This weeks #Otalk is on the topic of “hoarding” and will be hosted by Orla Hughes (@Orlatheot).
What is compulsive hoarding?
Compulsive hoarding, or hoarding disorder, is a pattern of behaviour that is identified by the following characteristics:
- Having difficulty or an inability to discard possessions (NHS Choices, 2015).
- Excessively acquiring objects, regardless of their monetary value, which prevents use of living and work spaces (Tolin, Frost, and Steketee, 2014).
- As a result, considerable impairment or distress in occupational, social, or other critical areas of functioning is present (American Psychiatric Association, 2013).
- The hoarding symptoms are not restricted to symptoms of another mental or physical condition, for example, food storing issues as a symptom of Prader-Willi Syndrome (Mataix-Cols et al., 2010).
This condition was formerly recognised to be a symptom of obsessive–compulsive disorder (OCD) but due to recent research, it is now classed as a separate diagnostic entity by healthcare providers and in the Diagnostic and Statistical Manual of Mental Disorders (Pertusa et al., 2010; Royal College of Psychiatrists, 2016).
The prevalence of compulsive hoarding
Clients who have the behaviours of hoarding and acquiring are common issues faced by staff in health, social-care, housing and environmental services (Dissanayake, 2012). A prevalence rate of 2-5% in the population have been found through studies in Europe and the United States (Bratiotis, Schmalsich and Steketee, 2011). Yet, when analysing these figures, in studies such as Samuels et al. (2008), it is not clear whether the 4% of participants who were found to compulsively hoard would have met the new diagnostic criteria outlined for the condition in this study. As a result, more research is needed in this field to quantify the population who compulsively hoard.
Current MDT practice
Although guidance is provided for working with hoarding symptoms within OCD, there is no specific guidance for working with compulsive hoarding (NICE, 2005). However, the NHS Choices website describes the condition and recommends Cognitive Behavioural Therapy (CBT) as the common treatment for the condition (NHS, 2015). A comprehensive search of the literature, from the fields of psychology and psychiatry, revealed that compulsive hoarding is mainly treated with both CBT and medication (Tolin D.F. et al., 2015). Serotoninergic drugs, such as fluvoxamine, have seen benefits for clients, yet no medication is currently advertising to treat compulsive hoarding (Saxena, 2008; Soares, Fernandes, and Morgado, 2016). CBT can include motivational interviewing, psychoeducation, developing cognitive techniques highlighting dysfunctional beliefs, and the graded discarding and sorting of items (Steketee and Frost, 2014). This combination has shown modest clinically-significant results for clients finishing treatments and therefore papers call for further studies to investigate the issues these clients confront and how to improve their well-being (Tolin D.F. et al., 2015; Vilaverde, Gonçalves, and Morgado, 2017).
Compulsive hoarding and occupational therapy
Compulsive hoarding can decrease occupational engagement in many areas of life, appropriate for occupational therapy input, such as functional independence, roles, and the social and physical environment (Dissanayake, 2012). Recent quantitative research, conducted by Dissanayake, Barnard, and Willis (2017), investigates the role of occupational therapy in the assessment and treatment of compulsive hoarding and calls for further research involving occupational therapy and this population which can begin to inform clinical practice.
Here are the questions we will be discussing:
- How would compulsive hoarding affect a person, how they perform their occupations, and interact with their environment?
- Do you feel equipped to work collaboratively with this population?
- What ethical issues do you predict you would encounter with this population?
- What occupational therapy interventions could be utilised?
- Finally, what could the role of occupational therapy be in this setting (the assessment and treatment of compulsive hoarding)?
American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders. 5th edn. Arlington, VA: American Psychiatric Publishing.
Bratiotis, C., Schmalisch, S., and Steketee, G. (2011) The Hoarding Handbook: A Guide for Human Service Professionals. Oxford: Oxford University Press.
Dissanayake, S. (2012) ‘Clearing the Clutter,’ in OT News, February 20 (2) pp.24-25 published by The Royal College of Occupational Therapists: London, UK
Dissanayake, S., Barnard, E., & Willis, S. (2017): “The emerging role of Occupational Therapists in the assessment and treatment of compulsive hoarding: An exploratory study”. New Zealand Journal of Occupational Therapy, 64 (2) 22-30.
Mataix-Cols D, et al. (2010) ‘Hoarding disorder: a new diagnosis for DSM-V?,’ Depression Anxiety, 27(1), pp. 556–572.
NHS Choices (2015) Hoarding Disorder. Available at: https://www.nhs.uk/conditions/hoarding-disorder/ (Accessed on 2nd December 2017).
NICE (2005) Obessive-compulsive disorder. Available at: https://www.nice.org.uk/guidance/cg31/evidence/cg31-obsessivecompulsive-disorder-full-guideline2 (Accessed on 22nd February).
Pertusa A, et al. ‘Refining the diagnostic boundaries of compulsive hoarding: a critical review,’ Clinical Psychology Review, 30(1), pp. 371–386.
Polkinghorne, D.E. (1989) ‘Phenomenological research methods,’ In R.S Valle and S. Halling (Eds.), Existential phenomenological perspectives in psychology. New York, NY: Plenum Press, pp.41-60.
Royal College of Psychiatrists (2016) Hoarding. Available at: http://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/hoarding.aspx (Accessed on 2nd December 2017).
Samuels J.F. et al. (2008) ‘Prevalence and correlates of hoarding behavior in a community-based sample,’ Behav Res Ther, 46(1), pp. 836–844.
Saxena S. (2008) ‘Neurobiology and treatment of compulsive hoarding,’ CNS Spectrum, 13(14), pp. 29–36.
Soares, C., Fernandes, N., and Morgado, P. (2016) ‘A review of pharmacologic treatment for compulsive buying disorder,’ CNS Drugs 30(4) pp. 281–91.
Steketee, G., and Frost, R. O. (2014) Compulsive hoarding and acquiring: Therapist guide. 2nd edn. New York, NY: Oxford University Press
Tolin, D.F., Frost, R.O., and Steketee, G. (2014) Buried in Treasures. Help for Complusive Acquiring, Saving, and Hoarding. Oxford: Oxford University Press.
Tolin D.F. et al. (2015) ‘Cognitive behavioral therapy for hoarding disorder: a meta-analysis,’ Depression Anxiety, 32(3), pp. 158–66.
Vilaverde, D., Gonçalves, J., and Morgado, P. (2017) ‘Hoarding Disorder: A Case Report,’ Frontiers in Psychiatry. Available at: https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00112/full (Accessed on 10th November 2017).