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Selected Annotated Bibliography:


Compulsive Hoarding - A Form of Self-Neglect
(1995-2005)


Compulsive hoarding is characterized by the acquisition of, and unwillingness or inability to discard, large quantities of seemingly useless objects that create a significantly cluttered living space, and cause considerable distress or impairment in functioning (Frost and Hartl, 1996). Research indicates that the behavior is accompanied by other features of self-neglect. For example, food preparation becomes difficult when appliances and utilities are rendered inaccessible or inoperable. Extreme clutter and debris may limit the ability to maintain proper hygiene and to safely or accurately dispense medications. Safety risks develop as a result of fire hazards, unsanitary conditions, and cluttered hallways and walking areas. When animals are also hoarded, living conditions appear to be even worse (Frost et al., 2000). The resulting conditions affect not only the hoarders and their families but neighbors as well, and often become public health concerns. Case studies indicate that in many instances, the dwellings of compulsive hoarders sustain costly or irreparable damage; often, homes are condemned and destroyed after hoarders have been removed.

Although there is limited data on the magnitude of the problem, research indicates that compulsive hoarding is a problem for some older individuals. These cases are extremely difficult to intervene in and successful outcomes are rare. Treatment is lengthy and intensive, clean up efforts are exhaustive and expensive, and recidivism is high. Balancing self-determination with the need to protect the individual's and public's welfare is extremely difficult.

The following references have been selected to highlight the difficulties of addressing compulsive hoarding. Although many of the articles are not specific to elders, studies have often included older individuals, and the materials are relevant for those working with older individuals.

Most of these reference materials can be obtained through local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the web addresses are also included.* If you have difficulty obtaining any of these materials, please contact the CANE office for assistance by emailing [email protected] or telephoning (302) 831-3525.

Note: This is a selected annotated bibliography, which does not include all published references related to this topic. The included references have been selected to provide readers with a current and comprehensive collection of books and articles representing a variety of perspectives on the subject. To search for additional reference materials, please visit the CANE Web site at: http://db.rdms.udel.edu:8080/CANE .

To search the CANE Bibliography Series, go to www.elderabusecenter.org/default.cfm?p=cane.cfm .

(*Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance.)




The National Center on Elder Abuse (NCEA) serves as a national resource for elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.

The NCEA is administered under the auspices of the National Association of State Units on Aging.

NCEA Partners
  • National Association of State Units on Aging (NASUA), Lead Partner
  • American Bar Association (ABA) Commission on Law and Aging
  • Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware
  • National Adult Protective Services Association (NAPSA)
  • National Committee for the Prevention of Elder Abuse (NCPEA)


This publication was made possible through the support provided by the National Center on Elder Abuse. Major funding for the National Center on Elder Abuse comes from the U.S. Administration on Aging, Department of Health and Human Services.                    Grant No. 90-AM-2792.

Opinions or points of view expressed do not necessarily reflect the official position or policies of the U.S. Administration on Aging.





2005

1. P5990-7
Hartl, T. et al.
Relationships Among Compulsive Hoarding, Trauma, and Attention-Deficit/Hyperactivity Disorder
Behaviour Research and Therapy; Vol. 43 (2), 269-276; 2005.
Journal article (research)
In this study, researchers examine aspects of post-traumatic stress disorder (PTSD) and attention deficit/hyperactivity disorder (ADHD) in compulsive hoarding behaviors through comparison of hoarders and nonhoarders. The hoarder sample was comprised of 26 participants from self-help organizations. Both the hoarder and control group (n=36) were predominantly female; the mean age of the hoarders was 54 and the mean age of the nonhoarders was 50. Participants completed the Saving Inventory-Revised (SV-R), the Possession Comfort Scale (PCS), the Traumatic Events Scale-Lifetime (TES-L), the Attention Deficit/Hyperactivity Disorder Symptoms Scale (ADHDSS), and the Cognitive Failures Questionnaire (CFQ). Hoarders reported a significantly higher number of traumas and more frequent traumatic events, more symptoms of inattention and hyperactivity, and greater comfort derived from possessions. Despite the limitations of a small sample, this suggests the need for further research and for the assessment of PTSD and ADHD symptoms as part of treatment planning for compulsive hoarders.




2004

2. P5984-31
Franks, M., Lund, D., Poulton, D. & Caserta, M.
Understanding Hoarding Behavior Among Older Adults: A Case Study Approach
Journal of Gerontological Social Work; Vol. 42 (3/4), 77-107; 2004.
Journal article (case study)
This article presents four case studies of older compulsive hoarders (one couple, two women, and one man) who became involved with adult protective services due to various crises. The articles describes the conditions of the dwellings (with photos), the mental health history of the elder(s), the applied interventions and outcomes. Both women were relocated to subsidized housing, the man was placed under guardianship and died while hospitalized, and the couple was placed in a nursing home. Two of the houses had to be destroyed, and one was in such a state of disrepair that it was significantly devalued when sold. The authors recommend enhanced education and coordination of services between social and public health agencies in order to identify cases before they become crises, and provide several warning signs for earlier recognition.

3. P5980-20
Frost, R., Steketee G. & Grisham, J.
Measurement of Compulsive Hoarding: Saving Inventory-Revised
Behaviour Research and Therapy; Vol. 42 (10), 1163-1182; 2004.
Journal article (research)
Although a number of studies appear to validate the internal reliability of the Hoarding Scale (Frost & Gross), it has a number of limitations. This article describes a potentially more effective instrument to assess hoarding behaviors. The instrument focuses on the content of the major symptoms of compulsive hoarding, reflects symptoms versus beliefs, is not limited to assessing hoarding of specific types of objects, and reflects the degree of distress and/or impairment that results in severe cases. The Savings Inventory-Revised (SI-R) was tested through factor analysis and a series of studies with hoarding participants, obsessive-compulsive (OCD) participants, community controls and elders. The 23-item SI-R (included) was found to be a valid and reliable assessment tool for compulsive hoarding. In addition, findings suggest that hoarding associated with OCD may have different causes and manifestations than hoarding not associated with OCD.

4. P5987-11
Hartl, T. et al.
Actual and Perceived Memory Deficits in Individuals with Compulsive Hoarding
Depression and Anxiety; Vol. 20, p59-p69; 2004.
Journal article (research)
In order to examine the hypothesis that memory deficits may underlie compulsive hoarding, researchers designed this comparative study to examine memory performance, memory confidence, and memory beliefs in hoarders and non-hoarders. Twenty-two individuals with severe hoarding symptoms and 24 non-hoarding control subjects were administered two measures of learning and memory: the Rey Osterrieth Complex Figure Test (RCFT) and the California Verbal Learning Test (CVLT). In addition, participants were questioned regarding the importance of remembering and the need to keep possessions in sight. Compulsive hoarders demonstrated poorer recall on both measures, and less effective organizational strategies on the RCFT. Hoarders appeared significantly less confident of their memories and experienced more catastrophic assessments of the consequences of forgetting where possessions were.

5. P5991-4
Merck, J.
What Self-Neglecting Clients Have to Teach Us
Victimization of the Elderly and Disabled; Vol. 7 (3), p35, 36, 44, 45; September/October 2004.
Newsletter article (scholarship)
In this commentary, an adult protective services professional describes the lessons learned while dealing with an older, self-neglecting couple who were also compulsive hoarders. Through case study analysis, she examines the following themes: the need to balance protection with self-determination; the importance of multidimensional assessment which considers the interaction between environment, mental and physical health, and risk; the inadequacy of the current mental health system to deal with self-neglecting clients who are experiencing chronic problems as opposed to crisis; and the difficulty of defining successful outcomes in light of recidivism associated with compulsive hoarding. Lastly, she notes that any improvement in the quality of life of this couple was due to collaborative, interdisciplinary interventions.

6. V54
The Humane Society of the United States
Animal Hoarding: A Community Task Force Solution
Humane Society of the United States, Washington, D.C.; 2004.
Video
This seven minute video presents an overview on animal hoarding as a societal and public health problem. It counters the myths that many people hold that animal hoarders as simply benign and eccentric, and describes the need for interdisciplinary and interagency collaboration in addressing the problem. (Note: This video is not available through CANE. To order, contact The Humane Society of the United States (HSUS), 2100 L Street, NW, Washington, DC 20037, 202/452-1100, Companion Animal section or visit the web site at: www.hsus.org . Price: $6.00.)

7. P5979-15
Maier, T.
On Phenomenology and Classification of Hoarding: A Review
Acta Psychiatrica Scandinavica; Vol. 110 (5), 323-337; 2004.
Journal article (literature review)
This article presents a survey of the literature describing the clinical spectrum of the phenomenon of hoarding. The identified articles are categorized as either empirical studies focusing specifically on hoarding behaviors in humans; empirical studies focusing on other conditions that appear relevant to hoarding (such as Obsessive-Compulsive Disorder or OCD); case studies, reviews and theoretical publications (which comprise more than half of the existing literature). The author notes that there is no consensus in the literature in terms of the assessment of hoarding; relatively few researchers use instruments designed to specifically measure hoarding. The author concludes that hoarding is a complex phenomenon, and recommends that clinicians assess each of the following components of the behavior along with the individual's accompanying thoughts and emotions: the act of collection or acquisition; the behavior of storing and keeping unnecessary objects; and the severe neglect that may result. In particular, the assessment should be made while considering the concepts of compulsion, impulse control issues, and stereotypic, ritualistic behaviors and tics.

8. P5983-12
Saxena, S. & Maidment, K.
Treatment of Compulsive Hoarding
Journal of Clinical Psychology; Vol. 60 (11), 1143-1154; 2004.
Journal article (scholarship)
This article provides an overview for the clinical treatment of compulsive hoarding. A comprehensive assessment of the patient's history and presenting problem is essential, and should include information regarding the amount of clutter, the patient's beliefs about possessions, information processing deficits, avoidance behaviors, daily, social and occupational functioning, medication compliance, and level of insight. The authors describe a partial hospitalization program for obsessive-compulsive disorders that employs intensive multimodal treatment to address hoarding behaviors. Treatment consists of cognitive-behavioral therapy (CBT), including exposure and response prevention (ERP) daily for approximately six weeks; in addition, when indicated, patients are prescribed medications (antidepressants, antipsychotics, etc.). CBT focuses on discarding, organizing, preventing incoming clutter, and introducing alternative behaviors. Before and after photos are used to emphasize the positive gains made throughout the treatment, and upon discharge from the partial hospital program patients are encouraged to continue with weekly CBT on an out-patient basis. A case study is presented that illustrates a successful outcome; at four months post-discharge the patient continued to make progress with weekly out-patient support.




2003

9. P5978-18
Marx, M. & Cohen-Mansfield, J.
Hoarding Behavior in the Elderly: A Comparison Between Community-Dwelling Persons and Nursing Home Residents
International Psychogeriatrics; Vol. 15 (3), 289-306; 2003.
Journal article (research)
This article examines a specific type of hoarding behavior among two elderly populations from different living arrangements. In this study, researchers analyze the correlates of the hoarding and hiding of objects among community-dwelling elders and nursing home residents. Hoarding was defined as "...putting many or inappropriate things in one's purse, pockets or drawer and/or keeping too many of an item. Hiding was defined as putting objects under or behind something..." Demographic, behavioral, and medical information was gathered on 408 nursing home residents, aged 70 to 99, and 177 community-dwelling elders, ranging in age from 61 to 97. Overall, 15 percent of the nursing home residents and 25 percent of the community-dwellers manifested the hoarding/hiding behaviors described above. Among the nursing home residents, hoarding behavior was significantly associated with having a greater appetite, taking fewer medications, higher social functioning, comparatively less ADL impairment, and manifesting nonaggressive agitated behaviors. Among the community-dwellers, hoarding/hiding appeared to correlate with being female, having a greater appetite, being more ambulatory and active, having fewer medical diagnoses, having a dementia diagnosis, experiencing hallucinations, experiencing delusions of infidelity, and manifesting aggressive and nonaggressive agitated behaviors. Although differences were noted when comparing these populations, commonalities suggest that elders with fewer health and functional limitations, and those who manifest agitated behaviors, are more likely to manifest hoarding/hiding behaviors.

10. M105-156
The Humane Society of the United States, and the Wisconsin Department of Health and Family Services
Creating Safer Communities for Older Adults and Companion Animals
The Department of Health and Family Services; Madison, WI and the Humane Society of the United States; Washington, D.C.; September 2003.
Manual
As quoted from the Foreword, this manual is intended to assist "...professionals in the adult protective services, elder abuse and animal protection fields to expand their working knowledge of the role of companion animals in patterns of abuse, exploitation and self-neglect..." While the manual highlights Wisconsin statutes and systems, much of the material can be adapted for use in other regions to foster multidisciplinary approaches in addressing such topics as animal hoarding and self-neglect, and animal cruelty as an indicator of family violence. The section devoted to animal hoarding addresses factors that contribute to the behavior, effective interventions, issues surrounding prosecution, rescue operations, case resolution, multidisciplinary collaboration, and recommendations for friends and family members. (Note: This manual is not available through CANE. To obtain an order form, contact Susan Veleke at
DHFS/DDES/Bureau of Aging & Long Term Care Resources, P.O. Box 7851,
Madison WI 53707-7851, email: [email protected] or phone: (608) 267-7285
Price: $5.00.)

11. P5434-23
Steketee, G. & Frost, R.
Compulsive Hoarding: Current Status of the Research
Clinical Psychology Review; Vol. 23 (7), 905-927; 2003.
Literature review
This article provides a review of the research on the topic of hoarding. In this overview, hoarding is defined as pathological when its impact creates distress and dysfunction for the hoarder and/or others. The difficulty in classifying this phenomenon as either a symptom of other psychological and psychiatric conditions (such as obsessive-compulsive disorder) versus a separate clinical syndrome is considered. Hoarding behavior has been associated with schizophrenia, organic mental disorders, eating disorders, brain injury, dementia, social phobia and depression. The developmental course of hoarding, which research indicates may begin in pre-adolescence, is reviewed. The cognitive behavioral model of compulsive hoarding is described and includes a discussion of deficits in information processing and issues of emotional attachment. Assessment tools, such as the Yale-Brown Compulsive Scale (Y-BOCS), the Hoarding Scale, the Saving Inventory-Revised (SI-R) and the Saving Cognitions Inventory (SCI) are also discussed. Several case studies of intensive cognitive behavioral treatments are presented and illustrate successful interventions.




2002

12. P5985-12
Hoarding of Animals Research Consortium (HARC)
Health Implications of Animal Hoarding
Health and Social Work; Vol. 27 (2), 125-136; May 2002.
Journal article (research)
In this article, researchers report upon the findings from an analysis of case reports of animal hoarding. Seventy-one case reports were gathered from animal control officers, humane law enforcement and police officers, public health veterinarians, social services professionals, and health departments. Respondents completed a standardized report form (included) that documented the origin and history of the complaint, living conditions, which other agencies were involved, the degree of clutter and functional impairment due to hoarding, the number, type and condition of the animals, and reasons for acquiring and hoarding animals. Hoarders were typically female, single, widowed or divorced, with an average age in the mid-fifties. At least 15.1 percent were aged 65 or older. Total number of animals hoarded in each case ranged from 10 to 918. In all households, additional objects were hoarded. The ability to complete basic functional activities was significantly impaired due to hoarding in half to three-quarters of the cases. Love of animals and perceiving animals as surrogate family members were the most commonly cited reasons for hoarding, and accidental breeding was the most common means of acquisition, although active solicitation was identified in nearly half of the cases. Self-neglect and neglect of others was evident in a majority of the cases. Health issues encountered included falls and injuries, poor nutrition and hygiene, potential for infection and zoonotic diseases, fire and safety hazards, and increased air ammonia levels.

13. P5074-9
Nathanson, J., and the Hoarding of Animals Research Consortium (HARC)
Animal Hoarding: Recommendations for Intervention by Family and Friends
Hoarding of Animals Research Consortium; June 6, 2002.
Online
This article describes recommendations for friends and family members wanting to help animal hoarders. Underlying all suggested interventions is the belief that change will come slowly, if at all, and will be based upon the development of a trusting, non-judgmental relationship. The importance of recognizing the depth of the human-animal bond is pivotal. Listening skills, recruiting the help of others (both personal and professional contacts), offering specific assistance and limit-setting are among the guidelines discussed. (Note: This article is available online only at http://www.tufts.edu/vet/cfa/hoarding/pubs/famfriend.pdf .)

14. P5072-6
Staff, Adult Abuse Review
Criminal or Savior? Animal Hoarding 101
Adult Abuse Review; Vol. 1 (3); December 2002.
Online
This overview describes the phenomenon of animal hoarding along with the skewed manner in which it is often presented by the media. It also summarizes the little available research that indicates most hoarders are older and female. In 80 percent of these cases, animals are found dead. The irony is that animal hoarders often believe they are saving animals from euthanasia or death in the wild. The author concludes by describing the growing awareness of the link between animal cruelty and family violence. (Note: This article is available online only at http://www.wordbridges.net/elderabuse/AAR/Vol1Issue3/hoarding101.html .)




2001

15. D2414-5
Patronek, G.
The Problem of Animal Hoarding
Municipal Lawyer, p6-p9, p19; May/June 2001.
Journal article (scholarship)
The author, a veterinarian and founder of the Hoarding of Animal Research Consortium (HARC) of Massachusetts, offers an overview of animal hoarding. He emphasizes the need for interdisciplinary team approaches as hoarders often "fall through the cracks" between humane, aging, mental health and criminal justice professionals. He also stresses the importance of recognizing abused and neglected animals as possible markers for other forms of domestic violence and neglect, including elder abuse. Management recommendations are provided. (Note: This article is available at http://www.tufts.edu/vet/cfa/hoarding/pubs/municipalawyer.pdf .)

16. N4640-9
Steketee, G., Frost, R. & Kim, H.
Hoarding by Elderly People
Health and Social Work; Vol. 26 (3), 176-184; August 2001.
Journal article (research)
This study was designed to observe how compulsive hoarding is manifested among the elderly, and to explore its impact upon functioning, as well as any relationship it may have with cognitive deficits and physical and psychological conditions. Thirty-six providers of home services to the elderly and eight public health officials were interviewed regarding forty-two cases of reported compulsive hoarding. Researchers hypothesized that information-processing and memory deficits would be present in compulsive hoarders. Findings did not support this; however, 44 percent of the hoarders appeared to have a mental illness, and nearly two-thirds demonstrated difficulty with self-care. For more than 80 percent of the hoarders, the clutter posed a physical threat to their safety.




2000

17. N4903-6
Boat, B. & Knight, J.
Experiences and Needs of Adult Protective Services Case Managers When Assisting Clients Who Have Companion Animals
Journal of Elder Abuse & Neglect; Vol. 12 (3/4), 145-155; 2000.
Journal article (research)
In this research, six adult protective service professionals were interviewed about their experiences with clients and their pets. Self-neglect, loss, hoarding of animals, and links between animal abuse and human violence, as well as encounters with aggressive animals, are among the topics discussed. Recommendations are presented that include asking, upon intake, about the presence of animals in the home.

18. P5073-10
Frost, R., for The Hoarding of Animals Research Consortium (HARC)
People Who Hoard Animals
Psychiatric Times; Vol. XVII (4); April 2000.
Online
This clinical discussion reviews the psychiatric and psychological theories regarding animal hoarding. Research, from the Hoarding of Animal Research Consortium (HARC), appears to support earlier findings that hoarders tend to be female, older and typically hoard objects as well as animals. Delusional disorders, dementia, addiction, zoophilia, attachment disorder and obsessive-compulsive disorder are among the psychiatric disorders discussed. Multi-faceted treatment approaches are warranted and should be tailored to the specific needs of the individual. (Note: This article is available online only at http://www.psychiatrictimes.com/p000425.html .)

19. P5988-6
Frost, R. Steketee, G. & Williams, L.
Hoarding: A Community Health Problem
Health and Social Care in the Community; Vol. 8 (4), 229-234; 2000.
Journal article (research)
This study examines hoarding cases reported to the Boards of Health throughout Massachusetts from 1992 to 1997. It also provides a comparison of the severity of cases of hoarding possessions only versus cases of hoarding animals as well. Of the 315 boards solicited for the survey, 88 health officials (representing a served population of 1.79 million residents) responded. A total of 471 cases were reported during this time period, with 64 percent of the health officers reporting at least one case, and more than half reporting repeat cases. The overall rate of hoarding among this population was 26.3 per 100,000 residents. Fifty-eight case reports were compiled for analyses. Complaints were most commonly lodged by neighbors, or fire or police departments, and most complaints were precipitated by unsanitary conditions. Fire hazards, odors, and odd behaviors were often alleged. Newspapers were the most commonly hoarded objects, followed by other paper trash, bottles and containers, food and food garbage. Nearly half of the hoarders collected other people's trash and almost one-third hoarded animals. Over one-third of the cases were rated as "heavily cluttered with filthy environment, overwhelming" and the houses of those who hoarded animals were significantly less sanitary than those who hoarded only possessions. The hoarding inhibited food preparation and basic hygiene. Hoarders tended to lack insight regarding these limitations. Overall, the officers rated hoarding cases as a moderate to severe public health problem. While nearly one-third of the hoarders were cooperative with efforts to address the problem, improvements were not always maintained, and animal hoarders were significantly less cooperative. In nearly half of the cases involving uncooperative hoarders, the buildings were condemned or the tenants were evicted; nearly one-third were moved to assisted care facilities.

20. L4399-4
Hurley, M., Scallan, E., Johnson, H. & De La Harpe, D.
Adult Service Refusers in the Greater Dublin Area
Irish Medical Journal; Vol. 93 (7), 207-211; 2000.
Journal article (research)
This observational study of service providers profiles 233 service refusers in the greater Dublin area. These individuals were community dwellers who were either reclusive, disruptive, or their living conditions were a "source of environmental concern to others," and who had refused a range of social support services. Fifty-four percent were female, over half lived in private residences, and forty-seven percent met the criteria for Diogenes Syndrome. Poor hygiene, suspiciousness and hoarding were among the traits commonly exhibited. Researchers recommend service coordination and creative, individualized approaches to offering interventions.

21. P5992-10
Steketee, G. et al.
Group and Individual Treatment of Compulsive Hoarding: A Pilot Study
Behavioural and Cognitive Psychotherapy; Vol. 28, p259-p268; 2000.
Journal article (scholarship)
In this pilot study, seven clients who experienced compulsive hoarding participated in group and/or individual cognitive-behavioral therapy. The sample included five men and two women, aged 36 to 61. Four were married or living with a partner. One participant received individual therapy only; the others attended 15 group sessions and also received weekly, individual home treatment sessions for a 20 week period. Although problems with clutter persisted, five of the participants showed noticeable improvement at the end of the intervention, particularly in the area of acquisition of possessions. Four participants continued with treatment for one year, and three showed further improvement, though none felt completely recovered. It appears that group support was a significant factor in motivation for change, as the client receiving individual treatment did not experience improvement. In addition, the fact that those clients continuing treatment lived with partners suggests that pressure from others is also a motivating factor.




1999

22. P5989-11
Hartl, T. & Frost, R.
Cognitive-Behavioral Treatment of Compulsive Hoarding: A Multiple Baseline Experimental Case Study
Behaviour Research and Therapy; Vol. 37 (5), 451-461; 1999.
Journal article (case study)
This article presents a clinical case study of a 53 year old female suffering from numerous symptoms of obsessive-compulsive disorder (OCD) and compulsive hoarding. The intervention consisted of a cognitive-behavioral approach that included decision-making training, exposure and response prevention, and cognitive restructuring. To measure the effectiveness of the intervention, therapists monitored the ratios of cluttered space to overall space in the targeted rooms, and compared them to the room used as a baseline control. The client was able to reduce clutter substantially in all targeted rooms and gains were maintained post-treatment. In addition, self-report measures indicate that other OCD symptoms also decreased.

23. P5982-9
Frost, R., Steketee, G., Youngren, V. & Mallya, G.
The Threat of the Housing Inspector: A Case of Hoarding
Harvard Review of Psychiatry; Vol. 6 (5), 270-278; 1999.
Journal article (scholarship)
This case study of a 40 year old woman diagnosed with bi-polar disorder, general anxiety disorder, and obsessive-compulsive personality disorder provides an opportunity for an in depth analysis of clinical treatment interventions for compulsive hoarding. Following the case report, which includes a psycho-social and mental health history, a summary of pharmacological interventions, and a synopsis of current therapy, three clinical consultants discuss various treatment options. Responses represent cognitive-behavioral, analytical and pharmacological perspectives.

24. A126-7
Patronek, G.
Hoarding of Animals: An Under-Recognized Public Health Problem in a Difficult-to-Study Population
Public Health Reports; Vol. 114, p81-p87; January/February 1999.
Journal article (research)
In this article, the author, the Director of the Center for Animals and Public Policy at Tufts University, draws upon data from a convenience sample of 54 animal hoarding cases to examine the characteristics of this phenomenon. Seventy-six percent of the hoarders were female, and nearly half were over age 60. One implication is that such behavior may be an indicator of mental health issues or dementia.

25. R6099-13
Stein, D., Seedat, S. & Potocnik, F.
Hoarding: A Review
Israel Journal of Psychiatry and Related Sciences; Vol. 36 (1), 35-46; 1999.
Journal article (literature review)
This article presents a review of the medical literature on the topic of hoarding, which has been characterized as symptom of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder. However, a computerized search of the Medline database revealed that while hoarding meets the diagnostic criteria for compulsion, it is also seen in a range of other psychiatric disorders, such as schizophrenia, dementia, and eating disorders, and has been associated with extreme self-neglecting behaviors in individuals with no apparent psychiatric disorders. Further research on various aspects of the condition, including treatment interventions, is warranted.




1998

26. R6097-8
Hwang, J. et al.
Hoarding Behavior in Dementia - A Preliminary Report
The American Journal of Geriatric Psychiatry; Vol. 6 (4), 285-289; 1998.
Journal article (research)
This study was designed to investigate the prevalence of hoarding behavior among the inpatients of a geropsychiatric ward that were diagnosed with dementia. Of the 133 patients admitted with a dementia diagnosis from August 1989 through February 1996, 30 (22.6 percent) demonstrated hoarding behaviors. The behavior was identified among patients with various types of dementia (Alzheimer's dementia, multi-infarct dementia, and dementia not otherwise specified). Among the objects commonly hoarded were (in order of highest frequency) items of daily necessity, food, garbage, and newspapers or magazines. There were no significant differences associated with gender, age, educational level or degree of cognitive impairment among hoarders and nonhoarders. Hoarders were more likely to demonstrate repetitive behaviors, hyperphagia (abnormally increased appetite), and pilfering.




1997

27. P5018-7
Thomas, N.
Hoarding: Eccentricity or Pathology: When to Intervene?
Journal of Gerontological Social Work; Vol. 29 (1), 45-56; 1997.
Journal article (scholarship)
This article provides an overview of hoarding behaviors as it relates to the elderly. The author, a seasoned geriatric social worker, provides case scenarios illustrating varying degrees of hoarding behaviors in which competency and dangerousness require assessment. Interventions are then tailored to the degree of dysfunction and receptivity of the client. Relationships between such behaviors and mental illnesses and dementias are discussed. Establishing an alliance with the client is considered essential in beginning the process of change, which is likely to be slow.




1996

28. P5981-10
Frost, R. & Hartl, T.
A Cognitive-Behavioral Model of Compulsive Hoarding
Behaviour Research Therapy; Vol. 34 (4), 341-350; 1996.
Journal article (scholarship)
A cognitive-behavioral model of compulsive hoarding is presented in this overview. Hoarding is conceptualized as a multi-faceted phenomenon, resulting from a number of factors. Hoarders may demonstrate information processing deficits through faulty decision making, deficits in categorization and organization, and memory impairment. Problems with emotional attachments may contribute to the behavior when hoarders view objects as extensions of themselves, or as safety signals. Behavioral avoidance is demonstrated through indecisiveness, perfectionism, and emotional attachments to possessions. Erroneous beliefs contribute to the problem as hoarders tend to acquire and save seemingly useless items "just in case" or keep possessions in order to prevent the objects from being harmed.




1995

29. N4927-6
Dunn, R.
Extreme Hoarders
CARING Magazine; p36-p42; July 1995.
Journal article (scholarship)
This article presents an overview of the topic of extreme hoarding and the difficulties faced by human service professionals as they attempt to assist individuals who display this behavior. The extreme hoarder is typically female, mentally competent, lacking in appropriate personal care, and socially isolated. While the behavior patterns start earlier in life, it is usually the elderly hoarder that is recognized, due to a crisis. Psychological theories range from obsessive-compulsive disorder to other mental health disorders such as depression. Balancing the client's right to self-determination with consideration for his or her welfare, and that of the community, creates difficulty in interventions. Every effort should be made to engage the client voluntarily in the process of change.




The topic of hoarding is also addressed in the following online resources:

The Hoarding of Animals Research Consortium (HARC)
http://www.tufts.edu/vet/cfa/hoarding/index.html


The Hoarding Web Site of the Obsessive-Compulsive Foundation
http://ocfoundation.org/1005/index.html

The Humane Society of the United States
http://www.hsus.org/

Understanding Hoarding
http://understanding_ocd.tripod.com/index_hoarding.html

WordBridges
http://www.wordbridges.net/



To search for additional reference materials on elder abuse, neglect and related topics, please visit the CANE Web site at: http://db.rdms.udel.edu:8080/CANE or review the CANE Bibliography Series at: www.elderabusecenter.org/default.cfm?p=cane.cfm.

Contact the CANE office at [email protected] or (302) 831-3525 for assistance in obtaining reference materials.

Last Updated: January 4, 2006  Top

     
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