Keep Talking: Compulsive Hoarding Disorder

[Music] hello and welcome back to keep talking a community dialogue about mental health my name is gay Maxwell and I'm the manager of the office of continuing education at the Brattleboro retreat the Brattleboro retreat is a one hundred and eighty three-year-old addictions and mental health hospital located in southeastern Vermont it serves adults adolescents and children and a variety of inpatient outpatient and partial hospitalization settings the Brattleboro retreat provides care and courage when being human Hertz today in the BC TV studio I have dr. Randy frost who is kind enough to have driven up from Northampton Massachusetts today to spend time with us and to talk about compulsive hoarding disorder dr. frost is a international expert on the subject of compulsive hoarding disorder and his resume is about as tall well maybe twice as tall as he is and that's really tall so I'm going to boil it down to a few points dr. frost is a professor at Smith College and Northampton mousies a professor of psychology he is also the a prolific author about the subject of compulsive hoarding disorder he has including these two books buried in treasures helped for the compulsive acquiring saving and hoarding and he also has written stuff compulsive hoarding and the meaning of things what I've been told is that this book is particularly informative for people who might not know a whole lot about psychology but really kind of want to know a little bit more about this subject so stuff the compulsive hoarding and the meaning of things um dr. frost thank you so much for joining us today thank you for having me oh great it is there anything I left out that I should about okay all right well let's start off with a question that I'm sure a lot of people have who don't who have heard about compulsive hoarding disorder and maybe have watched some of the more extreme cases on television and might be really interested but at the same time have a lot of misconceptions about it we all know people who have collections for instance we know people have art collections they have CD collections they have vinyl collections now that's pretty big let's say 20s vintage clothing I could be accused of having a yarn collection especially when I go by webs in Northampton but I've been accused of that so but what is the difference between someone who is a collector and someone who might have compulsive hoarding disorder well there are a number of differences there are some similarities as well the the nature of the attachments to possessions the things we own is sometimes similar in people who are collectors versus people have hoarding problems the difference comes about in the intensity of the attachment and the difficulty with managing the possessions so compulsive hoarding or hoarding disorder it really is composed of three different things first of all there's a disorder related to acquisition that the acquisition is excessive people buy and pick up free things and and accumulate things to a much greater extent than most people do the second is difficulty discarding once things come into people's homes it's very difficult for them to let them go and we can talk about some of the reasons why the third feature has to do with the ability to manage the possessions that the possessions typically are in a cluttered arrangement most of the time filling the middle of the room and oftentimes not filling up places like cupboards and and dressers where things should be for instance one of the one of the people in the in the book stuff is someone who was her home was absolutely packed her bedroom her clothes her on top of the dresser all the way to the ceiling but her dresser drawers were empty and what she said was if I put the clothes in the drawer I forget that I have them won't see them I need to see them in order to remember so one of the things that one that one of the attachments that we see in hoarding one of the things that that attaches people to their things is that these objects are reminders for them they're kind of memory tags for things and we see that repeatedly people wonder about is this really a mental health disorder I mean how did it get classified as a mental health disorder or is it just you know two of the seven deadly sins sloth and you know greed throw them together yeah what is the difference yeah it used to be that hoarding was thought of as a subtype of obsessive compulsive disorder and over the course of the last twenty years or so the research on this disorder has has bloomed and what we see is that it it really is distinct from obsessive compulsive disorder the reason it's a disorder is that it interferes with the function in people's lives you know the people's ability to use their homes the spaces the living spaces in the homes and the ways in which they were designed and this can be it well it sounds like it's sort of just some messiness and so forth it really can be a pretty serious problem the recent study done in Australia of looking at residential house fires in the state of Victoria and what they discovered was that the only a small percentage of residential house fires was associated with hoarding but those house fires where the home was hoarded accounted for 24% of fire related deaths and so it's not only a danger to the person living there but it's also a danger to first responders as well and now in places like New York City they they mark homes that they know have a hoarding problem as as Collier residents based on a famous case back in the 40s and and and those are tags so if if a fire occurs there firefighters know what they're faced with when they get there yeah because it's dangerous because it's dangerous for the firefighters yes well because they could get caught under piles of stuff exactly yes exactly so speaking of Australia and in the United States is this a disorder that is prevalent only in a consumer-driven industrialized world or does it cover a wide variety of cultures and nationalities yeah that's a great question there's not a lot of good evidence about it we do know that it exists virtually everywhere so even in third-world countries we see this behavior what we don't know is if it's as prevalent as it is here so in this country somewhere between 1 and 1/2 and 6% of the population suffers more there are about a half a dozen or more epidemiological studies looking at prevalence rates each one defines hoarding a little bit differently some more stringently than others but and by and large they the the window is somewhere between 1 and 1/2 and 6% of the general of the general population yeah because there you know I saw this study in Scientific American they said it was somewhere between 5 million and 14 million in the United States there was a report in The Washington Post that in in 2016 that said it was 19 million I wondered how accurate those numbers can be yeah the the Scientific American article I think picked the the window from one and a half to five percent which was what the early epidemiological studies suggested and that would make it between 5 and about 14 15 million something like that the the 19 million is about 6% of the u.s. population so that figure must have come from the other study that that found 6% of the population with this problem well you have done a tremendous amount of research in this area and back from the 1990s can you identify for me where I mean everybody is different and I'm sure everybody with a hoarding problem is different but have you been able to card the Wolves and and see what are the similarities among this population yeah what we've been able to do is identify a number of features that go into this disorder and first of all we know that this is partly genetic that if you have a family member who's had this problem you're more likely to develop this problem number two there are some background variables we see that are important here about half of people with this disorder are clinically depressed a large number have anxiety disorders so there's a lot of comorbidity here with other disorders mental health disorders we see also some profit some processing problems some information processing problems among these folks that is it appears as though the way in which their brain is working is a little bit different so first of all there are problems with attention a lot of attention deficit yes I noticed ADHD is is very big in this population and it shows up in a couple of ways one is a distractibility especially when a task requires a great deal of effort people with ADHD one they when they're faced with something that's hard and they have to think carefully about it that's when the the distractibility really takes over and so we see that a lot in hoarding the other thing we see is almost the opposite problem where people get narrowly focused on something and for people with hoarding disorder that usually happens when they're in some kind of acquiring episode or acquiring environment where they see something they want and they're there their focus of attention gets so narrow that they kind of lose track of the context of their lives so they forget about the fact that they don't have the money to buy this they don't have the place to store it and they already have three of them at home that information is it's like it's not available it's it's almost part of what you were talking about before about the attachment issue that you that there's an over focus I'm you know on this project on this object right and so and so they tension is a part of it another information processing problem we see and this goes directly to the ability to organize things is a difficulty categorizing things now most of us live our lives categorically we get an electricity bill and we take that bill and we put it with our other electricity bills or with utility bills in a folder somewhere if we want to find that individual member of that category we go to that category and we pick it out but people with hoarding problems don't organize their world that way their world has organized visually and spatially so the electricity bill would go on top of the pile a little over to the left and now if they want to find it they they reference a map that's in their head of where it is in this pile of things and so their world that especially the objects in the world are organized visually and spatially rather than categorically now I do that on my desktop I have piles of things I know what's there because I remember the pile putting them in the pile but if I did that with everything I owned it would be impossible to operate and that's what happens some of the examples of the information is there a tipping point where I mean where it is there a tipping point where it becomes unmanageable because it sounds almost like they build a map with objects I may be off on that and correct me if I'm wrong and then all of a sudden the map gets so clustered or cluttered that they can't find their way yeah that's pretty accurate that that that it the the the pile in the middle grows so much that they kind of lose track but it's remarkable how well they can remember the things that are in there and a couple of cases of people who had almost a perfect image of a pile of things and they could a huge room just filled with all kinds of things they walk into the room with no instantly whether someone's been in there and moved anything and it's it's it's it's like having this three-dimensional map and picture that they can reference when they come in and into the room and know that everything is still there does that also translate into a sense of identity of yourself as having these particular items that you you it's that's a large part of that that's has more to do with the nature of the attachments the emotional attachments to things then so the information processing is one piece of it yes the next piece is the nature of these attachments now is it unusual well possessions have a magical quality for all of us they if the things we own have meaning that goes well beyond the physical characteristics of the object like the a ticket stub to a favorite concert the ticket stubs no different than any other ticket stub to the concert but its meaning it's the the meaning that you put into it it's your sentimental attachment it's it contains your memory of that event and seeing the ticket brings that memory back and what we see in hoarding is that that same phenomena that all of us experience but with a greater intensity and apply to a large number of things so for instance one of the other and the people we've worked with is a woman who we were I was working with her one day on on papers and we had a box of paper she wanted to keep at a box she was gonna recycle and she picked up an ATM envelope out of the pile and it's an envelope she got five years ago from an ATM machine on the back she'd written how she spent the money that came in the envelope the envelope was empty she put it in the recycle box and she started to cry and what she said was it feels like I'm losing that day in my life and if I lose too much there'll be nothing left of me so this was a this was like a key for her that opened the memory for that day and this object was in a sense her personal history and her sense was that if she threw this away she would lose that personal history and therefore that part of herself now interestingly we kept going with this exercise and and a few minutes later I asked how do you feel now about the envelope and what she said was well you know that wasn't such a good day and so it was okay with her then but the initial reaction was this this real emotional kind of feeling of loss and a sense of identity kind of crumbling somehow so what brings people for help I just wonder is what does it take to recognize in oneself the problem and want to get some help with it yeah there there are two things that that that seem to bring people for help one is some kind of recognition of the function they've lost in their lives what can't I do anymore I can't cook I can't I can't sleep in my bed I can't sit on my couch you know that that kind of loss of function that's one thing that brings people in another is pressure pressure from family members pressure from authorities of one sort or another Health Department and so forth those are the two things that really bring people in most people who have this problem recognize there's something wrong we depending on on who you talk to people in in health departments for instance when you talk to them about a hoarding problem they they talk about people who don't have any insight who don't have any recognition that this is a problem that's a small portion of these folks and even even among those folks there is some degree of ambivalence here because almost everyone I've met who's got a hoarding problem recognizes that other people somehow think badly of them because of the way they live and so they have this sense of shame and and what that shame does is it it turns into isolation yes and so what happens is that they guard themselves against being seen by other people and they won't let anyone into their home and they stop having relatives come and visit and that's tight also into the into reactions of other people so for the most part people who come in for treatment suffered decade's worth of criticism and pressure from family members and some that's that gets in the way of the ability to recognize this as a problem to do something about it mm-hmm and that that tremendous cycle of shame and isolation must be extremely painful yeah what we see with people with this problem is that they are less likely to get married more likely to get divorced very likely to be alone with a very small circle of friends speaking of likelihood of getting divorced what is it if I'm living with a person who has this problem how do how do I is it gonna take me a long time to figure that out or is it you know how do I recognize that this has become beyond messy and disorganized mm-hmm I think most family members can do know when it's gone when it's gone beyond just sort of normal messiness and it all boils down to how much of the living space is functional and it's one of the things that that that works to destroy a relationship a family relationship when this happens and that's why we see high divorce or separation rates among people with hoarding disorder the people who are successful at navigating this and families typically have some way of negotiating space and so the person with the hoarding problem may have control over a certain part of the house and the other family member may if they can control the main living areas of the house and keep the clutter to a minimum then the relationship has a chance of lasting but often it's really hard to do and and battles develop and those battles turn into a real marital strife is and so what can family members do I mean are there things is this a tough love situation or rather is that the worst thing you can do yeah the worst thing you could do is to throw the person stuff out when they're not there they don't know or insist that it be thrown out what we see when this happens is that the the the race ship will fractured number one and the stuff stuff will come back in so it's really not a question decluttering or uncluttering a hoard at home is not an effective way of dealing with the problem because what happens is you can change the the situation you can change the physical space temporarily but since you haven't changed the behavior that space is gonna fill up again in short order for family members the first thing to do is is to try to put themselves in that person's shoes how do you how do they understand how do they relate to each of these objects why is it important to them what is the meaning and then get them to reflect on that meaning with respect to the function that is taken up by that meaning so in other words if I want to keep something okay there's a cost to keeping that thing and that cost to keeping that thing is that I don't have the space to use in a different way and so if you can engage the person in conversation that recognizes and appreciates the meaning of the object but try to balance it against the cost of keeping that object then there that opens a dialogue for the person to start thinking differently about their possessions what how do you find that people who are struggling with hoarding explain this to themselves and try to explain it to others for the most parts people people who I talk to and it all depends on how how you begin the conversation so for me my my view of this is I really want to know I'm really curious about the nature of the attachment that people have two possessions and once you once you convey that kind of curiosity people will open up and talk about the meaning of these things and that will get them to the point of saying well I do have a lot of clutter and there are things I can't do and so forth and that's what that's what will open people up but if I go to the door and I'm the health department and I say you know we at the health department don't like the way you're living and we think you should change the way you're living and we're gonna make you change the way you're living then that shuts down the conversation and the person becomes defensive and appears not to recognize that there's a real problem so the issue of how much the person can recognize there's a problem or how much insight they have really is based on the nature of the conversation and how it starts and how it progresses Wow so do you have you done work with health department's say to help them with these extreme I mean I know that there's the eviction becomes a really scary thing or for instance child custody if if a home has become so dangerous that Family Services is saying you know we the kids can't live here anymore yeah yeah yeah you know the health department's and other agencies have changed dramatically over the course of last 20 years in their approach to hoarding and now there are hoarding task forces that exist around the country there were last counts something like 120 different hoarding task forces around the country focus on this these task forces are made up of not just mental health professionals but people from the health department people from adult serve services from Child Services and so forth and and they if they sit around the table and they figure out strategies for dealing with this problem on a community-wide basis which is what it what it means if this is much more than a mental health problem this is a problem that affects other areas of life and other parts of the community and so the solution sometimes involves these other parts as well as meth well when you have worked with families how do you tell them ways that they can take care of themselves how can they take care of themselves yeah yeah that's the that's one of the most important things for a family member is to make sure that they are somehow emotionally supported so that that that that criticism is not there because that it the criticism of a family member with hoarding disorder will get you nowhere and it's hard for people to accept that because in a family context there there is a sense in which people think if I if I just keep telling this person if I just keep criticizing it their behavior will change but that doesn't happen in this case but it is important for people for family members to be able to to protect their own emotional well-being and sometimes that's hard particularly if a home has is completely full and they've got no space for themselves that's a that's a real problem okay I'm wondering where people go for help how what obviously you've you've worked in programs or created programs right now if somebody comes to you and says I need help with this problem do you refer them somewhere are there are there and and what ways work what are the things that you think work the best where I send them the first place I send them is to the International OCD foundation website that OSI Foundation dot o R G will make sure that's up on the screen when this gets good yeah they they on that website is a therapist finder and it covers the whole country and internationally and so that's the first place to go and there you're more likely to find a mental health professional who's been trained in how to treat hoarding we've done a number of workshops with therapists around the country and when they finish they get certified with a behavior therapy training institute oh that's wonderful that they've been through our training for hoarding so the international OCD foundation is it's step one because they can they can tell you in a within a 20 mile radius if there's a therapist who knows how to deal with this second thing is to check the local area for hoarding task force because many hoarding task forces keep records of resources for mental health professionals as other and other professionals there are a couple of other professions besides therapists professional organizers often are very helpful in this context there's a special group of professional organizers called the Institute for chronic disorganization and they focused mostly on hoarding cases I had no idea about that I have seen in the research I did that there are buried in treasures support groups is that something that I I don't know how many the prevalence of them or is this a self-starting kind of yeah this is this is something that we started a number of years ago because there were so few therapists who knew how to treat this we started running the various workshops paired nutritious workshops r16 session workshops based basically on based on the book very interested and what what is done in the workshop is each week is a different chapter of the book it's a self-help book for dealing with hoarding and acquiring problems and clutter and each week focus on a different chapter it's highly scripted it's I wouldn't describe it as a support group it's more of an action-oriented group so most of the time there is homework to do in between sessions there's check-ins about what people were able to do and and we've been we've been doing some research on the effectiveness of the very intrusive workshop and it looks like it's it's very promising from what we're seeing it looks like participating in vary in terms of workshop is almost as good as being in therapy buried in treasures workshops are run by virtually anyone we have a number of places where peers are on it that is people with lived experience of hoarding disorder are running the very interested workshops and the that the outcomes look as good as if it's run by clinician and they're these are running around the country and in fact in many other countries in the world as well so I don't know how many there are going on but there a lot we have up a facilitators guide so it's a it's a very detailed guide for how to run this workshop all the way down to how many pens and pencils you need to run it so it's very detailed now if people are interested they can contact me and I can I can send them the facilitator so anyone can set this up and run it we do we often do trainings for facilitators to run this accident we're interested wow we're getting close to the end and I want to just check in with a final question for you well actually two final questions have you seen people get better and feel better and have their lives changed yes yes absolutely both both with buried in treasures and in therapy we do see this we're now one of the things we're doing in our buried in treasures research is we're starting to look at the effect that program has on hope because when people when people come in with this problem for the most part they've struggled for decades they've been criticized for decades they feel such shame and they see they have no hope and so one of the first things we can do is to get them to see how they how they can change and even with a little change that their level of Hope improves and that's key to getting them motivated to keep going this takes a long time this takes a long time to work through this problem those attachments are deep the attachments are deep and you have to work on the attachments before really worrying about the clutter so what what sometimes happens is people worry about other treatment because we focus on one object at a time and you know in a home that's completely full working with one object at the time it's not going to unclutter very quickly but the real issue is it's it's these attachments that have to change first and once those change then you can get rid of the clutter and you also then have the practice and then you have the practice use our practice as well yeah last question you've worked with people with this problem for decades what have you what has been most admirable about this population it's an interesting question ah you know I think after after spending this much time studying these folks getting to know so many of them I think that this is a form of giftedness it is it reflects an ability to see possessions in a different way in a in a creative way and one of the things we haven't talked about is it was the attachments related to aesthetics there's a there's an aesthetic sensitivity here people's ability to recognize the beauty in objects that most of us don't an example one of the one of the people in the book stuff as a woman really just a wonderful person and I visited her many times as we worked through treatment and as I showed up one day she she said I've got to show you something she ran in the other room and came back with a large clear plastic bag filled with bottle caps and she said look at these bottle caps aren't they beautiful look at the shape and the color and the texture and I realized at that moment that I my aesthetic sensitivity was next to nothing because when I see a bottle cap without a bottle I just think of trash but for her it was a whole world a beauty and in some ways maybe that reflects a kind of giftedness too to see the beauty in the world to see the beauty in nature and not want to waste it yeah that's lovely that's lovely dr. frost thank you so much well thank you for ever giving your time and I can't wait to hear your presentation I didn't even mention that that you're presenting to mental health professionals through the office of continuing education on Friday March 23rd and that's going to happen in Agawam mass at the Crestview Country Club and I'm really looking forward to that and this is I think the fourth time that you come and presented at the retreat and at least in my tenure so I'm thrilled to have you back so thank you very much I'm looking forward to it I'm looking forward to thanks again and this is another episode of keep talking that's coming to a close thank you so much for joining us and I want to thank the BC TV community they are so great with helping us with this I couldn't do it without them and please join us again Thanks [Music] you [Music] [Music] you

Channel: Brattleboro Retreat

Views: 40,773

Keywords: OCD, Obsessive Compulsive Disorder, Hoarding, Chronic Disorganization, Help for hoarding, attention deficit disoder, ADHD, buried in treasures, Compulsive Hoarding Disorder, Acquiring Problems, Randy Frost PhD, Randy O. Frost PhD, Gay Maxwell, Compulsive Acquiring and Saving, Collyer brothers, Hoarders, International OCD Foundation

Id: 7gEW4uzVqbw

Length: 35min 2sec (2102 seconds)

Published: Wed Mar 14 2018