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Hoarding
Dr Christopher Mogan
The Anxiety Clinic, VIC
The Psychology of
Compulsive Hoarding
Dr Christopher Mogan
NATIONAL SQUALOR CONFERENCE
Sydney, November 5-6, 2009
Hoarding behaviours
Common to hoard stuff - keep just in case
Compulsive hoarding is more pervasive,
dominating time, space of self & others. Packed
garages, backyards, corridors, roof spaces,
rooms chaotic & unusable.
Unable to organize, discard things or prevent
clutter, high distress, hazards to health/safety.
Hoarding largely undiagnosed & untreated.
mogan@theanxietyclinic.com
Other hoarding-related
cognitions
Indecisiveness
ETIOLOGY (Causation)
Psychoanalytic approaches
Freuds construct of reactive defence against conflict
in the anal stage led Fromm to delineate a hoarding
character - remoteness, withdrawal from others.. a
controlling mode of relatedness - reduce anxiety by
control.
In Kleinian theory, the unconscious urge is to return
all that had been removed from the mother, yet brings
a un-resolvable conflict in the compulsive urge to
hold on.
Contemporary P/A theory emphasizes the loss of
adaptiveness & mental inflexibility of the hoarder in
fearing change/unpredictability
Neurological approaches
Heuristic value based on the reported
issues with memory & organization.
Research is still developing and findings
are inconclusive even with advances in
functional & structural imaging.
Meta-memory factors suggest memory
bias based on appraisal not on deficits.
Cognitive Behavioural
model
CBT has defined hoarding, developed
treatment on a multi-factorial model.
Information-processing deficits
memory, decision-making, categorizing
Faulty appraisal of importance of things
Disability associated with clutter, no
insight, emotional & rigid behaviours.
Squalor model
Dementia and other deteriorating models
emphasize loss of self-care & organization.
Secretive, isolated, uncooperative; decayed
food, animal waste, pest infestation
Hoarder profiles emphasize 65+, single, female.
Dementia brings a sudden deterioration to any
hoarding situation
Require structure, psychiatric assessment,
protective interventions and medication
3) Addiction model
- Total pre-occupied with hoarding focus
- denial, excuses, claims of persecution,
ignoring overall outcome of hoarding.
- Impulse control issues in compulsive
acquiring of things or animals.
- Significant comorbidities
4) Attachment model
Emphasizes disorganized early attachment
with compromised chaotic parenting. Animal
or object as stable fixtures.
Compensatory unconditional love for & from
animals has explanatory power.
Consistent with CH where sense of self and
grief-like loss connected with things
Compulsive need to keep animals or objects
to protect them, maintain connectedness
Obsessive Compulsive
Disorder Model
OCD associated with hoarders key FELT
RESPONSIBILITY to care for possessions
including things, animals, memories.
Harm prevention, special relationships or
other symbolic meanings.
Sense of mission whether for animals or
responsibility for things
Avoidance behaviours can reach delusional
levels
mogan@theanxietyclinic.com
mogan@theanxietyclinic.com
Clutter
mogan@theanxietyclinic.com
Safety concerns
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Phenomenology of hoarding
Examined in a study of known hoarders
in comparison with clinical groups
(OCD, anxiety states) and community
controls (N= 109).
Findings consistent with overseas
research.
Hoarding phenomenology is distinct
from other clinical and control groups.
Measuring hoarding?
Savings Inventory Revised: savings actions, time spent, emotional
responses to saving & discarding, usefulness of saving, interference
caused by saving.
Savings Cognitions Inventory: measuring beliefs associated with
possessions - need for things, why cannot throw things away, need to
control what happens, to get comfort from things.
Savings List of things kept.
Hoarding Rating Scale
Hoarding Interview
Visual Rating of Clutter
mogan@theanxietyclinic.com
Outcomes
The cognitive, affective and informationprocessing factors of CBT model
supported.
Emphasis on severity of clutter, amount
saved, and dysfunctional beliefs about
things.
Hoarders compared with other clinical
groups and community controls showed
significant difference in socio-economic
status (income).
mogan@theanxietyclinic.com
26
Predictors of hoarding in
analyses of the data: In order
i. Perceived lack of family warmth
ii. Padua Inventory OCS
iii. Fear of Neg. Eval. Social Anxiety
iv. Possessions in View Scale
v. Beck Anxiety Inventory
vi. OCPD Personality Disorder
vii. Frost Indecisiveness Sc Fear of decision making
viii.Consequences of Forgetting Scale
TREATING HOARDING IS
COMPLEX
Hoarders have highly-personalised reasons for
Hoarding
Hoarders have ambivalent and avoidant personality
styles
Uncertainty about self and others leads to objectdriven compensatory behaviour
Treatment interfering variables are common
Rigidity, Control, Reluctance for treatment
Fear of making decisions, control and memory and
the deep seated beliefs held by hoarders.
mogan@theanxietyclinic.com
Termination
Maintenance
Action
Relapse
Contemplation
Preparation
Precontemplati
on
Treatment of hoarding
Assessment of hoarders in their context to
determine the treatment needs.
Liaison with health & welfare agencies
complexities require collaboration.
Therapy is not quick-fix, outcomes based
on specifying goals. Harm minimization as
in drug addiction as a guide.
Treatment still being developed.
.
Treatment
Learning of skills in managing paper items
categorizing, judging worth, challenging keeping of
everything
Increasing confidence in discarding sessions in
clinic led to systematic practices in home.
Motivation needs to be very high
Respond to positive reinforcement, sense of
achieving very specific goals
mogan@theanxietyclinic.com
Therapy tips
Skills-building is based on practice.
Discard something however small every
day- DSD
Build a relationship affirming the difficult
task of CH Try to keep them attending
therapy motivation as key to change
Set small targets - safety of self/others
Visualization of de-cluttered room
mogan@theanxietyclinic.com
Future
Research needs financial commitment
Training of associated workers health, welfare,
community carers, state & local jurisdictions team approach.
Leadership for the long term research, planning
and resourcing, education, lobbying
Solution not in legislation and enforcement yet
they are essential elements, especially when risk
extend to children, elderly; and also animals.
Dr Christopher Mogan
The Anxiety Clinic
TMC Suite 6,140 Church St,
Richmond 3121
Tel 03-9420 1424
mogan@theanxietyclinic.com
mogan@theanxietyclinic.com