic Stress

Disorder (PSTD)

bull Prolonged Grief Disorder

bull Onset childhood adolescence

bull Hoarding increases with each decade

bull Generally people do not receive

treatment

bull Older adults with hoarding are

socially isolated and live alone

Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149

Age at onset and clinical features

of late life compulsive hoarding

Onset

bull Onset can start in childhood or early

adolescence

bull Severity increases over time (30s 50s)

bull Progressive and Chronic

bull Negative life event (death divorce)

bull Psychiatric or Physical illness

Ayers et al 2009 Grisham et al 2006 Samuels et al 2002

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

4

AcquiringSaving amp

Accumulating

OrganizingSorting

Removal

(Insight amp Executive Functioning)

(Excess)

Halpern 2018

Acquiring

bull Dollar Store

bull Home Shopping

bull Thrift stores

bull Tree lawns

bull Free samples

bull Senior fairs (pens clips sanitizers)

bull Trash

Emotional $hopping

Positive Emotions

bull Pleasure

bull Excitement

bull Pride

bull Joy

bull Fondness

bull Satisfaction

Negative Emotions

bull Griefloss

bull Anxiety

bull Sadness

bull Guilt

bull Anger

bull Frustration

9102018

5

Managing Possessions

Hoarding Collecting

Clutter Minimalist

Possessions

Organization

low high

Halpern 2018

Reasons for Saving

ldquoThrowing things away is wastefulrdquo

ldquoI may need itrdquo

ldquoI can fix thisrdquo

ldquoSomeone will value itrdquo

ldquoThis is beautifulrdquo

ldquoThese are my memoriesrdquo

ldquoI have to see it or I will lose itrdquo

ldquoThese items are my identityrdquo

9102018

6

An Extension of Self

HOARDING

Executive Functioning

Perfectionism

Lack of Insight

Procrastination

Churning

Disorientation

Trauma

Vulnerabilities

bull Family History

bull Losses

bull Depression

bull Social isolation

bull Health limitations

bull Acquiring inherited possessions

bull Downsizing

bull A lifetime to collect items

9102018

7

Profile for Elders

bull Problem solving

bull Executive functioning

bull Memory

bull Decision-making

Special Considerations

bull Diminished health and wellness

bull Chronic medical conditions

bull Lack of access to medical treatment

bull Complex family relationships

bull Limitedfixed income

bull Victimization

bull Low rate of overall happiness

9102018

8

Co-Morbidity

bull 60 Major Depression

bull 30 Social Phobia

bull 25 Anxiety Disorder

bull Dementia

bull Post Traumatic Stress

Disorder (PSTD)

bull Prolonged Grief Disorder

bull Onset childhood adolescence

bull Hoarding increases with each decade

bull Generally people do not receive

treatment

bull Older adults with hoarding are

socially isolated and live alone

Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149

Age at onset and clinical features

of late life compulsive hoarding

Onset

bull Onset can start in childhood or early

adolescence

bull Severity increases over time (30s 50s)

bull Progressive and Chronic

bull Negative life event (death divorce)

bull Psychiatric or Physical illness

Ayers et al 2009 Grisham et al 2006 Samuels et al 2002

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

5

Managing Possessions

Hoarding Collecting

Clutter Minimalist

Possessions

Organization

low high

Halpern 2018

Reasons for Saving

ldquoThrowing things away is wastefulrdquo

ldquoI may need itrdquo

ldquoI can fix thisrdquo

ldquoSomeone will value itrdquo

ldquoThis is beautifulrdquo

ldquoThese are my memoriesrdquo

ldquoI have to see it or I will lose itrdquo

ldquoThese items are my identityrdquo

9102018

6

An Extension of Self

HOARDING

Executive Functioning

Perfectionism

Lack of Insight

Procrastination

Churning

Disorientation

Trauma

Vulnerabilities

bull Family History

bull Losses

bull Depression

bull Social isolation

bull Health limitations

bull Acquiring inherited possessions

bull Downsizing

bull A lifetime to collect items

9102018

7

Profile for Elders

bull Problem solving

bull Executive functioning

bull Memory

bull Decision-making

Special Considerations

bull Diminished health and wellness

bull Chronic medical conditions

bull Lack of access to medical treatment

bull Complex family relationships

bull Limitedfixed income

bull Victimization

bull Low rate of overall happiness

9102018

8

Co-Morbidity

bull 60 Major Depression

bull 30 Social Phobia

bull 25 Anxiety Disorder

bull Dementia

bull Post Traumatic Stress

Disorder (PSTD)

bull Prolonged Grief Disorder

bull Onset childhood adolescence

bull Hoarding increases with each decade

bull Generally people do not receive

treatment

bull Older adults with hoarding are

socially isolated and live alone

Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149

Age at onset and clinical features

of late life compulsive hoarding

Onset

bull Onset can start in childhood or early

adolescence

bull Severity increases over time (30s 50s)

bull Progressive and Chronic

bull Negative life event (death divorce)

bull Psychiatric or Physical illness

Ayers et al 2009 Grisham et al 2006 Samuels et al 2002

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

6

An Extension of Self

HOARDING

Executive Functioning

Perfectionism

Lack of Insight

Procrastination

Churning

Disorientation

Trauma

Vulnerabilities

bull Family History

bull Losses

bull Depression

bull Social isolation

bull Health limitations

bull Acquiring inherited possessions

bull Downsizing

bull A lifetime to collect items

9102018

7

Profile for Elders

bull Problem solving

bull Executive functioning

bull Memory

bull Decision-making

Special Considerations

bull Diminished health and wellness

bull Chronic medical conditions

bull Lack of access to medical treatment

bull Complex family relationships

bull Limitedfixed income

bull Victimization

bull Low rate of overall happiness

9102018

8

Co-Morbidity

bull 60 Major Depression

bull 30 Social Phobia

bull 25 Anxiety Disorder

bull Dementia

bull Post Traumatic Stress

Disorder (PSTD)

bull Prolonged Grief Disorder

bull Onset childhood adolescence

bull Hoarding increases with each decade

bull Generally people do not receive

treatment

bull Older adults with hoarding are

socially isolated and live alone

Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149

Age at onset and clinical features

of late life compulsive hoarding

Onset

bull Onset can start in childhood or early

adolescence

bull Severity increases over time (30s 50s)

bull Progressive and Chronic

bull Negative life event (death divorce)

bull Psychiatric or Physical illness

Ayers et al 2009 Grisham et al 2006 Samuels et al 2002

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

7

Profile for Elders

bull Problem solving

bull Executive functioning

bull Memory

bull Decision-making

Special Considerations

bull Diminished health and wellness

bull Chronic medical conditions

bull Lack of access to medical treatment

bull Complex family relationships

bull Limitedfixed income

bull Victimization

bull Low rate of overall happiness

9102018

8

Co-Morbidity

bull 60 Major Depression

bull 30 Social Phobia

bull 25 Anxiety Disorder

bull Dementia

bull Post Traumatic Stress

Disorder (PSTD)

bull Prolonged Grief Disorder

bull Onset childhood adolescence

bull Hoarding increases with each decade

bull Generally people do not receive

treatment

bull Older adults with hoarding are

socially isolated and live alone

Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149

Age at onset and clinical features

of late life compulsive hoarding

Onset

bull Onset can start in childhood or early

adolescence

bull Severity increases over time (30s 50s)

bull Progressive and Chronic

bull Negative life event (death divorce)

bull Psychiatric or Physical illness

Ayers et al 2009 Grisham et al 2006 Samuels et al 2002

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

8

Co-Morbidity

bull 60 Major Depression

bull 30 Social Phobia

bull 25 Anxiety Disorder

bull Dementia

bull Post Traumatic Stress

Disorder (PSTD)

bull Prolonged Grief Disorder

bull Onset childhood adolescence

bull Hoarding increases with each decade

bull Generally people do not receive

treatment

bull Older adults with hoarding are

socially isolated and live alone

Int J Geriatr Psychiatry 2010 Feb 25(2) 142ndash149

Age at onset and clinical features

of late life compulsive hoarding

Onset

bull Onset can start in childhood or early

adolescence

bull Severity increases over time (30s 50s)

bull Progressive and Chronic

bull Negative life event (death divorce)

bull Psychiatric or Physical illness

Ayers et al 2009 Grisham et al 2006 Samuels et al 2002

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

9

Collected Items

bull Paper

bull NewspaperMagazines

bull Clothing

bull Food

bull Books

bull Trash

bull Animals (rare)

bull Alcohol bottles

bull Cat hair

Kim et al 2001

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

10

The Impacts of Hoarding

bull 45 could not use their refrigerators

bull 42 could not use the kitchen sink

bull 42 could not use their bathtub

bull 20 could not use the bathroom sink

bull 10 could not use the toilet

Am J Geriatr Psychiatry - January 2014

Hoarding Disorder in Older Adulthood

Problems and Safety Issues

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

11

General Risks of Hoarding

bull Fire

bull Blocked egress

bull Food poisoningcontamination

bull Infestations (rats fleas bed bugs)

bull Poorinadequate diet

bull Hygiene issues

bull Finesevictions

Geriatric Risks

bull Chronic illness

bull Problems with medication

bull Poorinadequate diet

bull Increased fall risk

bull ADL problematic

bull Social isolation

bull Eviction

bull Family conflicts

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

12

Assessment

Saving inventory Revised (widely used)(Frost Steketee amp Grisham 2014)

Hoarding rating scale(Tolin et al 2010)

Clutter image rating(Frost et al 2006)

Bedroom Livingroom Kitchen

Saving

Inventory

Revised (2014)

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

13

Hoarding

Rating Scale (Tolin et al 2008)

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

14

bull Improve the personrsquos quality of life

bull Improve functionality of target areas

bull Create living space and free use of space

bull Improve organizational skills

bull Make possessions more accessible

bull Improve decision making skills

bull Improve family relations

bull Reduce acquiring through substituting alternative

satisfying behaviors

bull Learn problem solving skills

Treatment Goals

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

15

bull Touch nothing without permission

bull Person makes all decisions about

possessions

bull Treatment should be systematic following a

plan but leaving room for flexibility

bull Person must think aloud while

bull OHIO principle (Only Handle It Once)

bullKeep ndash Discard ndash Donate ndash Display (sorting)

bullSorting criteria

Treatment Rules

What Helps - Trust

bull Emphasis on modeling

bull Teach skills

bull Homework and compliance

Get organized

Use calendar

Make a ldquoTo Dordquo list

Work on problems

Skills training

ldquoGood enoughrdquo

Tolerate distress of discarding

Treatment

bull Building trust

bull Home Visits Important

bull Education

bull Organization

bull Decision-makingExecutive functioning

bull Exposure to non-acquiring and

discarding

bull Cognitive Behavior Therapy

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

16

Cleaning Up

bull The person must be involved in

the decision-making

bull Hoarders are reluctant to part

with anything

bull Can cause anxietydistress

sense of loss

bull Clearing out is not always the

best approach

bull Once cleaned recidivism is

high

Supporting Personal Goals

bull Encouraging incremental efforts

bull Talk through the process

bull Articulate ambivalence

bull By expressing empathy

bull Rolling with resistance

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

17

Case Studies

Case 1 - Betty

Case 2 - John

Case 3 - Lou

Keep in Mind

bull A mental health disorder not a decision

bull Not a moral issue Not caused by laziness

lack of standards lack of responsibility

bull Clutter is only a symptom of the problem

bull Others are usually more aware ofbothered

by the clutter than the individual

bull 92 of individuals have 1 or more mental

health issues (depression anxiety OCD

social phobias)

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000

9102018

18

Resources

Bostonrsquos Center for Hoarding Intervention

httpswwwmetrohousingbostonorgwhat-we-dohoarding-intervention

Children of Hoarders

httpchildrenofhoarderscomwordpress

Hoarding On-line Support Group (Free and National)

httpshoardingcleanupcomhoarding_support_group

Institute for Challenging Disorganization

httpsicdorgmemberclicksnet

International OCD Foundation

httpshoardingiocdforg

State and City Hoarding Task Force

San Diego

httpocdsocalorgwp-contentuploads201404SDHC-Resouce-Directorypdf

San Diego ndash Hoarding in Older Adults Study

httpshealthucsdeduspecialtiespsychPagesCrest-hoarding-in-older-

adultsaspx

Marilyn Halpern LSW

mhalpernsecuredallianceorg

7207240000