Refining the diagnostic boundaries of compulsive hoarding: A critical review

By: Alberto Pertusa , Randy O. Frost, Miguel A. Fullana, Jack Samuels, Gail Steketee, David Tolin, Sanjaya Saxena, James F. Leckman, David Mataix-Cols

Abstract:
Like most human behaviors, saving and collecting possessions can range from totally normal and adaptive to excessive or pathological. Hoarding, or compulsive hoarding, are some of the more commonly used terms to refer to this excessive form of collectionism. Hoarding is highly prevalent and, when severe, it is associated with substantial functional disability and represents a great burden for the sufferers, their families, and society in general. It is generally considered difficult to treat. Hoarding can occur in the context of a variety of neurological and psychiatric conditions. Although it has frequently been considered a symptom (or symptom dimension) of obsessive–compulsive disorder, and is listed as one of the diagnostic criteria for obsessive– compulsive personality disorder, its diagnostic boundaries are still a matter of debate. Recent data suggest that compulsive hoarding can also be a standalone problem. Growing evidence from epidemiological, phenomenological, neurobiological, and treatment studies suggests that compulsive hoarding may be best classified as a discrete disorder with its own diagnostic criteria..." More

Understanding the human aspects of animal hoarding

December 2008

By: Amanda I. Reinisch

An animal hoarder is defined as someone who has accumulated a large number of animals and who: 1) fails to provide minimal standards of nutrition, sanitation, and veterinary care; 2) fails to act on the deteriorating condition of the animals (including disease, starvation or death) and the environment (severe overcrowding, extremely unsanitary conditions); and often, 3) is unaware of the negative effects of the collection on their own health and well-being and on that of other family members (1). Animal hoarding has been gaining more attention from researchers in various areas of study, including sociological, psychological, and veterinary fields. Animal hoarding is considered a special manifestation of compulsive hoarding (2,3,4).

The Hoarding of Animals Research Consortium reviewed the case records of 71 incidents from across the United States and Canada to determine what characterizes a typical animal hoarding case (5). Of the cases reviewed, 83% involved women (71% involved individuals, who were widowed, divorced, or single); 53% of the animal hoarding residences were home to other individuals including children (5%), elderly dependents and disabled people (21%). Often essential utilities and major appliances such as showers, heaters, stoves, toilets, and sinks were not functional. Residential home interiors were usually unsanitary, 93%; 70% had fire hazards; and 16% of residences involved in animal hoarding were subsequently condemned as unfit for human habitation. In 25% of the cases, the hoarder was placed under permanent or temporary protective care (3).

Elderly individuals are at an increased risk for zoonotic diseases due to underlying medical conditions that weaken their immune systems (1,3). There is also a health risk from to ammonia, which at high concentrations causes ocular and respiratory irritation (1,3). The ammonia threshold limit values (TLVs) for a healthy individual should not exceed 25 ppm over an 8-hour period (4). The TLV is lower if the exposure has exceeded 8 h or if the individual is elderly or has respiratory problems (3). For short-term exposure (15 min), the recommended TLV is 35 ppm (3), while 20 ppm will cause an individual to feel uncomfortable, and 100 ppm will cause irritation of the upper respiratory tract, eyes, and nose (4). There is little information on ammonia levels in animal hoarding cases; however, 1 case reported levels of 152 ppm (5).

General public health considerations for responding to animal hoarding cases.

Title Annotation:	ADVANCEMENT OF THE PRACTICE
Author:	Castrodale, Louisa; Bellay, Yvonne M.; Brown, Catherine M.; Cantor, Fredric L.; Gibbins, John D.;
Date:	Feb 27, 2010
Words:	3681
Publication:	Journal of Environmental Health
ISSN:	0022-0892

Introduction

Animal hoarding is an under-recognized problem that exists in most communities and adversely impacts the health, welfare, and safety of humans, animals, and the environment. Animal hoarding is defined by four characteristics (Patronek, Loar, & Nathanson, 2006):

* failure or inability to provide animals minimal standards of sanitation, space, nutrition, and veterinary care;

* inability to recognize the effects of this failure on the welfare of the animals, human members of the household, and the environment;

* obsessive attempts to accumulate or maintain a collection of animals in the face of deteriorating conditions; and

* denial or minimization of the problems and living conditions for people and animals. Most hoarding cases involve private individuals who claim ownership of numerous animals in a single rented or owned facility. In some cases, established shelters, rescue no-kill groups, or puppy mills may create a physical setting that mimics a hoarding situation.

The management of recognized animal hoarding situations should be well planned, interdisciplinary, and handled by trained personnel. People may encounter risks while on a premises evaluating or responding to issues caused by animal hoarding itself or the animal hoarding may be an incidental finding during a visit for another purpose. Anyone aware of serious animal hoarding situations should report them to local animal control or public safety authorities for appropriate coordination, investigation, and follow-up. Remediation is extremely difficult and rarely successful in the long term. The multifaceted nature of these situations, refractory behaviors of individuals involved, unclear criteria about animal cruelty, and privacy and personal property rights can be major obstacles to permanent solutions. A complete discussion of remediation is beyond the scope of this article...."

Preparing for a Response
Health and Safety Considerations
Disease Exposure
Air Quality
Injuries
Personal Protective Equipment (PPE)

Read the entire report/thesis here

Animal Hoarding: Slipping Into the Darkness of Comorbid Animal and Self-Neglect

Author: Jane N. Nathanson ^a

Journal of Elder Abuse & Neglect, Volume 21, Issue 4 October 2009 , pages 307 - 324

Abstract Substantial research and literature indicate how people and companion animals form relationships that are, for the most part, mutually beneficial. Yet there are highly dysfunctional human-animal relationships that do occur, meriting attention and remediation. One of the most perplexing and problematic human-animal relationships is encountered in cases of animal hoarding—a deviant behavior associated with extremely deleterious conditions of comorbid animal and self-neglect. Adult Protective Services workers often encounter theoretical and methodological dilemmas with these complex cases. To intervene most effectively, it becomes critical to elucidate some of the developmental factors of animal hoarding behavior and its correlation with self-neglecting behaviors in general. This article presents an in-depth diagnostic perspective as derived from the author's research and clinical experience. An analysis of the complex dynamics of the relationship between animal hoarders and their pets is presented in conjunction with accepted theories of self-neglect. With enhanced knowledge and understanding of animal hoarding, human service professionals will be better prepared to respond to these clients, evoke greater rapport and cooperation, and engage in the interdisciplinary efforts that are essential for optimal resolution..." More a Private Practice, Boston, Massachusetts, USA

Delivery of internet treatment for compulsive hoarding (D.I.T.C.H.)

By: Jordana Muroff^a, , Gail Steketee^a, Joe Himle^b and Randy Frost^c

Available online 17 September 2009.

Abstract

This study tested the effectiveness of an existing private online CBT-based group intervention designed to help people with hoarding. Web-group participants were hypothesized to show more improvement in hoarding symptoms over time compared to those placed on a naturalistic waitlist. This web-based self-help group (N = 106 members, N = 155 waitlisted) includes a formal application process and requires that participants post action steps and progress at least once monthly. Members have access to educational resources on hoarding, cognitive strategies, and a chat-group. Potential research participants were invited to complete an anonymous web-based survey about their hoarding behaviors and clinical improvement on five occasions (3 months apart). The sample was mainly middle-aged, female and White. Regression analyses show that Recent members reported greater improvement and less clutter at 6 months (than Waitlist). Long-term members reported milder hoarding symptoms than Recent ones, suggesting benefits from group participation over time. All members showed reductions in clutter and hoarding symptoms over 15 months. Less posting activity was associated with greater hoarding severity. Online CBT-based self-help for hoarding appears to be a promising intervention strategy that may extend access to treatment. Evaluating the benefits of internet self-help groups is critical given growing popularity of and demand for web-based interventions..." More

^a Boston University, Boston, MA 02215, USA

^b University of Michigan, Ann Arbor, MI 48109, USA

^c Smith College, Northampton, MA 01063, USA

The Hoarding Syndrome: Screening and Treatment

Home Healthcare Nurse

July/August 2009
Volume 27 Number 7
Pages 432 - 440

By: Sharon M. Valente APRN, CS, PhD, FAAN

Abstract

Hoarding syndrome is a serious public health hazard. It may pose risk of fire, falls, infestation, and bacterial growth. Hoarding can reduce activities of daily living, adherence to treatment, and quality of life. The hoarder collects excessive quantities of poorly useable items of little value, fails to discard items, and has difficulty organizing tasks. Hoarding places the individual at risk for social, psychological, and physical outcomes, which lead to a decline in quality of life. This article examines the etiology, characteristics, signs and symptoms, evaluation, and treatment of hoarding syndrome. A case example illustrates the management of hoarding syndrome in home care..." More