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Case-Based Differential Diagnostic Mental Health Evaluation for Adults
Published in Kunsook S. Bernstein, Robert Kaplan, Psychiatric Mental Health Assessment and Diagnosis of Adults for Advanced Practice Mental Health Nurses, 2023
Kunsook S. Bernstein, Robert Kaplan
Obsessive-compulsive disorder (OCD) is characterized by the presence of (1) obsessions, which are recurrent, persistent, and intrusive thoughts, urges, or images; and (2) compulsions, which are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. A person with OCD may have an obsession, a compulsion, or both (APA, 2013). There are a variety of OCD-related disorders, such as body dysmorphic disorder, hoarding disorder, trichotillomania (hair pulling), and excoriation disorder (skin picking). OCD is the fourth most common psychiatric disorder, and the lifetime prevalence of OCD in the general US population is estimated at 1–3%. The mean age of onset is approximately 20 years, and among adults, women are affected at a slightly higher rate than are men. Approximately 50–70% of clients with OCD have a sudden onset of symptoms following a stressful event, such as the death of a loved one, a serious illness, or a sexual problem (Sadock et al., 2019). Many OCD clients have full insight that their behaviors are senseless and excessive.
Addressing Hoarding in Home Care
Published in Danielle L. Terry, Michelle E. Mlinac, Pamela L. Steadman-Wood, Providing Home Care for Older Adults, 2020
Late-life hoarding disorder (HD) is a challenging issue that can be driven and maintained by complex psychiatric, cognitive, and functional factors. These cases can become overwhelming to provider and patient alike. Safety of staff entering the home is critical, and precautionary measures should be taken to ensure care can feasibly be provided within the cluttered space. Animal hoarding may co-occur and can cause additional distress and health precautions for providers. In fact, patients with severe hoarding may never receive routine medical home care as they will likely opt out or avoid home visits altogether. However, they may end up involved with Adult Protective Services (APS) or undergoing guardianship proceedings and require capacity evaluations. Mental health providers in home care have a unique vantage point in being able to assess and provide treatment to those challenged by HD. This chapter provides a brief survey of assessment and intervention approaches to HD and offers suggestions for further resources.
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).
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.