Say you saw it in the Beacon | Housing Options
BALTIMORE BEACON — JUNE 2013
Hoarding From page B-18 to discard them. Need for control. The hoarder usually doesn’t want anyone else to make decisions about her possessions, so it can be difficult for the family to help.
An escalating problem Over the years, compulsive hoarding takes an increasing emotional, financial and sometimes physical toll. The home becomes unsafe. The stove may be piled with junk and the hallways blocked. Accumulated dust and mold may trigger asthma and other allergic reactions. Guests may be forbidden. “Family members are much more likely to seek help than the hoarder. Hoarders are reluctant to change. And they’re usually upset about their hoarding only if people are putting lots of pressure on them to change,” said Dr. Michael Jenike, professor of psychiatry at Harvard Medical School and founder of the hoarding clinic at Massachusetts General Hospital. Family interventions don’t always help. The hoarder may resist efforts to get her to hire a professional cleaner. Extra storage units may simply be filled up. Relatives or friends may try to strong-arm a hoarder into getting rid of her stuff, but that tactic often ends disastrously, causing lifelong resentments. “You need someone to negotiate for you,” said Jenike. “In some cases, a person isn’t going to deal with this until the Board of Health gets involved.”
Treating hoarding What to do? A lot depends on whether the hoarder wants to change. A motivated person with relatively mild symptoms may be able to use a self-help program or work with a professional organizer. But most hoarders need professional therapeutic help. Treatment can be difficult and lengthy and may require several approaches. First, it’s important to find a good physician, mental health professional, or neurologist who can determine whether the hoarder has any underlying or contributing conditions that can be treated along with the hoarding itself. As we noted earlier, OCD is
one such condition. There are others. In a 2011 study published in Depression and Anxiety, researchers found that 28 percent of compulsive hoarders have a form of attention deficit disorder, which can make it difficult to focus long enough to make headway in clutter removal. Half of hoarders suffer from major depression, which saps their energy and makes it difficult for them to do anything about the problem. Hoarding can also result from several other conditions, including schizophrenia, dementia, eating disorders, head injuries and certain personality disorders. There are no specific anti-hoarding medications. Drugs that are used to treat OCD may help, especially selective serotonin reuptake inhibitor (SSRI) antidepressants or tricyclic antidepressants. But compulsive hoarders often don’t respond to these medications. Studies show that people with OCD are less likely to respond to SSRIs if hoarding is one of their symptoms. On the other hand, these drugs may be useful for treating the depression and anxiety that often accompany hoarding.
is almost never a long-term solution. To find a therapist with experience in the treatment of hoarding, check the treatment provider listing in the hoarding section of the International OCD Foundation Web site. — Harvard Women’s Health Watch © 2012 President and fellows of Harvard College. All rights reserved. Distributed by Tribune Media Services, Inc.
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Changing thoughts, behaviors Traditional cognitive behavioral therapy (CBT) hasn’t worked well either, often because patients are reluctant to participate. Therapists have been getting better results with specially designed behavioral therapy programs. In a controlled trial based at Boston University (published in Depression and Anxiety, May 2010), a CBT intervention for hoarding showed substantial benefit. After 26 sessions, three out of four patients were rated as “much” or “very much” improved. The therapy helps hoarders identify and confront distorted thinking or beliefs, bolster their organizational and decision-making skills, and cope with (and lessen) their anxiety about discarding or organizing possessions. Therapists may also make home visits to help with sorting, organizing, and discarding. “We learned that the therapy works pretty well for many people, but at the end, they aren’t symptom-free, and the process is long. Twenty-six sessions was much better than 12 sessions, but 12 sessions beats
How to help a hoarder 1. Listen. Let the person tell his/her story. Respect the person’s perspective and attachment to the possessions. Don’t tease or criticize. 2. Go slow. There’s no need to rush changes unless the person’s living situation is unsafe or she needs to move to smaller quarters or a nursing facility. 3. Engage. Involve the hoarder in decisions about where to put things and what to throw out. 4. Notice other changes. If there are signs of other cognitive or emotional problems, arrange for a professional evaluation. For example, hiding belongings or spending a lot of time rummaging
doing nothing or reading a self-help book. With a book, you’re presented with the same skills, but you may not practice them,” said Dr. Gail Steketee, dean of Boston University’s School of Social Work. TV shows — particularly those that emphasize cleanup services rather than therapy — can present a distorted picture of the serious work involved. Cleanup alone
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through stuff can be a sign of dementia. 5. Provide structure and emotional support. During the de-cluttering process, keep the person company and help him/her stay focused on one area at a time. 6. Lift and tote. An elderly hoarder may need family, friends or professional cleaners or movers to help with handling the clutter. 7. Work with others. More than 75 communities have hoarding task forces that address psychiatric, legal, geriatric and housing concerns. One possible source of information is your local Area Office on Aging. — Harvard Women’s Health Watch
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