Hoarding has long been documented, but has only been systematically studied just within the last decade. Hoarding Disorder was only added to the most recent DSM update in 2013, when the DSM-V was released. This is the extreme side of hoarding where it interferes with normal daily activities such as cooking, sleeping, moving through spaces, as well as relationships with family, friends, or loved ones. It can even become a health or safety hazard either because of restricted movement or as a result of the items themselves (possible decomposition or attracting critters, etc.).
A component that often distinguishes pathological hoarding is self-neglect. Self-neglect can appear as a lack of care in personal hygiene and/or appearance, or the lack of care toward an individual’s personal space, such as their room or their home. The individual may no longer experience shame and not maintain typical grooming practices, brush their teeth, shower regularly, wear torn, old, or dirty clothes, for example. In addition to the excess clutter, their home or space may have dirty dishes, accumulated trash, or serious disrepair (e.g., mold problems, bug infestations, unresolved plumbing issues, etc.).
Sometimes this condition coupled with extreme hoarding is called Diogenes Syndrome and often affects seniors late in life.
Why Does this Happen?
For those who are fortunate enough to make it to old age, it can come with difficult consequence as well. Loss of social interactions is prevalent, either due to deaths of family & friends, or illness/injury making it more difficult to connect with others or participate in regular activity. This can leave an individual feeling lonely or isolated, for which they try to fill other things to satisfy that void. Sometimes this turns into hoarding, and can become such a strong behavior/compulsion that it spirals out of control. A strong compulsion develops in the individual to save something that they “may need for later,” but in reality has little or no value.
A specific traumatic event(s) can also trigger hoarding behavior. It may be an extreme expression of the mind attempting to compensate for a perceived loss of control in the individual.
It is also suggested that compulsive hoarding is associated with anxiety and OCD, with some research indicating that a pre-Alzheimer’s personality can contribute to the development of hoarding disorder.
Why Is it a Problem?
Many people have specific collections, or even numerous material items in their home to the point of clutter. The problem reaches a pathological threshold when the individual is saving things that have no value (junk mail, plastic bags beyond reuse, etc.) and feelings of anxiety and anguish arise at even the thought of throwing away or parting with such items. As mentioned previously, these accumulations of items can prevent ease of movement throughout the home or space, and even become physical or health hazards, yet the individual feels more compelled to hoard than to remedy the situation.
Additionally, as individuals are moved into an assisted living situation, there is literally and figuratively little space for hoarding behaviors. Health code is obviously stricter and does not allow for a collection of excess materials to accumulate, as it presents major health & safety code violations, as well as preventing personnel from safely accessing the residents, health supplies, or perform daily or necessary tasks properly.
Helping Individuals with Strong Hoarding Behaviors
The worst way to deal with another individual’s hoarding behavior is to go through their belongings without permission and throw everything away. Even with permission, deep anxiety can arise in the individual just addressing the thought of parting with their item(s), despite any kind of logic or benefit presented.
A study conducted by Boston University School of Social Work revealed that trust is essential in effectively helping an individual with hoarding behaviors. To clarify, trust isn’t solely based on the length of time an individual knows someone. Many of us even have family members that we love, but may not trust enough or feel entirely comfortable when placed in a vulnerable situation. The same applies to people with hoarding disorders. A strong, genuine rapport must be carefully established; the study indicated that individuals were more receptive to social workers with whom they had developed a trusting relationship.
Obviously, these relationships take time to cultivate and even under the best possible circumstances, mitigating strong hoarding behaviors will continue to be an arduous process.
For the short-term, it might seem too time consuming and even frustrating trying to develop this relationship. However, the long-term benefits in investing in this strong foundation will ultimately help in future problems or crises that may arise, and the resident can feel more secure in knowing they have someone they feel is ‘safe’.
Avoid the Power Struggle
One important thing to remember is to keep the individual involved in the process. While an outsider may view them as impeding the process with possible setbacks and a slower timeline in remedying a ‘problem space’, this will ultimately help resolve the underlying problem instead of hastily applying a band-aid.
Part of the hoarding disorder is rooted in control; completely taking the situation away and handling it for them can send the individual into distress and further aggravate their symptoms. By including them in the process, their feelings and concerns are validated, which helps build trust and increases the chances of compliance.
Ways to Support Residents with Hoarding Behaviors
Though it will take time to curb the hoarding behavior, there are other ways in which to provide support that may help the discourage the behavior indirectly.
A study from the University of California, San Francisco found that 15% of older adults with depression also exhibited extreme hoarding behaviors, versus 2-5% of the older population exhibiting extreme hoarding without the depression comorbidity.
Because a snowball effect can exacerbate hoarding behaviors (loneliness or loss of independence leading to depression, depression manifesting into hoarding), providing elderly residents with outlets for social interaction, creativity, movement (exercise, dance, etc.), music, and more can ideally replace hoarding as behaviors used to fill a void. These activities or a combination thereof can really help to inspire confidence, engage the resident, and possibly ease them from their extreme compulsion to hoard.
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