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Addressing Hoarding in Home Care
Published in Danielle L. Terry, Michelle E. Mlinac, Pamela L. Steadman-Wood, Providing Home Care for Older Adults, 2020
Brief hoarding assessments can be useful, and several are validated for older adults. The Clutter Image Rating Scale allows the examiner to understand how the patient sees the extent of the clutter in their home. The patient is shown a photo array of sample rooms (e.g., a kitchen) being gradually filled with clutter, and asked to identify which photo most closely matches the severity of their own clutter. Anecdotally, when using this tool during visits in hoarded homes, it is often quite startling to see the discrepancy between the patient’s view of the hoarding severity and that of the provider’s, while standing together in the midst of the clutter. This tool, which has been validated with older adults (Dozier & Ayers, 2015), can serve as a good starting point for treatment as providers can adjust their own understanding of the problem prior to embarking on an intervention pathway. The Savings Inventory-Revised, a 23-item self-report scale that aims to quantify intensity and frequency of hoarding behaviors, has also been shown to be valid with older adults who hoard (Ayers, Dozier, & Mayes, 2017).
The Anxious Couple
Published in Len Sperry, Katherine Helm, Jon Carlson, The Disordered Couple, 2019
Katie L. Springfield, Rosa M. Macklin-Hinkle
Individuals with Hoarding Disorder have persistent difficulty parting with possessions, regardless of the actual value of the items. The difficulty parting with items is compounded by distress with discarding items. Such difficulty parting with possession results in cumulating possessions that congest and clutter active living spaces. Notably, the criteria may still be met if living areas are uncluttered due to family intervention (American Psychiatric Association, 2013).
Obsessive-Compulsive Disorder
Published in Stephen M. Stahl, Bret A. Moore, Anxiety Disorders: A Guide for Integrating Psychopharmacology and Psychotherapy, 2013
Jonathan S. Abramowitz, Ryan J. Jacoby
The DSM presents OCD as a homogeneous disorder, yet research has identified reliable and valid subtypes or dimensions of OCD symptoms (Abramowitz et al., 2010; for a review, see McKay et al., 2004). These include (1) harming (aggressive obsessions and checking rituals), (2) contamination (contamination obsessions and decontamination rituals), (3) symmetry (obsessions about order or neatness and arranging rituals), (4) unacceptable immoral or violent thoughts with mental rituals and neutralization, and (5) hoarding symptoms. Most recently, however, research suggests that hoarding is not a symptom of OCD, but rather a separate psychological disorder (e.g., Abramowitz, Wheaton, & Storch, 2008).
Managing Behavioral Health Risks in Older Adults
Published in Clinical Gerontologist, 2021
Next, we move to conditions and experiences that may bring older adults to the attention of behavioral healthcare professionals as well as adult protective service professionals. Hoarding disorder is one such condition that, when severe, may lead to both behavioral health interventions and adult protective service involvement. In an intriguing study of 49 adults in treatment for hoarding disorder, participants sorted home items for being discarded for 1–15 minutes, rating pre- and post-task emotions (Dozier et al., 2020). Fear, while the most commonly experienced emotion was not highly endorsed. The authors conclude that anxiety and fear may not be universal drivers of hoarding across the lifespan. We look forward to continued work from this group in establishing etiological mechanisms for hoarding and effective treatments.
The Association between Age and Experienced Emotions in Hoarding Disorder
Published in Clinical Gerontologist, 2021
Mary E. Dozier, Julie Loebach Wetherell, Nader Amir, V. Robin Weersing, Charles T. Taylor, Catherine R. Ayers
Participants who reported experiencing a fear-related emotion discarded significantly fewer items than did participants who reported an emotion unrelated to fear during a typical exposure session for HD. This is consistent with previous research showing that reporting higher levels of the negative emotions was associated with discarding fewer items within participants with HD (Tolin et al., 2009, 2012). This suggests there may be two etiological paths for the development and maintenance of hoarding disorder: patients who avoid sorting because they are fearful of making the wrong decision and patients who avoid sorting because of other reasons yet to be established. The current study indicates that these potential etiologies may be identifiable through patients’ reported affect when faced with the prospect of discarding their possessions. Such identification could lead to separate treatments tailored to patients’ reported experience sorting items. This may be especially critical for older adults, for whom there was a decreased tendency to experience fear-based emotions related to sorting.
Multifaceted impulsivity in obsessive-compulsive disorder with hoarding symptoms
Published in Nordic Journal of Psychiatry, 2021
Selim Tumkaya, Bengu Yucens, Mehmet Mart, Didem Tezcan, Himani Kashyap
A comparison of OCD (without hoarding symptoms) and hoarding disorder showed greater impulsivity in individuals with hoarding disorder, and during the conflict monitoring and response inhibition condition in the Go/No-Go task, patients with hoarding disorder had significantly greater activity than control subjects in the anterior cingulate cortex (ACC) and right dorsolateral prefrontal cortex (DLPFC) [26]. Behavioral results from the study showed greater impulsivity in individuals with hoarding disorder in addition to the imaging results. These findings suggest that hoarding disorder is independently associated with impulsivity. Although the direction of the relationship and/or underlying causes still remain unclear, it has been hypothesized that hoarding may be a direct consequence of impairment of the anterior cingulate cortex (ACC), impaired neurocognitive functions, particularly inattention, or of a regulatory/inhibitory dysfunction of the normal tendencies to collect/acquire objects.