From Clutter to Calamity

Compulsive hoarding can be treated. New studies have shown that Paxil (an SRI medication) has been effective in treating patients with compulsive hoarding syndrome. Additional medicines help reduce the symptoms of depression and anxiety that often makes the condition worse. However the best approach to treatment involves both pharmacology and psychological therapy. Cognitive behavioral therapy is the ideal method. This type of therapy challenges the hoarder's thoughts and beliefs about the need to keep items and about collecting new things. Eventually the individual progresses to working on behavioral changes, such as practicing the removal of clutter (with the help of a coach). Individuals are then encouraged to work independently, or with a person of their choosing, to remove or recycle most if not all clutter. Next the hoarder is encouraged to go out without buying or picking up new items. Finally a plan is developed to prevent future hoarding. Until the hoarder is motivated to change they will usually not accept offers to help. Attempts by others to simply clean out the home of a hoarder without treating the underlying problems invariably fail.

What Law Enforcement Officers Can Do

If you encounter an individual whose hoarding behavior appears to represent a significant health or safety risk to the hoarder or others, there are some actions you can and must take. As protected classes under state and federal laws, children, older adults, and disabled individuals must be protected from abuse and/or neglect which may result from a hoarding situation. Make a referral to Adult Protective Services or Child Protective Services if you suspect abuse or neglect (including self neglect). Take photographs. Write a report and discuss the situation with a detective. Additional referrals can be made to public health, the fire department and vector control (however, this is usually handled by the protective agencies). Additionally, evaluate the need to place the hoarder on a 72 hour psychiatric hold as a gravely disabled adult. Examples of criteria in which hoarding constitutes a grave disability include the following:

• The presence of filthy conditions in the home; fire hazards that the person cannot correct; vermin infestations; and lack of bathing and toilet facilities
• The inability or unwillingness to follow medical instruction regarding treatment and self-care which are essential to health
• The inability to manage his or her household in such a way as to avoid clear dangers to health
• Endangered health by gross negligence related to diet and nutrition
• Having spoiled food in refrigerator and/or no food for a lengthy period of time in the house
• Wearing filthy or soiled clothes and/or severe personal hygiene problem
• The hoarding of nonsensical items while misplacing necessary items

Hospitalization also allows the social service staff to intervene with the help of community resources and the hoarder's relatives before the individual is discharged to return to the same conditions. If time allows, try to follow-up with the hoarder on your beat.

If you have now realized that your prized collection has reached a critical breaking point, you may want to make de-cluttering a priority New Year's resolution.