Post on 17-Feb-2018
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Hoarding Disorder:
A Brief Overview
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Denition
Compulsive hoarding:
the acquisition of, and failure to discard, alarge numer of possessions that appear
to e useless or of limited value living spaces are su!cientl" cluttered so
as to preclude activities for which thosespaces were designed
signicant distress or impairment infunctioning caused " the hoarding
#$rost % Hartl, 1&&'(
)
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Hoarding, *qualor andAnimal Hoarding
Hoarding and squalor are not the same
*qualor is dened as lthiness or degradation fromneglect: +wo forms domestic and personal
Hoarding is related to the volume of clutter in thehome, not the cleanliness
Animal hoarding: involves the failure to provideadequate facilities for animals overcrowded or
unsanitar" living conditions, inadequate veterinar"care, poor nutrition, etc - Contact the .*/CA or+ufts 0niversit" Hoarding of Animals ResearchConsortium for information aout animal hoarding
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Demographics % /revalence
*aving egins in childhood 2 age 1
Average age in treatment 3 45
.arital *tatus: tend to e single
6ow marriage rate, high divorce rate, tend to livealone
7ducation: ranges widel"
$amil" histor" of hoarding is common
*qualid conditions uncommon among treatment
see8ers 7stimates 94 of 0* /opulation #14 million Americans(
Occurs cross9culturall": ;apan, 0
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.ore on Hoarding
Hoarding is a mental health disorder not adecision
Hoarding is not a moral issue@ t is not caused" lainess, lac8 of standards, lac8 of
responsiilit" Clutter is onl" a s"mptom of the prolem t is often characteried " low insight: others
are often more aware of>othered " the clutterthan the individual
&) of individuals with hoarding have 1 ormore other mental health #e-g-, depression,generalied aniet", osessive9compulsivedisorder, social phoia(
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Course of Hoarding Disorder
6ittle evidence for histor" of materialdeprivation
Hoarding ma" e precipitated " loss Chronic or worsening course
nsight uctuates
*everit" range from mild to life9ta8ing
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Hoarding Behaviors
*aving: *entimental, instrumental, intrinsic
Acquisition: Bu"ing, acquisition of free things
Clutter>Disorganiation: Eandom piles,churning
Di!cult" Discarding: ndecision, attachment
F
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n ers an ng eChallenges of Gor8ing with
/eople who Hoard Beliefs and 7motions associated with
oects
Beliefs aout self in relation to world Iulnerailities #+ime, $amil" Histor", 6oss, etc-(
Co9morid Conditions #.ental and /h"sical Health(
Cognitive Distortions #/rolematic +hin8ing( .otivation
J
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Hoarding and nsight
/eople with hoarding prolems havevar"ing levels of insight aout the
etent of their prolem and the wa"sthat it impacts them % those aroundthem
Kon9insightful
nsightful ut unmotivated
nsightful, motivated, ut noncompliant
&
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Assessing Hoarding
HO.7* .ulti9disciplinar" Hoarding Eis8Assessment
nstructions for 0se
HOMES.ulti9disciplinar" Hoarding Eis8 Assessment provides a structural measure throughwhich the level of ris8 in a hoarded environment can e conceptualied-
t is intended as an initialand briefassessment to aid in determining the nature and parameters
of the hoarding prolem and organiing a plan from which further action ma" e ta8en99 including
immediate intervention, additional assessment or referral-
HOMEScan e used in a variet" of wa"s, depending on needs and resources- t is
recommended that a visual scan of the environment in comination with a conversation with theperson#s( in the home e used to determine the eMect of clutter>hoarding on Health, Ostacles,Mental Health, Endangerment and Structure in the setting-
+he $amil" Composition, mminent Eis8, Capacit", Kotes and /ost9Assessment sections areintended for additional information aout the hoarded environment, the occupants and their
capacit">strength to address the prolem-
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neMective ntervention *trategies
.a8e decisions #aout a plan ofaction( for a tenant
Argue or /ersuade /ressure the tenant to discard
+ell the tenant how to feel
=ive veral and non9veral cues thatare udgmental or negative in nature
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7Mective ntervention *trategies
Be clear aout epectations andlimitations
As8 open9ended questions Eeectivel" listen
0se respectful, non9udgmental language
.irror the language used " the tenant
NGor8 with the tenant instead of Ndoingfor
1)
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$ocus on nternal .otivation:+he P.agicQ Bullet
Ghat ma8es people motivated to changeR
Condence mportance
$actors nuencing .otivationHow much social support?
Are there any home visitors?
Can anyone monitor homework?How depressed is the tenant?
Can tenant tolerate discomfort?
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7nhancing .otivation
Suestions to start dialogue:
How has hoarding aMected "our famil"R
How does the clutter t with the things"ou value in lifeR
Ghat successes have "ou had that ma8e"ou thin8 "ou address "our hoarding
prolemR
Gh" would "ou want to change if itmeans giving up part of "ourselfR
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14
HOAEDK=:
+H7 67=A6$EA.7GOE
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67=A6 S07*+OK*
GH7K DO7* HO0*7
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/AE+ 1
GH7K DO7* HOAEDK=B7CO.7 A 67=A6
/EOB67.R
1F
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HOAEDK= * A 67=A6 /EOB67.GH7KU
t violates applicale housing health andsafet" standards, including those foranimals
t endangers vulnerale people as dened" state law
Children
7lders
/ersons with Disailities
1J
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HOAEDK= * A HO0*K= /EOB67.
Ghen it violates or progresses towardviolating:
+he 6ease
H0D>DHCD *tandards
6ocal or state health and safet" codes
Animal cruelt" standards
1&
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)5
7**7K+A6 HO0*7 neighors,
staM
.AK+AK 0K+, Common Areas
KO *7EO0* COD7 IO6A+OK*
$ollow E7A*OKAB67 HO0*7 E067*
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H0D HO0*7 E067* #1(
.a" include requirements for: =arage disposal, including disposal of
=rease
*mo8ing materials 0sed s"ringes or other iohaards
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H0D HO0*7 E067* #)(
.a" prohiit
*torage of haardous materials
Bloc8ing of eits Bloc8ing of heating vents
Overloading circuits and haardous
use of etension cords =arage or clutter that attracts insects
or rodents or produces foul odors
))
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H0D HO0*7 E067* #(
.a" prescrie repair>maintenancestandards
/rompt reporting of repair needs
Clear access to repair area
/rompt reporting of infestation
Cooperation with necessar"etermination
)
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)?
H0D *AK+AET *+AKDAED*
CA+
.a" require changing of cat litter, ut nomore than twice>wee8
.a" require removing waste from litter,
ut no more than once>da"
CA+* % DO=*
.a" prescrie disposal of litter and waste Eequire control of noise and odor
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H0D AKD DHCD*+AKDAED*
H0D
*ection J Housing Sualit" *tandards
#HS*( Ch 15
/et /olic"
DHCD
)?C$E &J) and HS* Ch J #/ulic Housing
and Certicates( *tate *anitar" Code 154 C.E ?15 #all
Housing(
)4
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AK.A6 CE076+TE7S0E7.7K+*
.=6 chapter )F): *ec FF forids
unnecessaril" fail#ing( to provide #ananimal( with proper food, drin8U #and(sanitary environment
)'
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HOAEDK= * A *7EIC7/EOID7E 67=A6 /EOB67.
Ghen it endangers:
Children
7lders #over '4(
/ersons with Disailities #an" age( Animals
)F
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GHA+ s"stems haards
)J
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/AE+ )
)&
GH7K DO7* E7A*OKAB67ACCO..ODA+OK CO.7
K+O /6AT
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5
/7E*OK G> A D*AB6+T 9CI6 E=H+* D7$K+OK
A /HT*CA6 or .7K+A6 ./AE.7K+
which *=K$CAK+6T K+7$7E7* withone or more .A;OE 6$7 AC+I+7*
n this case, the maor life activit" ofhouse8eeping #and possil" otheractivities(
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HOAEDK= A* A D*AB6+T
Civil Eights Denition is$0KC+OKA6, not diagnostic #D*.(
0* *upreme Court: the person isNunale or Nver" restricted in theailit" to do some Ndail" life activit"#house8eeping(
1
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E7A*OKAB67ACCO..ODA+OK #1(
Applicale when:
Eesident has a disailit"
Disailit" is cause of house8eepingprolem
Eesident wants an accommodation
)
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E7A*OKAB67ACCO..ODA+OK #)(
Applicale when:
Disailit" is ovious or there is relevantverication including ailit" and
willingness of resident to cooperate
Accommodation does not
pose undue urden or require a fundamental change in nature of
program
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?
0KD07 B0ED7K
$inancial urden Ko set formula
Cost of accommodation vs- sie % nancial
condition of ownerQs overall housing usiness
Administrative urden #staM time(
How much timeR
7Mect on ailit" to carr" out otherresponsiilities
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$0KDA.7K+A6 CHAK=7K +H7 KA+0E7 O$ +H7 /EO=EA.
4
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Accommodation /lan ncludes#1(
1- *pecic standards in specic areas
)- +he timeline for each step and the deadline
- Gho will do the clean up and trash removal
?- Gho will chec8 and how often
Continued'
Accommodation /lan ncludes
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Accommodation /lan ncludes#)(
4- *ervices resident will accept
'- Eelevant releases
F- Consequences for failure to follow plan
J- Ongoing monitoring
F
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J
*77< CO0E+ EAA=E77.7K+ $U
+here is potential dangerto others
Eesident is in denialaout seriousviolation
Kecessar" to involve serviceproviders and/or family (TenancyPreservation Program)