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From Clutter to Calamity

A missing person's case in Las Vegas came to a ghastly end in August 2010 after a four month search. Billie Jean James had vanished from her home in April and had taken no belongings. There was no evidence of foul play. Metro police took the report and searched the home, a difficult task because the victim was a compulsive hoarder. Search dogs were brought to her home to no avail. The desert around Billie Jean's home was scoured extensively by Metro, community members, family, and friends for months. Then Bill James, her husband, made a shocking discovery in a back room of the house. He saw his wife's feet sticking out from under a ceiling-high pile of trash and clutter. The Clark County's coroner reported that the body's condition had deteriorated to the point that determining how she had died was impossible. Her death was deemed accidental.

You have probably seen one of several television shows about hoarders. You may know a compulsive hoarder. You may have even gone to a call related to checking the welfare of a hoarder, or complaints of offensive smells by neighbors. As you enter the home or yard, you notice an inordinate amount of clutter and the stench makes you sick. You have to ask yourself, How does anyone live this way?

Compulsive Hoarding Syndrome

Hoarders keep their possessions for the same reason others do: for sentimental value (to remember an important emotional attachment or event); for utility value (the object is or could be useful); or for aesthetic value (the object is considered to be attractive or beautiful).

People elevate the pros and cons of discarding objects:

  • This is too good to throw away;
  • This is important information;
  • I may need this later on;
  • This should not be wasted.
  • and more...

Obsessive hoarding involves amassing objects that have little if any value. Commonly hoarded items include: newspapers, old mail circulars, clothing, boxes, bags, decorations, and discarded food packaging. Hoarders can fixate on almost anything. Sometimes the items may be valuable but are in far excess of what can reasonably be used. Some people hoard garbage or rotten food. In extreme cases, items like hair, fingernail clippings and even feces are hoarded.

Professionals look for these three things when evaluating for compulsive hoarding:

  1. An inability to discard objects which appear useless that is coupled with discard anxiety
  2. Significant life distress or impairment in functioning due to hoarding
  3. A cluttered living space that has become so filled with objects that its functionality has become useless

Hoarders also display marked indecisiveness, disorganization, and procrastination. They are frequently perfectionists who postpone doing anything. They may appear lazy to others. Fundamentally they are terrified of making mistakes, including discarding items. In order to prevent making a mistake, they will avoid making decisions. Even the smallest task, such as washing the dishes, may take all day because it has to be done just right.

Epidemiology

Compulsive hoarding is a mental health condition that currently falls into a sub-category of obsessive compulsive disorder (OCD). It is also seen in individuals who have other disorders including anorexia, schizophrenia, and dementia. Because compulsive hoarding sufferers are often isolated and embarrassed by the secretive nature of their lifestyle it is difficult to determine how many individuals have the disorder. It seems likely that serious hoarding problems are present in between 2-5% of the population. Compulsive hoarding is estimated to affect up to 2 million people in the United States. It is an equal opportunity disorder affecting all age groups and both sexes. The initial onset for compulsive hoarding is believed to occur in childhood or adolescence, more specifically between the ages of ten and twelve. However, hoarding is a chronic and progressive process. The average age of a person seeking treatment for the disorder is fifty. Dementia and hoarding may be the only psychiatric disorders that actually increase in severity and prevalence throughout the life course.

Hoarding or Collecting?

After reading this you may believe that you or a loved one may be a hoarder. It is important to understand that hoarding is not the same as collecting even large amounts of items. Perhaps you have a very large doll collection is a spare room. It is organized, is limited to that one room, but may appear overwhelming to others. You enjoy sharing your collection with visitors. You appropriately budget your money to acquire more dolls. A family member believes you are an obsessive hoarder. Are you? Or, perhaps you have an excessive amount of tools, wood, screws, etc somewhat sorted and organized in the garage? You are always on the lookout for new affordable items, but don't discard the old. Your unfinished projects are making it impossible to park the car in the garage. Are you a hoarder or a collector? Although these examples represent collecting that may be considered excess, it probably doesn't constitute obsessive hoarding.

True hoarders usually feel embarrassed by their possessions and are uncomfortable with others seeing them. They may refuse to let others in their home or on their property. They will not call repair workers when essential items need to be fixed or replaced. In an effort to hide their secrets they rationalize that there is no room for the work to be done, or no place for needed appliances to be delivered. Compulsive hoarders are frequently in debt. They are aware of the hoarding cycle and experience sadness, or depression after acquiring additional items.

Hoarding in Older Adulthood

Hoarding is particularly dangerous for the elderly, who frequently have significant physical and cognitive impairments. Their inability to function in the home becomes profound. Hoarding and hiding behaviors are commonly reported in individuals who have dementia. A study of elderly hoarders found that hoarding constituted a physical health threat in 81% of identified cases. This threat included the risk for fires, falling, unsanitary conditions, and an inability to prepare food. An additional study of older hoarders found that 45% could not use their refrigerators, 42% could not use their kitchen sink, 42% could not use their bathtub, 20% could not use their bathroom sink, and 10% could not use their toilet. They become incapable of managing health and medication regimes. Additionally, elderly hoarders are at a significantly higher risk for eviction and premature relocation to senior housing, which may have devastating emotional and psychological consequences.

The Consequences of Compulsive Hoarding

Hoarding can cause serious and even devastating consequences. Hoarders frequently fail to recognize the dangers of their behaviors to themselves and possibly others. Many hoarders live in squalor and may subject their elderly parents, children or spouses to numerous hazards. In some cases the legal system is forced to intervene. Standard legal interventions often involve sanctions, such as evicting the individual, mandating a clean out, or removing vulnerable individuals from the home. Public health and/or fire safety issues may put the home at risk for condemnation. If the hoarder has children or elderly living with them they may be charged with abuse and/or neglect resulting in protective services intervention. Frequently loved ones are removed from the home related to their threatened physical safety, thwarted emotional, social and educational development, and failure to receive needed attention and care.

Treatment for Hoarders

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.



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