February 5, 2011

Are you suffering from hoarding?

From time to time, the media carry stories about houses full of cats or other animals. That's what is called animal hoarding.

In a 2008 case in British Columbia, a couple had 48 cats living in a house so full of feces that you could not see the floor.  The animals themselves were full of lice and other parasites, and dead cats were strewn around with the living.  SPCA staff who went into the house to deal with the situation came down with nausea, dizziness, headaches, and breathing problems, even though they wore ventilators.

An article in the Washington Post about another cat hoarder provided some insight into the behavior.  The woman admitted that she “just couldn’t keep up” with all her animals, but she rejected the charge that she was cruel to animals.  “They’re dear cats.  I love them.”  As Elaine Birchall, a social worker whose practice focuses on hoarding, explained, “Animal hoarders usually claim to be pet rescuers.” 

According to Birchall, animal hoarders do not provide the needed food, sanitation, and veterinary care and are blind to what their behavior does to living conditions in the house.  They also lack concern about how these conditions affect their own health. 

She says that animal hoarding can in many cases be traced back to unsatisfactory childhood experiences, where the person found closeness only with one or more animals.  In her practice, she has fond the animal hoarders to be among the most challenging.  Even after difficult treatment leading to success, the success rarely holds.  Relapse is the norm. 

Other kinds of hoarding are far more frequent than animal hoarding, though animal hoarders may sometimes hoard other things as well. 

Common hoarding involves collecting such a quantity of stuff that space becomes crammed.  It is difficult to get around.  I recall going to the house owned by an elderly woman who was being hospitalized and then transferred to long-term care.  The house was packed with all manner of furniture, clothing, food, a baby carriage, and stuffed animal toys.  The kitchen table was covered with clothes and stuffed toys.  The house itself was in serious disrepair and the cupboard and kitchen drawers were full of ants and other insects.

As is sometimes the case, the hoarder in this instance was suffering from Alzheimer’s disease.

Birchall says that hoarders do discard things, but they accumulate at a faster rate.

Getting a place cleaned up is not the answer because that simply gives the person more space to pack things into. Instead treatment is needed to address the reasons for the hoarding. This treatment is highly specialized. 

In her own practice, in addition to providing therapy she also gives seminars and presentations to various groups such as police, real estate managers, and mental health professionals.  Her website, hoarding.ca, gets hits from across Canada and around the world. 

An extreme form of hoarding is called the Diogenes syndrome. 

The home is cluttered with objects, including rotting garbage and other filth.  This hoarder also is apt to have untreated medical and dental problems, even if money is not a problem.  He may not have appropriate clothing and nutrition may be inadequate.  He lives as a single and is very much a loner.  While intelligent, the person is stubborn and highly suspicious. 

Hoarders have difficulty discarding things.  Perhaps the item may be useful sometime in the future.  Alternatively, it may have sentimental value or may be seen as being esthetically pleasing.  If a hoarder does decide to part with something, the desire is to give it to someone who can use it or appreciate it.  Till that someone is found, the hoarder wants to hold on to it.

While Birchall says that hoarding is not always due to mental illness, one would hardly describe the hoarder as in top mental health. 

She states that there is some evidence of a genetic factor.  It tends to run in families.  However, aside from or in addition to any genetic involvement, there is also the factor of the impact of a family culture that includes hoarding.

The specialized treatment of the hoarder needs to, as indicated, get at the underlying causes to treat them. 

The therapist needs to be calm and soft-spoken.  The therapy does not begin by focusing on the hoarding.  Of course, this is the ideal beginning.  Where there are immediate threats to health or safety of the hoarder or other people, authorities need to be involved right away. 

The immediate alleviation of the situation is not the solution to the problem because there is the danger of resumption of the behavior without treatment.