The experience of working with people that hoard: a Q-sort exploration

Background: The impact and burden of working with people that hoard is largely unexplored. Aim: To explore professionals’ varied experiences of engagement and intervention with this client group. Method: Five semi-structured interviews were initially conducted with professionals with detailed experience of working with people that hoard. A thematic analysis then identified key statements for a 49-item Q-set. The Q-sort was subsequently administered to public sector professionals with wide experience of working with people who hoard (N= 36; fire-fighters, environmental health, housing and mental health). Organizational support and job-related wellbeing measures (anxiety/contentment and depression/enthusiasm) were also administered. Results: Factor analysis identified three distinct clusters (a) therapeutic and client focused (N = 15), (b) shocked and frustrated (N = 2) and (c) pragmatic and task focused (N = 5). Therapeutic and client focused professionals were significantly more content and enthusiastic regarding their work with clients with hoarding difficulties. Conclusions: Professionals experience and approach their work with people that hoard in discrete and dissimilar ways. Service delivery and training implications are considered

A Review of the Diagnosis and Management of Hoarding Disorder

Hoarding disorder (HD) is a severe psychiatric and public health problem characterized by extreme challenges with discarding possessions and severe acquisition resulting in excessive clutter that impairs daily functioning and may cause substantial health and safety risks. Over the past 20 years, research on HD has grown substantially and lead to its recent designation in the DSM-5 as a discrete disorder. The key features of the cognitive behavioral etiological model of hoarding include core vulnerabilities, information processing deficits, cognitions and meaning of possessions, and emotionally driven reinforcement patterns. This model has served as the theoretical foundation for efficacious, specialized cognitive behavioral treatment (CBT) for hoarding and validated hoarding assessment measures. The individual manualized CBT treatment has been adapted for delivery through various modalities (e.g., group, web-based, self-help), populations (e.g., geriatric), and providers (e.g., clinicians, peer support, case managers). While CBT is associated with significant reductions in hoarding severity, clinical levels of hoarding symptoms persist for greater than half of treatment completers; thus, more efficacious treatments need to be developed. Further research is necessary to elucidate components of the CBT model and their interaction, in order to inform treatment targets. Although research on pharmacological treatments for HD is in the nascent stages and extant results are somewhat mixed, future studies may assess medication as a standalone treatment or combined with CBT. Family-focused hoarding interventions may also be important given that persons with hoarding behaviors may have limited insight and motivation and its negative effects on the family. Current data indicate a cost-effective and coordinated response that combines community-based and individualized interventions for hoarding may be optimal in order to (1) reach the broadest group of clients with hoarding (e.g., beyond those who voluntarily seek treatment), (2) maximize incentives and motivation through housing, health services, and safety laws, (3) enhance communication and coordination between diverse teams of providers, (4) provide sustainable comprehensive services in a stepped care approach, and (5) reduce stigma