Tuesday, June 1, 2010
Coincidentally, in the middle of coordinating my move (which included acquiring a lot of new stuff), I attended a one-day seminar on Mental Health and Aging put on by NAMI San Diego and The Senior Mental Health Partnership. First talk of the day was on hoarding.
Much to my relief, I learned that I was an unmitigated slob, not a hoarder. As Catherine Ayers of UCSD explained, hoarding does not equate with messiness. Rather, I am merely too lazy to throw away my old things rather than being driven by an obsessive need to hold on to them. Someday there may be a DSM diagnosis for people like me, but not yet.
According to Dr Ayers, individuals who hoard have a distorted belief about the importance of a possession (such as a discarded water bottle) combined with an obsessional fear of losing that possession. The hoarding interferes with the individual's ability to use their home.
Accounts of individuals literally buried alive beneath domestic clutter may come across as comic, but the reality borders on tragedy. As Dr Ayers explained, 45 percent of older people who hoard could not gain access to the fridge and 10 percent could not use the toilet. Getting from one area of the house to the other typically involves negotiating labyrinthine (and often treacherous) "goat trails."
Hoarding is fairly common, accounting for 5.3 percent of the population. Hoarders are typically female, unmarried, and living alone. Never having been married is associated with greatest impairment. Hoarding tends to start in the 30s, with the severity increasing over time. Eighty-four percent of those who hoard have a first degree relative of similar disposition.
Behavior may include indecisiveness, perfectionism, procrastinating, difficulty organizing tasks, and avoidance. Dr Ayers also mentioned an abnormal desire to take control and exercise responsibility. She mentioned one individual who took it upon herself to tape NPR. Her home contained 500,000 tapes.
Three out of four hoarders shop too much, but a real danger, Dr Ayers pointed out, is from stuff that comes into the house, such as mail. Hoarded items tend not to be of high value, such as paper. Since it takes time to go through paper, that paper is not going anywhere.
The illness is attributed to a deficiency in informational processing, though not necessarily in older adults. Older adults may have good neuro-cognitive function, but may be deficient in other areas. Hoarding is listed as a symptom of OCD, but brain scans reveal a different pattern. The draft DSM-5 is proposing the new diagnosis of "hoarding disorder."
Unfortunately, Dr Ayers explained, hoarders don't go to doctors' offices seeking help. Having someone else clean out the place is only a temporary fix, as hoarders go right back to their old ways. SSRIs may help, and cognitive-behavioral therapy aimed at addressing hoarding behavior is in its infancy. Dr Ayers suggested that intensive outpatient therapy seems to be the most effective treatment, with a focus on getting the patient to decide on every item.
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