Hoarding behavior: causes, effects, and treatment approaches

¶ … articles on hoarding behavior in dementia patients and in the elderly. Compulsive hoarding is an interesting and compelling phenomenon in a wide variety of the population. The two studies investigate hoarding in the elderly, and in patients with dementia, attempting to find the causes of the behavior and some of the affects the behavior has on those who hoard, including psychiatric symptoms associated with the behavior.

Hoarding is characterized by a need to acquire and maintain a wide variety of possessions that eventually clutter and fill living areas until they can no longer be used for the purpose they were designed for. This behavior has come under scrutiny from the media in recent years, and several studies have been conducted to discover why people hoard, and what the consequences of the behavior can be. Hoarding does occur in the general population, but it is also quite prevalent in the elderly, and in dementia patients, as these two studies indicate.

The first study indicates hoarding behavior is relatively common in dementia patients. All the patients had been diagnosed with varying forms of dementia, and had been hospitalized for their illness. The 133 patients in the study were divided between those who hoarded and those who did not hoard. Twenty-two point six percent of the patients hoarded items, and the items varied from daily necessities to food, newspapers, and even cigarette butts. These items were stored in a variety of places around their homes, in boxes, in closets, or even carried with the patients (Hwang et al., 1998, pg. 286). Psychiatric symptoms of the hoarders included repetitive behaviors, hyperphagia, and pilfering (Hwang et al., 1998, pg. 287). The elderly hoarders collected many of the same items. The elderly study reports, "elderly clients commonly hoarded paper, containers, clothing, food, books, and objects from other people's trash" (Steketee, Frost & Kim, 2001, p. 179). Usually, the clutter was so prevalent that it prevented using certain rooms in the home, and clutter usually occurred in more than one room of the home. In addition, these elderly collectors often showed signs of problems with their own personal care, in addition to the cleanliness of their homes. The dementia patients usually had some form of nursing or aide care, but they also had problems with personal care. The study found that in the elderly, "home sanitary condition, odor, and physical appearance were all significantly related to clutter and impairment from clutter. More clutter was especially associated with poorer sanitation in the home" (Steketee, Frost & Kim, 2001, p. 180). Thus, because the elderly most often live alone or with a long-time partner, the clutter problem is worse, because it may have been going on longer, and there is no daily intervention to manage or attend to the clutter. Many of the elderly living in cluttered homes face sanitary and health issues that would not affect the same elderly living in a non-cluttered environment.

Both groups tend to hoard food and other items that can create health and safety issues. Newspapers can be a fire hazard. Many of the elders studied had so much clutter that moving though the home was difficult, and the clutter could cause a trip and fall hazard. In addition, many of the hoarders could not use pieces of furniture, including beds, sofas, refrigerators, and freezers because of the clutter in their homes. Clearly, this, combined with hoarding food, could create a very dangerous situation if the elderly consume food that has not been properly stored and refrigerated. The dementia patients faced similar issues. The dementia study noted some patients persisted in eating bad or spoiled food, causing intestinal and stomach problems (Hwang et al., 1998, pg. 287). Thus, the dementia patients and the elderly patients both had many hoarding traits in common, but the elderly had more opportunity to hoard, and did so more effectively and completely. Mental health and service providers felt the hoarding was a physical threat for at least 81% of the elderly studied (Steketee, Frost & Kim, 2001, p. 181), while it was not such an issue in the dementia patients under hospitalization. Twenty-two percent of the elderly patients in the study were not believed to have any mental disorders, while the rest of the 62 were determined to have some sort of mental health issue, from unipolar depression to paranoia and anxiety disorder (Steketee, Frost & Kim, 2001, p. 181). Thus, it seems that a majority of hoarder have some kind of mental or psychiatric issue. The dementia patients who hoarded food were sometimes successfully treated with the drug fluvoxamine 15 Phenyopropanoloamine (Hwang et al., 1998, pg. 287), while most of the elderly received physical assistance in cleaning and/or clearing out the home, but this treatment was not "consistently effective" (Steketee, Frost & Kim, 2001, p. 182). A majority of the elderly hoarders were women, while dementia patients did not show a specific pattern. More than have of the elderly who hoarded lived alone, and had never married (Steketee, Frost & Kim, 2001, p. 182).

Another study in 2001 studied the same problem of hoarding in the elderly, and found some similar results. The study followed 62 cases found through social and service organizations, where the members were 65 or older. Caseworkers were interviewed about their elderly clients, and patterns were established. Often health services intervened because of the hoarding problem, and other social service agencies of one sort or another serviced the homes of the hoarders. Most of the elderly studied lived in homes or apartments. Of those that had homes, 36% also had clutter in the yards of the homes. Most of the hoarding problems came to the attention of service agencies because of complaints by neighbors, friends, or family members, and it seemed that many of the cases had a lengthy history of hoarding. Unlike the dementia patients, the elderly hoarders had more opportunity to hoard items because they were not under hospital care, and the hoarding had the potential to be far more damaging.

In addition to the obvious space and health issues with hoarding a variety of items like trash and spoiled food, both studies indicate hoarding also creates other hazards, as these studies have shown. Hoarding not only affects the collector, it affects the family, and even the neighbors when sanitary conditions become too difficult or dangerous to ignore. Some elderly also hoard animals, collecting large numbers of pets in addition to their other clutter, which only adds to the problem of sanitation and safety. Often, the clutter was odiferous, and when it spread to the yard of the residence, it was also an eyesore to the neighborhood.