Compulsive Hoarding Disorder
Dee
"Dee"
Status Update
- Dee is a 63-year-old female
- Dee's problems with hoarding began in childhood
- Her problems worsen sixteen years ago when she moved into her new home and continued to worsen in the last ten years
- Dee’s house consisted of three bedrooms, two baths, and a den. The volume of cluttered possessions took up approximately 80-90% of the living space. The clutter reached as high as four feet in some areas. No rooms in the house could be used for their intended purpose, especially the kitchen, which was completely unusable secondary to the accumulated clutter
- Dee always thought about seeking treatment, but it wasn't until after her daughter urged her to do so that she finally had taken the first step into seeking help
- Dee eventually admitted her self to the UCLA Intensive Treatment Program
- Outcome and Follow-Up by the end of the six-week treatment program:
- The plan for Dee after graduating from the program was to follow up in an outpatient setting to maintain her gains and continue improving
- Weekly outpatient follow-up therapy was set up with a therapist in addition to in-house visits by interns twice a week process with direct supervision by the therapist
- Dee had completely cleared her computer room and kitchen of all clutter
- She had taken “before” and “after” photos to track her progress and for future encouragement
- Her pictures served as a reminder of the advantage of setting and sticking to specific goals
- In addition, Dee would meet with her psychiatrist for medication management once every three months
- Cognitive Behavior strategies had been effective in treating her disorder
Hoarding Experience (Symptoms)
Dee experienced the following symptoms:
- Complete social isolation due to embarrassment about others seeing her home in this state
- Difficulty throwing things away (Dee admits that when she was a child she used to hide things under her bed so her mother would not discard them)
- Mild symptoms of depression. She had“crying spells” and “painful emotions” when thinking about being a failure due to wasted time and inability to control her hoarding disorder
- Fear of throwing away "valuable" items that might be useful in the future or have monetary value
- Two previous episodes of depression
- Functional impairments such as loss of living space, social isolation, family discord
Treatment Options ; Biological, Sociocultural, Cognitive
Different Approaches to treatment
Diagnosis (DSM-IV Criteria)
- Dee met the DSM-IV criteria for OCD and was diagnosed with compulsive hoarding Disorder
- The behavior usually has harmful effects—emotional, physical, social, financial, and even legal—for the person suffering from the disorder and family members
- For individuals who hoard, the quantity of their collected items sets them apart from people with normal collecting behaviors
- They accumulate a large number of possessions that often fill up or clutter active living areas of the home or workplace to the extent that their intended use is no longer possible
- Symptoms of the disorder cause clinically significant distress or impairment in social, occupational or other important areas of functioning including maintaining an environment for self and/or others
- While some people who hoard may not be particularly distressed by their behavior, their behavior can be distressing to other people, such as family members or landlords
- Biological Approach: Dee was started on Escitalopram Oxalate (trade name: Lexapro; Antidepressant Drug) and her dosage was increased from the initial 10 mg to 30 mg per day after the first week
- Other available medications include:
- Seroquel , Haldol , and Prolixin
- Cognitive Approach: The pretreatment phase began with a thorough assessment of the amount and type of clutter, beliefs about erroneous beliefs that terrible consequences would occur if she threw something away, ERP (exposure and response prevention) process with direct supervision
- Sociocultural Approach: Dee had set goals to rebuild the relationships affected by her disorder, she received family therapy with her daughter to rebuild their relationship affected by Dee's disorder
Dangers of Compulsive Hoarding
Videos by "Compulsive Hoarders"
Bibliography
Hoarding Disorder. (n.d.). Retrieved March 24, 2014, from http://www.psychiatry.org/hoarding-disorder
Hoarding Disorder. (n.d.). Retrieved March 24, 2014, from http://www.psychiatry.org/hoarding-disorder
Miller, G. (2010). DSM-Vat a Glance. Science, 327(5967), 770-771. Retrieved March 31, 2014, from http://www.jstor.org/stable/10.2307/40509860?ref=search-gateway:145cadd3c3f20b6652de9f372d22c249
Staging an Intervention | Anxiety and Depression Association of America, ADAA. (n.d.). Retrieved March 31, 2014, from https://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics/staging-intervention