WEBVTT NOTE This file was generated by Descript 00:00:00.000 --> 00:00:03.800 Julia: And thank you for joining us today for Hoarding Disorder 101, the reality 00:00:03.800 --> 00:00:05.920 versus what you see on Reality TV. 00:00:06.530 --> 00:00:09.560 Today we're gonna be talking about hoarding behaviors and their impacts on 00:00:09.560 --> 00:00:14.120 someone's lives, as well as factors to developing hoarding disorder criteria 00:00:14.120 --> 00:00:18.320 for being diagnosed and how to help and how to get help for someone and the 00:00:18.320 --> 00:00:20.120 evidence-based treatments available. 00:00:20.810 --> 00:00:24.230 Also, after the webinar, we'll have clinicians available to talk 00:00:24.230 --> 00:00:27.709 to you one-on-one, to listen, lend support, and offer additional 00:00:27.709 --> 00:00:29.330 resources if you're interested. 00:00:29.330 --> 00:00:33.780 If you talk with somebody, please send us a message through the chat anytime 00:00:33.780 --> 00:00:37.620 during the webinar, and we'll get you connected as soon as the webinar is over. 00:00:38.340 --> 00:00:41.070 I'm pleased to introduce today's speaker, Amy Miller. 00:00:41.400 --> 00:00:44.880 Amy is the licensed, is a licensed clinician, and also our director of 00:00:44.880 --> 00:00:46.860 senior services here at Jefferson Center. 00:00:47.505 --> 00:00:50.715 Before I hand the mic over to Amy, I do have a few housekeeping items 00:00:50.715 --> 00:00:52.215 to cover about the presentation. 00:00:52.665 --> 00:00:56.985 First, the webinar will be available on demand after this live session, and we'll 00:00:56.985 --> 00:01:01.065 also email that out to you along with additional resources and the slide deck. 00:01:01.635 --> 00:01:05.365 I would also like to encourage you to visit our website at jcmh.org, 00:01:05.685 --> 00:01:08.295 where you'll find more information about how to get started if you're 00:01:08.295 --> 00:01:11.655 interested in talking with a therapist, as well as blog posts and 00:01:11.655 --> 00:01:14.985 information about upcoming webinars on our other mental health topics. 00:01:15.690 --> 00:01:18.180 Please keep your microphones muted and turn off your video 00:01:18.180 --> 00:01:19.440 During the presentation. 00:01:19.680 --> 00:01:22.230 You'll also wanna change your zoom view to speaker mode for 00:01:22.230 --> 00:01:23.850 the best viewing experience. 00:01:24.240 --> 00:01:27.480 And next, we'd love to hear from you during today's presentation. 00:01:27.480 --> 00:01:30.960 So if you have a question for Amy, please feel free to send it through 00:01:30.960 --> 00:01:32.670 the chat at the bottom of your player. 00:01:32.910 --> 00:01:36.119 We'll be answering questions at the end of the session, but if we don't get to 00:01:36.119 --> 00:01:39.540 your question during today's webinar, we'll be sure to follow up afterwards. 00:01:39.929 --> 00:01:43.170 And finally, we'd like to encourage you to follow us on our social networks and 00:01:43.170 --> 00:01:46.679 share the recording of this webinar and other information about Jefferson Center. 00:01:47.310 --> 00:01:50.309 And without further ado, Amy, I'll turn it over to you. 00:01:51.360 --> 00:01:51.869 Okay. 00:01:51.869 --> 00:01:53.010 Amy Miller: Thanks so much, Julia. 00:01:53.010 --> 00:01:54.270 Yes, welcome everyone. 00:01:54.270 --> 00:01:57.360 We're gonna be talking about hoarding disorder today. 00:01:57.360 --> 00:02:01.410 This has been a, an exciting new service line here at Jefferson Center. 00:02:01.410 --> 00:02:06.660 And it's, been such a rewarding experience and we're excited to share some of 00:02:06.660 --> 00:02:11.370 the things we've learned as well as treatments and, supports and resources 00:02:11.370 --> 00:02:12.615 that are available to the community. 00:02:14.279 --> 00:02:18.240 So I'd just like to start off by telling folks about Jefferson Center. 00:02:18.690 --> 00:02:21.839 We are the community mental health center for Jefferson Clear Creek 00:02:21.839 --> 00:02:23.670 and Gilpin Counties in Colorado. 00:02:23.790 --> 00:02:28.740 And we are really here to inspire hope, improve lives, and strengthen 00:02:28.740 --> 00:02:32.700 our community by providing mental health and other related solutions 00:02:32.700 --> 00:02:34.290 for individuals and families. 00:02:34.709 --> 00:02:37.680 And we serve all ages, children up to seniors. 00:02:38.015 --> 00:02:42.600 The program I oversee as, as well as specialized programs for families, 00:02:42.600 --> 00:02:47.160 veterans, military personnel, and we offer the traditional individual 00:02:47.160 --> 00:02:51.149 group family therapy medication management, but also some really 00:02:51.149 --> 00:02:56.725 nice wraparound services in terms of wonderful peer specialists who can help. 00:02:57.320 --> 00:02:58.880 Walk alongside clients. 00:02:59.240 --> 00:03:02.839 These are professionals that have experience, lived experience with a 00:03:02.839 --> 00:03:06.709 mental health condition, and they're just a wonderful resource, as well as 00:03:06.709 --> 00:03:12.260 different classes resources, school-based services and substance use treatment. 00:03:12.260 --> 00:03:16.790 So we are here for you and, please don't hesitate to reach out if we can help. 00:03:18.195 --> 00:03:22.094 So today we're gonna be covering a sort of a broad overview of hoarding disorder. 00:03:22.094 --> 00:03:26.654 There's certainly a lot of content and more that then can be covered in one hour. 00:03:27.315 --> 00:03:29.865 But we're gonna, we're gonna cover the basics. 00:03:29.865 --> 00:03:34.245 So covering what it is and how common it is, why people develop it, how 00:03:34.245 --> 00:03:35.834 to assess for hoarding disorder. 00:03:36.075 --> 00:03:39.974 Where's that line between someone who's maybe a collector or has a lot of clutter 00:03:40.245 --> 00:03:44.354 versus something that would qualify as a diagnosis for hoarding disorder. 00:03:44.985 --> 00:03:48.224 What treatment strategies are available that are shown to be effective? 00:03:48.464 --> 00:03:51.675 And then where to go to learn more if you're someone with hoarding disorder, 00:03:52.125 --> 00:03:55.185 if you're someone who cares about someone with a hoarding disorder or 00:03:55.185 --> 00:03:59.474 possible hoarding disorder, or if you're a professional out in the community, 00:03:59.534 --> 00:04:04.274 either a mental health professional or a professional that works with individuals 00:04:04.394 --> 00:04:06.135 in a more of a community based setting. 00:04:06.615 --> 00:04:09.195 There are additional resources and we will definitely cover 00:04:09.195 --> 00:04:10.515 where you can go to learn more. 00:04:11.565 --> 00:04:16.995 I do wanna give a special thank you to Dr. Gale Stucky and Dr. Christiana Brodis. 00:04:17.625 --> 00:04:22.845 A lot of this content came from a presentation they shared at the 2019 00:04:22.845 --> 00:04:27.855 International OCD conferences, hoarding disorder meeting, and they have 00:04:27.855 --> 00:04:31.935 graciously given me Pres permission to share a lot of their content. 00:04:32.835 --> 00:04:37.995 I just wanna really acknowledge them and their good work and thank them for, making 00:04:37.995 --> 00:04:39.735 this available to the wider community. 00:04:41.835 --> 00:04:45.285 Starting off with, the basics, what is hoarding disorder? 00:04:45.285 --> 00:04:50.565 Sometimes this is a term that gets thrown around a lot of we may jokingly call 00:04:50.565 --> 00:04:54.375 someone a hoarder if, they have a lot of stuff in their home or things like that. 00:04:54.855 --> 00:04:57.585 But, what does it actually mean in a clinical sense? 00:04:58.485 --> 00:05:00.615 And there's some key features. 00:05:00.615 --> 00:05:02.115 The first being really. 00:05:03.045 --> 00:05:07.605 Persistent difficulty letting go of items because there's this 00:05:07.665 --> 00:05:10.905 perceived need, there's this feeling that I might need this someday. 00:05:11.295 --> 00:05:14.565 So it's hard for people with hoarding disorder to let things go because 00:05:14.565 --> 00:05:15.615 they think they might need it. 00:05:16.185 --> 00:05:19.575 And you'll notice I'm using the word letting go versus discarding 00:05:19.635 --> 00:05:24.675 because for folks with hoarding disorder it can feel very harsh and 00:05:25.605 --> 00:05:30.615 emotionally difficult to think of discarding one of their possessions, 00:05:30.615 --> 00:05:32.325 just letting it go by the wayside. 00:05:32.655 --> 00:05:35.565 So in our groups, we often use the term letting go of things, letting 00:05:35.565 --> 00:05:37.095 them go on to their next home. 00:05:37.905 --> 00:05:42.015 Because that's a little bit more manageable, more tolerable 00:05:42.015 --> 00:05:44.655 than the idea of just discarding something by the wayside. 00:05:45.525 --> 00:05:51.630 The thought of getting rid of items causes distress, it causes anxiety or stress. 00:05:51.630 --> 00:05:53.190 Just the thought of, oh, I might need this. 00:05:53.190 --> 00:05:54.150 I can't get rid of it. 00:05:54.719 --> 00:05:59.760 And so with that, you get a large accumulation of items and you often 00:05:59.760 --> 00:06:01.260 have a mix of things of value. 00:06:01.260 --> 00:06:05.490 So you will have potentially trash mixed in with something like a 00:06:05.490 --> 00:06:08.820 valuable antique or a check or money. 00:06:08.880 --> 00:06:11.219 And so it all mixes together. 00:06:11.640 --> 00:06:14.039 But it's not so much about the value of the items. 00:06:14.039 --> 00:06:18.150 It used to be thought that only only worthless items could be 00:06:18.150 --> 00:06:19.620 considered for hoarding disorder. 00:06:19.620 --> 00:06:23.940 But we know now that hoarding disorder really covers collecting 00:06:24.390 --> 00:06:26.700 things of a wide range of value. 00:06:27.930 --> 00:06:33.030 And so there's really three key components that feed into the final visible result 00:06:33.030 --> 00:06:34.650 of hoarding disorder, which is clutter. 00:06:35.070 --> 00:06:38.460 So there's the saving, so having difficulty letting go 00:06:38.460 --> 00:06:40.050 of things, hanging onto things. 00:06:40.560 --> 00:06:44.340 For many people, acquiring is a large part of the equation going out and 00:06:44.340 --> 00:06:49.440 either getting free things from the curb or from Craigslist or Facebook 00:06:49.440 --> 00:06:54.539 marketplace or going to the thrift shop or going shopping and bringing 00:06:54.719 --> 00:06:56.760 excessive amounts of items into the home. 00:06:57.090 --> 00:07:01.680 And then there's a third component which is really what distinguishes hoarding 00:07:01.680 --> 00:07:06.599 disorder from someone who might be just a very significant collector and have a lot 00:07:06.599 --> 00:07:09.630 of items is this disorganization piece. 00:07:09.630 --> 00:07:14.370 A collector will typically keep things pretty well organized and pretty 00:07:14.370 --> 00:07:17.849 well easy to find and and manageable. 00:07:18.060 --> 00:07:21.810 But with hoarding disorder, it tends to all get mixed in together 00:07:22.140 --> 00:07:24.690 and it's hard for people to find what they're looking for. 00:07:24.690 --> 00:07:28.289 So that disorganization piece is a pretty significant part of 00:07:28.289 --> 00:07:31.080 hoarding disorder, and we'll talk a little bit more about that later. 00:07:32.489 --> 00:07:36.450 But, and in terms of the prevalence, it's one of the more common mental 00:07:36.479 --> 00:07:40.739 health conditions in the U.S. And this is pretty consistent in the studies 00:07:40.739 --> 00:07:42.059 around the world that have been done. 00:07:42.059 --> 00:07:47.339 But in the United States, it's estimated that about 5% of 00:07:47.689 --> 00:07:49.789 individuals have hoarding disorder. 00:07:49.999 --> 00:07:52.400 And so that's one in 20 people. 00:07:52.429 --> 00:07:55.699 I heard we had 80 people registered for the webinar today. 00:07:55.699 --> 00:08:00.650 So if you know that statistic held true, that would be close to, oh, now 00:08:00.650 --> 00:08:05.090 I made myself do math, but probably close to about 15 people on the 00:08:05.090 --> 00:08:06.979 webinar that have hoarding disorder. 00:08:06.979 --> 00:08:10.400 And if you think of the people you know you probably are here because you 00:08:10.400 --> 00:08:11.749 know someone with hoarding disorder. 00:08:11.749 --> 00:08:15.889 So it's very common and it starts early on in life. 00:08:15.889 --> 00:08:20.539 The average age that symptoms start appearing is age 16. 00:08:21.329 --> 00:08:23.219 And for many people it's younger than that. 00:08:23.549 --> 00:08:28.619 So this is something that appears early on in life and that it tends to, without 00:08:28.619 --> 00:08:32.669 intervention, tends to get worse over time, which we'll talk more about too. 00:08:33.599 --> 00:08:39.389 But that moderate to severe hoarding really peaks later in life around age 50. 00:08:39.960 --> 00:08:43.199 And this is a chart that sort of describes it, where this is the 00:08:43.199 --> 00:08:47.939 percentage of different age groups that report moderate to severe hoarding. 00:08:47.939 --> 00:08:53.220 So you see around age 20, only about 30% of people who meet the criteria 00:08:53.220 --> 00:08:59.069 for hoarding disorder experience it moderate to severely about 70%. 00:08:59.069 --> 00:09:00.089 It's more mild. 00:09:00.240 --> 00:09:03.659 It's causing issues, but it's not severely impacting their life. 00:09:04.050 --> 00:09:07.439 And you see how that escalates over time into later life. 00:09:07.439 --> 00:09:11.399 And that's a big part of the reason that the, hoarding services ended up in 00:09:11.399 --> 00:09:13.500 senior services here at Jefferson Center. 00:09:14.280 --> 00:09:19.139 Often early on in life, kids may have parents that help them manage things. 00:09:21.075 --> 00:09:24.085 Help manage their possessions, help keep their room in line in early 00:09:24.085 --> 00:09:28.244 adulthood, and maybe a spouse or other people living in the home. 00:09:28.244 --> 00:09:32.355 But as people age, more and more stuff accumulates, and that's 00:09:32.355 --> 00:09:34.395 part of why severity increases. 00:09:35.264 --> 00:09:39.345 But then also as people maybe get divorced or widowed or start living 00:09:39.345 --> 00:09:43.694 alone, there's less people around them to keep the levels of clutter 00:09:43.875 --> 00:09:45.915 in check the way we would expect. 00:09:47.260 --> 00:09:52.180 And so the diagnostic criteria, the manual that mental health professionals 00:09:52.180 --> 00:09:56.859 use is the DSM five, and that latest version came out in 2013. 00:09:57.220 --> 00:10:00.760 Before that hoarding disorder was not recognized as a mental illness. 00:10:01.180 --> 00:10:05.889 And so this really gave us some criteria and a diagnosis where we 00:10:05.889 --> 00:10:09.099 could start providing services that would get reimbursed by insurance. 00:10:09.099 --> 00:10:14.589 So this was a, pretty important step, but the criteria for someone to be considered 00:10:15.609 --> 00:10:20.319 a person with a diagnosis of hoarding disorder is that difficulty discarding 00:10:20.319 --> 00:10:22.780 or letting go or parting with objects. 00:10:23.649 --> 00:10:25.960 That difficulty is due to urges to save. 00:10:25.960 --> 00:10:29.619 So it's not that maybe they have some physical limitations that 00:10:29.800 --> 00:10:33.909 physically make it hard for them to move items around or to take 00:10:33.909 --> 00:10:35.530 their trash out or things like that. 00:10:35.530 --> 00:10:40.599 But it's really this sort of psychological need that's causing that urge to save. 00:10:41.909 --> 00:10:46.649 These symptoms result in the clutter that clutter the living areas of the home. 00:10:46.859 --> 00:10:52.829 We'll talk a little bit more about that too, and it causes distress 00:10:52.889 --> 00:10:54.810 or interference in their life. 00:10:56.250 --> 00:11:00.929 The collecting of items, the saving of items, the clutter that results 00:11:01.560 --> 00:11:05.669 either causes distress to the person they find it distressing, they're 00:11:05.669 --> 00:11:09.359 frustrated with themselves, they feel bad about themselves, they're feeling 00:11:09.359 --> 00:11:13.349 guilt or shame, or it's interfering with their ability to go to work, 00:11:14.369 --> 00:11:19.079 have relationships, go to school, do different activities of daily living. 00:11:19.919 --> 00:11:26.669 If you can't find the keys to your car because, it's in a pile of clutter, it 00:11:26.669 --> 00:11:28.319 can be hard to make it to work on time. 00:11:28.679 --> 00:11:31.349 If you can't find your homework because it's mixed in the pile of 00:11:31.349 --> 00:11:37.079 papers on the desk, it can be hard for school to be a successful experience. 00:11:37.740 --> 00:11:41.669 If your significant other partner is frustrated with the level of 00:11:41.669 --> 00:11:45.149 clutter in the house it can damage interpersonal relationships. 00:11:45.270 --> 00:11:48.750 And so that's what we're really that's really the key for really 00:11:48.750 --> 00:11:52.740 any mental health diagnosis is it's causing some sort of distress 00:11:52.949 --> 00:11:54.720 or impairment in your daily life. 00:11:54.960 --> 00:11:58.589 But certainly with something like hoarding disorder, that's a key distinction. 00:11:59.849 --> 00:12:03.000 It's not better accounted for by another medical condition. 00:12:03.000 --> 00:12:12.839 So certain things like autism or even something like Alzheimer's can also 00:12:12.839 --> 00:12:15.569 create some of those collecting behaviors. 00:12:15.569 --> 00:12:19.829 With autism, they often have fixed interests and so they may really get 00:12:19.829 --> 00:12:24.210 into one particular type of toy or trains or whatever the case might be. 00:12:24.210 --> 00:12:26.189 And so they collect and collect. 00:12:26.849 --> 00:12:28.980 And that wouldn't qualify as hoarding disorder. 00:12:28.980 --> 00:12:31.829 That's something that's more related to the diagnosis of autism. 00:12:32.954 --> 00:12:35.835 And it's not better accounted for by other mental illnesses. 00:12:36.464 --> 00:12:42.825 So for example, like with OCD, if you have a compulsion around not 00:12:42.825 --> 00:12:46.004 being able to touch things 'cause you're afraid of contamination. 00:12:46.484 --> 00:12:51.194 So if you have a contamination phobia and you can't get rid of trash 'cause 00:12:51.254 --> 00:12:55.425 of the fear that you could get germs from the trash from handling it. 00:12:55.754 --> 00:12:58.454 And so the trash piles up and piles up, that wouldn't 00:12:58.454 --> 00:12:59.835 qualify as hoarding disorder. 00:12:59.895 --> 00:13:02.175 That would better be accounted for OCD. 00:13:04.335 --> 00:13:08.175 So those are the conditions that have to be present for it to be 00:13:08.175 --> 00:13:09.524 considered hoarding disorder. 00:13:09.915 --> 00:13:15.045 These diagnostic specifiers are things that are often present in folks with 00:13:15.045 --> 00:13:16.754 hoarding disorder, but not always. 00:13:18.345 --> 00:13:19.814 Excessive acquisition. 00:13:19.814 --> 00:13:24.375 So that's where people bring things into the home and have a hard time 00:13:24.375 --> 00:13:26.804 controlling the impulse to acquire things. 00:13:27.194 --> 00:13:31.905 That's present in 60% of people with hoarding disorder. 00:13:32.264 --> 00:13:35.895 And then another 28% have had that in the past. 00:13:35.984 --> 00:13:39.165 But either because they physically can't get out of the house as much 00:13:39.165 --> 00:13:43.185 as they used to, or financially they can't afford to pay for things, or 00:13:43.185 --> 00:13:48.014 they've come up with a coping strategy of, I'm just not gonna buy more stuff. 00:13:48.014 --> 00:13:51.405 I'm gonna avoid going to the store so that I don't bring more stuff in. 00:13:52.034 --> 00:13:55.905 They maybe aren't acquiring now but they have in the past. 00:13:56.264 --> 00:14:03.089 And only about 8% of folks with hoarding disorder have no level of excessive 00:14:03.089 --> 00:14:06.450 acquisition equal either current or past. 00:14:06.839 --> 00:14:10.440 For those folks, it could be things like mail coming into the house. 00:14:10.470 --> 00:14:10.740 Right? 00:14:10.740 --> 00:14:14.159 You get a pile of mail and it's just really hard to know where things go. 00:14:14.159 --> 00:14:17.879 You're worried about making a mistake about how to sort things, what should be 00:14:17.879 --> 00:14:22.649 shredded, what should be recycled, what should be kept, and so it just never gets 00:14:22.649 --> 00:14:24.599 dealt with and the mail starts to pile up. 00:14:24.659 --> 00:14:29.579 That would be an example of passive acquisition, where just the things that 00:14:29.579 --> 00:14:33.629 we need on a day-to-day basis in terms of food and mail and things that naturally 00:14:33.629 --> 00:14:38.760 come into the home even if it's coming in at a slower rate, if nothing ever leaves, 00:14:38.940 --> 00:14:40.980 that clutter will still accumulate. 00:14:41.970 --> 00:14:45.629 And then level of insight is something that's, pretty unique 00:14:45.629 --> 00:14:47.010 with hoarding disorder as well. 00:14:47.010 --> 00:14:50.819 This refers to the person's understanding that the clutter 00:14:51.510 --> 00:14:53.520 that the acquiring is a problem. 00:14:54.270 --> 00:14:59.069 And with folks with hoarding disorder, there's parts of the brain that judge 00:14:59.129 --> 00:15:00.780 the importance of different things. 00:15:00.899 --> 00:15:05.609 And it's, interesting when they're looking at their own possessions 00:15:05.609 --> 00:15:10.020 and trying to decide what to do with them functional MRIs will often 00:15:10.020 --> 00:15:12.300 show overactivity in those areas. 00:15:12.300 --> 00:15:16.260 And so everything seems very, important, and that's part of why it 00:15:16.260 --> 00:15:18.179 feels so hard to let go of things. 00:15:18.629 --> 00:15:22.919 But when they're not looking at things, at their things, at their possessions, 00:15:23.250 --> 00:15:25.169 often those areas are underactive. 00:15:25.169 --> 00:15:30.329 And so certain things seem less important to them, including it's not that big of a 00:15:30.329 --> 00:15:31.980 deal if there's clutter around the house. 00:15:31.980 --> 00:15:34.770 So that can contribute to that lower level of insight. 00:15:35.099 --> 00:15:39.929 So often when we're making that diagnosis, we'll specify good, fair or poor insight. 00:15:42.119 --> 00:15:45.750 So what do people with hoarding disorder save? 00:15:46.829 --> 00:15:49.379 I'd encourage you to take a moment here and think about the things 00:15:49.379 --> 00:15:52.649 that you save in your home or the things that tend to accumulate. 00:15:53.010 --> 00:15:54.569 I know for me it's my mail. 00:15:55.379 --> 00:15:59.879 I have to set aside a day, a week, or maybe every two weeks to go through 00:15:59.879 --> 00:16:03.359 and actually sort through and open up mail because I get so much junk mail. 00:16:04.020 --> 00:16:06.089 But also kitchen gadgets are my vice. 00:16:06.089 --> 00:16:07.379 I love a good kitchen gadget. 00:16:07.379 --> 00:16:10.409 I love something that promises to make my life easier, and so 00:16:10.409 --> 00:16:11.909 I have a kitchen full of stuff. 00:16:13.649 --> 00:16:16.290 And, for you it may be something different, but what the research 00:16:16.290 --> 00:16:20.190 shows is people with hoarding disorder save the same type of things as 00:16:20.190 --> 00:16:21.720 people without hoarding disorder. 00:16:21.990 --> 00:16:23.369 They just save much more of it. 00:16:24.180 --> 00:16:26.639 So things like magazines, newspapers, right? 00:16:26.639 --> 00:16:29.250 Many of us can probably relate to having a stack of things we 00:16:29.250 --> 00:16:33.750 wanna read on our, side table or on the dining room table, clothes, 00:16:33.750 --> 00:16:36.540 dishes, containers things like that. 00:16:37.454 --> 00:16:43.034 And so what happens is with disorganization, all those 00:16:43.034 --> 00:16:45.974 things tend to get mixed together again, regardless of value. 00:16:45.974 --> 00:16:51.284 So again, with the mail you may have bills or that stimulus check that came right 00:16:51.284 --> 00:16:55.964 a few months ago mixed in with trash or food wrappers or things like that because 00:16:56.234 --> 00:16:57.734 it's, hard to know what should go where. 00:16:57.734 --> 00:16:59.804 That's another sort of functional difference. 00:17:00.345 --> 00:17:03.134 In the brains of people with hoarding disorders, often they have a hard 00:17:03.134 --> 00:17:06.074 time categorizing what goes together. 00:17:06.554 --> 00:17:11.474 And so everything often seems so special or so unique that they have 00:17:11.474 --> 00:17:14.264 a hard time saying, okay, these are bills that need to be paid. 00:17:14.594 --> 00:17:16.514 These are papers that need to be filed. 00:17:16.514 --> 00:17:20.054 This is letters I need to respond to. 00:17:21.014 --> 00:17:23.145 And it all just ends up mixed together. 00:17:25.035 --> 00:17:29.145 So why do people save or bring stuff into the home? 00:17:29.565 --> 00:17:33.645 Again, I would encourage you to think about what you, why you hang 00:17:33.645 --> 00:17:35.415 onto things, why you save things. 00:17:36.254 --> 00:17:39.285 Often it's because there's a level of emotional attachment. 00:17:40.935 --> 00:17:46.935 A wedding dress or photo albums or a special gift that someone gave to us. 00:17:47.265 --> 00:17:51.465 It may not have any sort of value to anyone else, but to us, those things can 00:17:51.465 --> 00:17:54.085 be very special and we hang up to them. 00:17:55.485 --> 00:17:57.794 Also things that are just useful, right? 00:17:58.725 --> 00:18:01.485 Things like kitchen gadgets they're, useful. 00:18:02.205 --> 00:18:06.195 They have an instrumental impact and so we hang on to them because we use them, 00:18:07.995 --> 00:18:10.245 but also simply because they're beautiful. 00:18:10.304 --> 00:18:13.304 There are things that we just appreciate the look of them. 00:18:13.304 --> 00:18:14.685 Maybe they don't have a function. 00:18:14.925 --> 00:18:18.735 I'm, looking at a beautiful piece of artwork I was gifted at my 00:18:18.735 --> 00:18:20.834 last job and I treasured that. 00:18:21.915 --> 00:18:26.445 And often with hoarding disorder, so many of the challenges are the results 00:18:26.504 --> 00:18:28.485 of really too much of a good thing. 00:18:28.995 --> 00:18:33.735 And often folks with hoarding disorder have such a great appreciation for 00:18:33.824 --> 00:18:37.245 the beauty of things that other people maybe don't recognize. 00:18:38.084 --> 00:18:42.254 But again, when everything seems beautiful and everything seems special, 00:18:42.465 --> 00:18:44.175 it's hard to let go of anything. 00:18:44.850 --> 00:18:47.220 And so it's, really just too much of a good thing. 00:18:48.150 --> 00:18:52.200 But also there are values that tie into why people hang on to things. 00:18:52.800 --> 00:18:57.090 The, sense of frugality, of getting a great deal or seeing something 00:18:57.090 --> 00:18:58.470 for free on the side of the road. 00:18:58.470 --> 00:19:02.280 I think many of us can relate to it to that, but also the idea of bringing 00:19:02.280 --> 00:19:07.350 something into the home or paying for something and then it doesn't get used, 00:19:07.380 --> 00:19:11.160 maybe because there's no space or the person can't find it, or they just didn't 00:19:11.160 --> 00:19:13.110 use it the way they thought they would. 00:19:13.470 --> 00:19:19.899 It feels very wasteful often to let go of those items if they never got used. 00:19:19.899 --> 00:19:24.220 So that sense of frugality again, too much of a good thing just gets 00:19:24.220 --> 00:19:26.200 taken to an extreme oftentimes. 00:19:27.549 --> 00:19:33.219 Creativity often people can think of many uses for an item. 00:19:35.469 --> 00:19:37.539 I might have an empty tissue box, right? 00:19:37.539 --> 00:19:42.039 Once I use this all up and, I might think this is garbage now I'm gonna 00:19:42.549 --> 00:19:44.259 recycle it or throw it in the trash. 00:19:44.949 --> 00:19:47.909 But someone with hoarding, hoarding disorder could probably 00:19:47.909 --> 00:19:50.489 think of many uses for this. 00:19:50.489 --> 00:19:55.369 It could hold shopping bags, it could be a pen holder, it could 00:19:55.369 --> 00:19:57.949 be a cat toy or many other things. 00:19:57.949 --> 00:20:01.549 And so when everything seems like it could be so useful it seems 00:20:01.549 --> 00:20:04.099 like a waste to not do that. 00:20:05.749 --> 00:20:12.259 And then that level of resourcefulness too, of not wanting to run out of things, 00:20:12.259 --> 00:20:14.089 wanting to have something when we need it. 00:20:14.089 --> 00:20:17.389 I think many of us could relate to this at the beginning of the pandemic. 00:20:17.389 --> 00:20:19.579 That's why there was no toilet paper, right? 00:20:19.579 --> 00:20:23.809 We wanna have things when we need it, and so again, they're resourceful. 00:20:23.809 --> 00:20:26.179 They go out, they find things, they make do. 00:20:26.959 --> 00:20:30.019 But it's just again, taken to an extreme that often it's hard for 00:20:30.019 --> 00:20:34.129 them to let go of things even after they're no longer useful. 00:20:39.004 --> 00:20:44.794 Okay, so it is common for folks with hoarding disorder to experience 00:20:44.794 --> 00:20:46.444 other mental health concerns. 00:20:47.014 --> 00:20:49.384 The most common is major depressive disorder. 00:20:49.384 --> 00:20:52.654 More than half of folks with hoarding disorder also have 00:20:52.654 --> 00:20:53.884 major depressive disorder. 00:20:53.884 --> 00:20:58.264 And that can be really challenging because we know depression can really sap that 00:20:58.414 --> 00:21:01.114 motivation, judgment, decision making. 00:21:01.804 --> 00:21:05.854 It can affect a lot of the skills and things that are needed to 00:21:05.854 --> 00:21:07.654 effectively address hoarding disorder. 00:21:08.434 --> 00:21:12.664 Similarly with anxiety, about a quarter of people with hoarding disorder, 00:21:12.664 --> 00:21:16.894 either having generalized anxiety disorder or social anxiety disorder, 00:21:17.284 --> 00:21:21.334 and often the items around them, their possessions can help soothe 00:21:21.334 --> 00:21:23.584 that anxiety and relieve that anxiety. 00:21:24.664 --> 00:21:29.389 Interestingly, many people with hoarding disorder also have an A 00:21:29.389 --> 00:21:35.239 DHD diagnosis, attention deficit hyperactivity disorder, about 27%. 00:21:35.959 --> 00:21:41.060 And this is certainly shown to be true in, the folks that are attending our groups. 00:21:41.060 --> 00:21:46.280 And it makes sense because that difficulty focusing and staying on task and 00:21:46.280 --> 00:21:51.709 making decisions makes it hard to sort through things, to declutter things. 00:21:51.770 --> 00:21:54.739 And so often those go hand in hand too. 00:21:55.370 --> 00:22:00.249 Interestingly, the incidents of trauma in people with hoarding disorder, and 00:22:00.249 --> 00:22:03.789 this is one thing that on the TV shows they often like to feature some sort 00:22:03.789 --> 00:22:07.929 of traumatic event that happened in the person's life and hold that up 00:22:07.929 --> 00:22:09.669 as the reason they started hoarding. 00:22:10.810 --> 00:22:14.560 But really what we know is the incident of trauma in people with hoarding disorder 00:22:14.560 --> 00:22:18.639 is the same as a general population, but folks with hoarding disorder actually 00:22:18.639 --> 00:22:21.850 have a lower prevalence of PTSD. 00:22:22.239 --> 00:22:25.810 So there does seem to be some sort of comforting protective 00:22:25.810 --> 00:22:30.969 effect of their items and it does provide them some comfort and some 00:22:30.969 --> 00:22:33.909 relief for many PTSD symptoms. 00:22:34.239 --> 00:22:37.600 And that's a big reason why if we can avoid doing a big clean out. 00:22:38.040 --> 00:22:43.350 All at once, we wanna do that because their stuff serves a purpose. 00:22:43.439 --> 00:22:48.600 And so if we take that away before they have other coping skills in place, we may 00:22:48.600 --> 00:22:50.610 actually be causing more harm than good. 00:22:51.090 --> 00:22:54.209 Sometimes it's necessary and we'll get into that a little bit later. 00:22:54.899 --> 00:22:59.070 But it does have a function and I wanna make sure that's clear. 00:23:00.840 --> 00:23:03.899 About three quarters of people have some sort of anxiety or 00:23:03.899 --> 00:23:07.649 mood disorder other than OCD in addition to their hoarding disorder. 00:23:07.739 --> 00:23:11.340 And that might seem overwhelming, but the good news is addressing 00:23:11.340 --> 00:23:13.530 one often helps the other. 00:23:13.800 --> 00:23:17.729 And we've seen this in our group, whereas people are able to more 00:23:17.729 --> 00:23:19.830 effectively manage their possessions. 00:23:20.129 --> 00:23:26.070 It builds the sense of autonomy and efficacy and empowerment that they 00:23:26.070 --> 00:23:30.030 can do things and they can address this issue and that translates 00:23:30.030 --> 00:23:31.439 to other parts of their life. 00:23:31.800 --> 00:23:36.274 And so it gives us an opportunity for multiple venues of intervention. 00:23:38.794 --> 00:23:43.445 So there's often the question of why people hoard, and often people will 00:23:43.445 --> 00:23:49.024 want to say something like their mother was a clutter bug or a pack rat, or 00:23:49.024 --> 00:23:50.284 they lived through the depression. 00:23:51.080 --> 00:23:55.909 And we, or like in the TV shows they, they had a trauma and certainly 00:23:55.909 --> 00:23:57.800 those things can feed into that. 00:23:57.800 --> 00:24:02.209 But we also know people who have, parents who hoard don't always go on to hoard. 00:24:02.629 --> 00:24:04.969 We know people who grow up in the depression that 00:24:05.540 --> 00:24:07.129 didn't have a cluttered home. 00:24:07.879 --> 00:24:11.270 So it's not as simple as one factor and that's frustrating. 00:24:11.270 --> 00:24:15.290 Our brains wanna have the one thing that caused, the issue. 00:24:16.009 --> 00:24:17.600 But really it's complex. 00:24:18.199 --> 00:24:24.679 Evolutionarily speaking back in prehistoric times there wasn't a 00:24:24.679 --> 00:24:29.030 target around the corner and Amazon didn't have two day free shipping 00:24:29.389 --> 00:24:31.489 and things were hard to come by. 00:24:31.580 --> 00:24:35.179 And so it was natural to hang onto the things you came across that were 00:24:35.179 --> 00:24:39.800 useful that were beautiful, that had a sentimental attachment because you may 00:24:39.800 --> 00:24:41.209 not come across something like that. 00:24:41.209 --> 00:24:44.959 So it was really a survival strategy that just doesn't translate 00:24:44.959 --> 00:24:49.729 to our new modern world where there's stuff everywhere we turn. 00:24:50.750 --> 00:24:52.280 Biology and neurobiology. 00:24:52.280 --> 00:24:56.959 Certainly there seems to be with genetics as well a family component. 00:24:56.959 --> 00:25:02.179 Certain people seem to be more hardwired to experience hoarding disorder. 00:25:03.469 --> 00:25:07.760 And there's different brain functions or the, brain functions 00:25:07.760 --> 00:25:10.550 a little bit differently in folks with hoarding disorder. 00:25:10.550 --> 00:25:14.330 And that's not to say it's, bad or that their brains that 00:25:14.330 --> 00:25:15.350 there's something wrong with them. 00:25:15.350 --> 00:25:17.000 They just function a little bit differently. 00:25:17.054 --> 00:25:19.514 All of our brains function a little differently from each other. 00:25:19.634 --> 00:25:23.294 And with hoarding disorder again it's, the part of the brains 00:25:23.294 --> 00:25:27.824 that often relate to judgment and understanding the importance of things. 00:25:28.094 --> 00:25:33.404 And those areas can either be overactive or underactive in the situation. 00:25:34.245 --> 00:25:38.804 Certainly as people age and maybe they have more cognitive challenges, if it's 00:25:38.804 --> 00:25:43.804 something related to mild cognitive impairment some of those executive 00:25:43.804 --> 00:25:48.695 functioning difficulties like attention decision making, being able to organize 00:25:48.695 --> 00:25:52.715 and categorize things can make it harder to manage their possessions. 00:25:52.715 --> 00:25:57.334 Which is also why hoarding disorder tends to get worse over time. 00:25:57.844 --> 00:26:02.524 And then older adults in particular often struggle with complex thinking 00:26:02.554 --> 00:26:04.534 and what we call prospective memory. 00:26:04.865 --> 00:26:07.355 So that memory that says, I need to remember to do this. 00:26:07.355 --> 00:26:09.395 I need to remember to pay that bill. 00:26:09.395 --> 00:26:10.475 I need to remember to call. 00:26:10.475 --> 00:26:16.080 So often they'll leave different items out as a way to try to help jog their memory. 00:26:16.920 --> 00:26:20.190 But when all those things start to mix together it doesn't 00:26:21.180 --> 00:26:22.379 doesn't work as intended. 00:26:25.220 --> 00:26:29.570 So in terms of how to screen and assess for hoarding disorder, 00:26:29.570 --> 00:26:33.290 there's a lot of really good evidence-based assessments out there. 00:26:33.290 --> 00:26:35.960 The hoarding rating scale is available online. 00:26:37.100 --> 00:26:40.910 So if you're a mental health professional or someone who works 00:26:41.030 --> 00:26:45.460 like in a housing building or senior housing building, these are questions 00:26:45.460 --> 00:26:47.290 you could certainly ask of someone. 00:26:48.730 --> 00:26:52.650 Because of the clutter, how difficult is it for you to use the rooms in your home. 00:26:53.790 --> 00:26:58.080 To what extent do you have difficulty letting go of ordinary things that 00:26:58.080 --> 00:26:59.310 other people would get rid of? 00:27:00.030 --> 00:27:02.730 Do you currently have a problem with collecting free things or 00:27:02.730 --> 00:27:06.360 buying more things than you need or that you can use or afford? 00:27:07.500 --> 00:27:11.130 To what extent do you experience emotional distress because of clutter, 00:27:11.370 --> 00:27:14.700 difficulty discarding, or problems with buying or acquiring things? 00:27:14.820 --> 00:27:18.390 And to what extent do you experience impairment in your daily life? 00:27:18.795 --> 00:27:21.855 Again, the things we were talking about, daily routine job or school, 00:27:21.855 --> 00:27:26.055 social activities, family activities, financial difficulties because of 00:27:26.055 --> 00:27:29.925 clutter, difficulty discarding, or problems with buying or acquiring things. 00:27:30.045 --> 00:27:34.635 And so if, you have a good rapport with the person and you can have a good, 00:27:34.635 --> 00:27:37.215 open, respectful conversation with them. 00:27:37.215 --> 00:27:39.735 This can be really helpful in terms of gauging. 00:27:40.465 --> 00:27:42.955 The scoring is online as well, but in general. 00:27:43.915 --> 00:27:49.435 A total score of 14 or higher is the cutoff score for hoarding disorder. 00:27:49.885 --> 00:27:53.635 So if they're averaging about a three again, it can be mild, it 00:27:53.635 --> 00:27:56.875 could be a mild hoarding disorder, but if they're averaging a three 00:27:56.875 --> 00:28:01.465 or above that tends to indicate the potential for hoarding disorder. 00:28:01.735 --> 00:28:04.345 So that's certainly one way to assess. 00:28:04.345 --> 00:28:08.185 Now if, you're in a situation where maybe the person isn't as open to talking 00:28:08.185 --> 00:28:13.525 about their clutter or their struggles, there is another way you can assess, and 00:28:13.525 --> 00:28:16.315 this is the clutter image rating scale. 00:28:16.375 --> 00:28:17.965 These are also available online. 00:28:17.965 --> 00:28:19.885 There's even an app you can download. 00:28:19.915 --> 00:28:22.045 So if this is something you might find yourself using a 00:28:22.045 --> 00:28:24.895 lot, you can, download that. 00:28:24.895 --> 00:28:27.115 But this is really helpful. 00:28:27.115 --> 00:28:31.645 It's also helpful if you see the client not in their home, right? 00:28:31.645 --> 00:28:34.855 So if you're a mental health professional and the person is coming to the 00:28:34.855 --> 00:28:38.845 office, or you're only seeing them by Zoom, you could show them this and 00:28:38.845 --> 00:28:43.270 people are pretty good at accurately describing their home situation. 00:28:43.270 --> 00:28:46.000 Again, they may not think it's a big deal if there's someone with 00:28:46.000 --> 00:28:47.740 hoarding disorder with low insight. 00:28:48.340 --> 00:28:52.060 But they can usually pretty accurately describe the level 00:28:52.060 --> 00:28:53.110 of clutter in their home. 00:28:53.920 --> 00:28:56.680 And really we're looking at the bedroom, the kitchen, and the living room. 00:28:57.670 --> 00:29:00.670 We don't really, when it comes to hoarding disorder, we're not looking at things 00:29:00.670 --> 00:29:03.490 like garages basements that aren't. 00:29:03.925 --> 00:29:07.375 Meant to be living space attics, right? 00:29:07.375 --> 00:29:10.045 Those are natural storage spaces. 00:29:10.045 --> 00:29:14.875 So if someone's attic is packed it may be causing challenges, but as 00:29:14.875 --> 00:29:18.355 long as the living areas are still functional it wouldn't necessarily 00:29:19.045 --> 00:29:20.745 be considered hoarding a disorter. 00:29:21.355 --> 00:29:23.845 So you can, you've probably been looking at these pictures and 00:29:23.845 --> 00:29:25.645 everyone's like where's, the cutoff? 00:29:26.185 --> 00:29:30.775 So for the average population, they're usually around a 1.5 in these different 00:29:30.775 --> 00:29:32.215 pictures a little bit of clutter. 00:29:33.265 --> 00:29:37.135 For someone who's at a four or above that really indicates 00:29:37.855 --> 00:29:41.845 probable hoarding disorder and a need for clinical intervention. 00:29:42.355 --> 00:29:45.355 Or if not hoarding disorder, maybe something like major depressive 00:29:45.355 --> 00:29:48.535 disorder where they just don't have the energy to clean their room. 00:29:48.595 --> 00:29:50.185 And so things tend to pile up. 00:29:51.115 --> 00:29:54.175 It may not be hoarding disorder, but four or above certainly indicates 00:29:54.175 --> 00:29:55.915 the need for clinical attention. 00:29:58.060 --> 00:30:00.400 Similarly for the kitchen, four or above. 00:30:00.400 --> 00:30:06.070 So you can see the stack of newspapers on that right hand side start to grow, 00:30:06.070 --> 00:30:10.300 things on the counter, things on the floor, surfaces on the table, starting 00:30:10.300 --> 00:30:12.940 to get more and more possessions. 00:30:15.040 --> 00:30:16.120 And then the living room. 00:30:17.245 --> 00:30:19.915 And it was interesting they created this with a group of grad students. 00:30:19.915 --> 00:30:21.355 They got some funding to do it. 00:30:21.595 --> 00:30:25.585 And so they would put like staples boxes and then add stuff over the top. 00:30:26.155 --> 00:30:30.145 And Gail Stucky who created this said the only thing she would do different 00:30:30.145 --> 00:30:35.125 is often the cluttered has more of a bowl shape, like a concave shape, as 00:30:35.125 --> 00:30:39.115 opposed to being a big mound, things tend to pile up against the walls 00:30:39.115 --> 00:30:40.645 instead of in the middle of the room. 00:30:41.425 --> 00:30:44.365 But beyond that it's still shown to be very accurate. 00:30:45.145 --> 00:30:49.615 People still can pretty easily and consistently identify 00:30:49.615 --> 00:30:50.755 their level of clutter. 00:30:51.355 --> 00:30:55.915 And it's accurate when a professional goes in and does the same level of assessment. 00:30:58.045 --> 00:31:00.925 So there certainly are options for intervention. 00:31:00.925 --> 00:31:02.425 There are things that can help. 00:31:02.545 --> 00:31:07.465 And with this slide, we're really going from an ideal situation 00:31:07.465 --> 00:31:12.475 to a less than ideal, but sometimes necessary intervention. 00:31:12.925 --> 00:31:16.915 So best case scenario at the top down, a worst case scenario. 00:31:17.665 --> 00:31:20.875 But certainly when there's a safety issue or when there's kids 00:31:20.875 --> 00:31:24.625 in the home or when potentially maybe animals are being hoarded. 00:31:25.255 --> 00:31:30.480 Sometimes there's intervention that needs to happen without the person's consent. 00:31:30.990 --> 00:31:36.060 But the first step, if at all possible, is always to have a 00:31:36.060 --> 00:31:41.790 supportive, slow, consistent, step-by-step reduction of clutter. 00:31:42.570 --> 00:31:46.440 So we really want the person to learn some of the new skills they need to be 00:31:46.440 --> 00:31:48.420 able to manage the clutter in their home. 00:31:48.420 --> 00:31:49.320 And that takes time. 00:31:49.530 --> 00:31:54.900 It's, really unlearning a lifetime of thought processes 00:31:54.900 --> 00:31:57.090 and decision making skills. 00:31:57.090 --> 00:31:59.820 And it's a whole new way of thinking about their items. 00:32:00.180 --> 00:32:01.590 And so it, it takes time. 00:32:01.590 --> 00:32:04.470 And so ideally there's some sort of behavioral coach. 00:32:04.590 --> 00:32:06.510 It doesn't have to be a mental health professional. 00:32:07.470 --> 00:32:12.330 There are, professional organizers certified professional organizers, 00:32:12.360 --> 00:32:16.590 CPOs that specialize in what they call chronic disorganization. 00:32:17.280 --> 00:32:20.280 So they can be a great resource, but really anyone. 00:32:20.760 --> 00:32:27.330 Care managers, family members, if you can have the patience and respect 00:32:27.330 --> 00:32:30.780 the person's autonomy that these are their possessions and they get to 00:32:30.780 --> 00:32:32.640 make the choice about what happens. 00:32:33.120 --> 00:32:37.770 Having that coach to help them think through whether or not to keep something. 00:32:38.220 --> 00:32:42.810 To ask questions about how likely is it you'll get to use this? 00:32:42.810 --> 00:32:43.680 Things like that. 00:32:43.770 --> 00:32:47.250 And to keep them focused on the task at hand, especially if there's someone with 00:32:47.250 --> 00:32:50.200 maybe a co-occurring ADHD diagnosis. 00:32:50.200 --> 00:32:52.960 It can be really hard for them to stay focused on clearing this 00:32:52.960 --> 00:32:55.720 one tabletop or this one chair. 00:32:56.410 --> 00:32:58.990 So having someone to keep them on task can be helpful. 00:32:59.925 --> 00:33:04.215 But certainly mental health treatment is important and has its 00:33:04.215 --> 00:33:07.845 place, especially when there's a co-occurring mental health diagnosis. 00:33:08.175 --> 00:33:11.925 So there is a form of treatment called specialized CBT for hoarding. 00:33:11.925 --> 00:33:13.725 We'll talk a little bit more about that later. 00:33:14.355 --> 00:33:19.935 And CBT is really the gold standard because so much of the clutter results 00:33:19.935 --> 00:33:25.905 from inaccurate or unhelpful thoughts about the person's possession. 00:33:25.905 --> 00:33:29.865 So the idea that I might need this someday, or I got such a great 00:33:29.865 --> 00:33:31.335 deal I don't wanna let go of it. 00:33:31.575 --> 00:33:35.205 Having someone who's really skilled at challenging some of those thoughts 00:33:35.535 --> 00:33:39.915 in a supportive and respectful way helps people learn to think 00:33:39.915 --> 00:33:41.445 differently about their items. 00:33:42.325 --> 00:33:45.085 There's group treatment options, which is something we've started 00:33:45.085 --> 00:33:46.345 at Jefferson Center as well. 00:33:46.345 --> 00:33:47.365 We'll talk more about. 00:33:48.625 --> 00:33:50.215 Community led interventions. 00:33:50.395 --> 00:33:55.165 One of the great things about the group we've started is anyone can facilitate it. 00:33:55.735 --> 00:34:00.355 It was actually the facilitator's manual was written by co-written 00:34:00.445 --> 00:34:06.415 by Randy Frost, who's out of Boston as well, and a psychologist. 00:34:06.630 --> 00:34:11.590 And really between him and Gail Stucky, they're like the people, 00:34:12.280 --> 00:34:14.020 the experts on hoarding disorder. 00:34:14.020 --> 00:34:20.800 So Randy Frost and Lee Shore, who is a gentleman who has hoarding disorder and is 00:34:20.800 --> 00:34:23.020 in recovery and continues to work on it. 00:34:23.440 --> 00:34:25.960 They together created this buried and treasures model. 00:34:25.960 --> 00:34:29.200 So it's designed to be led by someone with hoarding disorder or 00:34:29.560 --> 00:34:31.690 really anyone out in the community. 00:34:31.900 --> 00:34:37.510 It's a really written facilitator guide, so we'll talk a little bit more about 00:34:37.510 --> 00:34:41.920 that but there's certainly options if you don't have a mental health professional 00:34:42.310 --> 00:34:44.590 in your area that specializes in this. 00:34:44.590 --> 00:34:49.100 There are other options including bibliotherapy books you can read, 00:34:49.100 --> 00:34:51.139 and I've got a list at the end. 00:34:52.040 --> 00:34:57.094 Sometimes harm reduction strategies is the best intervention and we may not be 00:34:57.094 --> 00:35:03.095 able to convince the person to get rid of the majority of their possessions, but 00:35:03.095 --> 00:35:08.645 if we can explain that we need to have three foot pathways so that if there's a 00:35:08.645 --> 00:35:12.905 medical emergency or if there's a fire, people can get in and out of the home. 00:35:14.105 --> 00:35:17.015 We don't wanna have flammable objects on top of the stove. 00:35:17.075 --> 00:35:21.905 We want the heating vents to be free of clutter so that there's proper 00:35:21.905 --> 00:35:23.795 ventilation and air circulation. 00:35:24.185 --> 00:35:28.625 So if we can together create a plan that keeps the home 00:35:28.625 --> 00:35:31.385 environment safe, that's a win. 00:35:31.985 --> 00:35:33.905 That's a, worthwhile intervention. 00:35:33.905 --> 00:35:36.845 And then from there, they may make more progress or they may not. 00:35:37.475 --> 00:35:40.955 But if at least we can ensure that safety that's a huge gain. 00:35:42.515 --> 00:35:47.945 So there may come a point where because of the clutter, maybe 00:35:47.945 --> 00:35:49.925 the home falls into disrepair. 00:35:50.495 --> 00:35:53.645 Often what will happen is a refrigerator will stop working or 00:35:53.645 --> 00:35:55.085 there will be a plumbing issue. 00:35:55.085 --> 00:35:58.925 And because of the embarrassment around the clutter people with 00:35:58.925 --> 00:36:01.985 hoarding disorder will not want repairmen to come into the home. 00:36:02.135 --> 00:36:04.625 And so things can stop functioning properly. 00:36:05.195 --> 00:36:08.315 And so at a certain point, it gets to be too much for one person. 00:36:08.315 --> 00:36:12.335 And if there's health and safety concerns often they can't 00:36:12.335 --> 00:36:15.005 address things like plumbing or electrical issues on their own. 00:36:15.005 --> 00:36:20.675 So having a supported clean out where the client is there and has a support 00:36:20.675 --> 00:36:25.565 person, a a family member who's had some training or a mental health professional 00:36:25.865 --> 00:36:30.245 to help be part of the process, to have some control over the process. 00:36:30.885 --> 00:36:35.325 To help them emotionally manage the stress of having things leave 00:36:35.325 --> 00:36:39.525 the home, that can sometimes be the intervention that's needed. 00:36:40.245 --> 00:36:44.774 Sometimes that's too challenging and the person can't just, can't manage the 00:36:44.774 --> 00:36:46.725 anxiety of seeing their things leave. 00:36:46.725 --> 00:36:51.015 And so sometimes they cannot be there for their own mental health. 00:36:51.015 --> 00:36:55.064 And again, if we can involve them in the process, that tends to be better. 00:36:55.064 --> 00:36:59.384 But if that's not possible and they choose not to sometimes the 00:36:59.384 --> 00:37:03.015 clean out without the client there is the option we need to go with. 00:37:03.524 --> 00:37:07.964 And then eventually if it gets to be too extreme and the person is refusing 00:37:07.964 --> 00:37:12.464 any level of service it can lead to eviction and even homelessness. 00:37:12.464 --> 00:37:17.430 So this is definitely a situation where if we can intervene early, ideally with 00:37:17.564 --> 00:37:20.265 the client's buy-in, that's the best. 00:37:20.475 --> 00:37:23.805 And, we'll talk about some ways to have some of those conversations and 00:37:23.805 --> 00:37:26.194 encourage people to engage in treatment. 00:37:27.539 --> 00:37:30.899 But I do just wanna reemphasize the research shows that 00:37:30.899 --> 00:37:33.240 cleanouts don't actually work. 00:37:33.899 --> 00:37:38.849 This was a study that was looking at the results of cleanouts of 00:37:38.849 --> 00:37:41.069 62 older adults of their home. 00:37:41.639 --> 00:37:45.509 And what they found is 15% of the time there was sustained improvement. 00:37:45.839 --> 00:37:49.199 The level of clutter stayed low in the home. 00:37:50.639 --> 00:37:55.529 8% of the time there was some initial improvement, but eventual relapse where 00:37:55.529 --> 00:37:59.249 stuff started coming back into the home after a period of improvement. 00:38:00.299 --> 00:38:02.939 43% of the time there was no change. 00:38:02.939 --> 00:38:06.599 The level of clutter went right back to where it was before the cleanout. 00:38:07.079 --> 00:38:10.769 And in 15% of cases, the clutter actually got worse. 00:38:11.069 --> 00:38:15.990 Often if people feel that attached to items and it's that traumatic 00:38:16.229 --> 00:38:21.875 for things to leave, again, people acquire items, hang onto items 00:38:21.875 --> 00:38:23.345 because it makes them feel better. 00:38:23.555 --> 00:38:25.805 And so sometimes it can actually make the clutter worse. 00:38:25.805 --> 00:38:29.645 So it sometimes has to happen for health or safety reasons, but 00:38:29.645 --> 00:38:32.075 it's not the go-to intervention. 00:38:32.765 --> 00:38:38.615 It's just harder to make a TV show with, years and years of, weekly psychotherapy. 00:38:38.645 --> 00:38:43.355 So the cleanouts had that nice before and after effect that we like to see. 00:38:45.380 --> 00:38:49.910 So in terms of the specialized CBT for hoarding, really we wanna look 00:38:49.910 --> 00:38:51.680 at the whole picture for the person. 00:38:51.680 --> 00:38:53.090 Did they grow up in poverty? 00:38:53.090 --> 00:38:55.009 Did they have family members who hoarded? 00:38:55.250 --> 00:38:57.140 Did they experience something traumatic? 00:38:57.320 --> 00:38:59.960 Because that's gonna guide how we intervene. 00:39:00.350 --> 00:39:04.610 Perhaps they need to have trauma treatment to address their PTSD symptoms 00:39:04.940 --> 00:39:08.750 so that they're not so reliant on the clutter that's around them to soothe 00:39:08.750 --> 00:39:11.150 them or provide that sense of safety. 00:39:12.050 --> 00:39:15.770 There's techniques for enhancing motivation and really with this and as 00:39:16.190 --> 00:39:20.390 a family member or community member, what we wanna do is we don't wanna brush 00:39:20.390 --> 00:39:27.020 over the challenges or gloss over the challenges that the clutter causes. 00:39:27.589 --> 00:39:31.399 And part of it is bringing attention in a gentle and 00:39:31.399 --> 00:39:33.770 respectful way to the challenges. 00:39:33.770 --> 00:39:37.669 So saying things like, wow, it must be really hard that your daughter 00:39:37.970 --> 00:39:41.060 feels like she can't bring her kids here because it's not safe. 00:39:41.060 --> 00:39:42.350 That must be really hard. 00:39:42.980 --> 00:39:46.819 And just reflecting back, not saying, oh, she's overreacting, or, oh, that's no big 00:39:46.819 --> 00:39:49.009 deal, or, oh, you can see them elsewhere. 00:39:49.009 --> 00:39:53.060 But like really acknowledging the pain that it's caused because it's not until 00:39:53.600 --> 00:39:59.210 the discomfort of our present behaviors becomes greater than the fear of changing. 00:39:59.870 --> 00:40:01.279 Now we actually make any change. 00:40:01.279 --> 00:40:03.620 And that's true for substance abuse. 00:40:03.620 --> 00:40:05.029 That's true for smoking. 00:40:05.029 --> 00:40:06.290 That's true for overeating. 00:40:06.500 --> 00:40:10.790 There's gotta be something that triggers a level of discomfort or pain 00:40:11.299 --> 00:40:16.025 that is greater that overrides that fear of doing something different. 00:40:16.025 --> 00:40:20.435 And so part of motivational interviewing is not shaming or guilting, but 00:40:20.435 --> 00:40:25.115 just like acknowledging the reality of, wow, this is a tough situation. 00:40:25.165 --> 00:40:28.255 I'm scared that you might fall trying to go to the bathroom. 00:40:28.435 --> 00:40:29.635 I'm, worried about you. 00:40:29.635 --> 00:40:31.285 Do you ever worry about that? 00:40:32.065 --> 00:40:36.565 And just asking some of those gentle questions that can help bring attention to 00:40:36.565 --> 00:40:38.305 Yeah, this is actually pretty challenging. 00:40:39.535 --> 00:40:42.715 We wanna give people strategies for reducing their acquiring. 00:40:42.715 --> 00:40:46.705 So often we'll have clients create a list of questions that they 00:40:46.705 --> 00:40:48.055 can take with them to the store. 00:40:48.055 --> 00:40:50.425 So things like, how many of these do I already have? 00:40:52.135 --> 00:40:55.555 Is this unique enough to add to my collection? 00:40:55.885 --> 00:40:58.975 Will bringing this home help my hoarding problem? 00:40:59.545 --> 00:41:02.035 That's one that tends to be really powerful for people. 00:41:02.035 --> 00:41:06.685 So finding ways to reduce that urge to acquire and also finding other pleasurable 00:41:06.685 --> 00:41:10.165 activities that they can do instead of going shopping so that there's another 00:41:10.165 --> 00:41:16.015 way for them to get those feel good hormones that our brain tends to spurt 00:41:16.015 --> 00:41:17.605 out when we do something pleasurable. 00:41:18.745 --> 00:41:22.765 Giving them some cognitive skills around organizing problem solving. 00:41:22.795 --> 00:41:26.545 Okay, so you're worried you might need this can opener. 00:41:27.595 --> 00:41:30.355 That the first two can open burners that you have won't work 00:41:30.355 --> 00:41:31.555 and you'll need this third one. 00:41:32.215 --> 00:41:36.145 So say that happens and you need a can opener and you don't have this one. 00:41:36.145 --> 00:41:38.815 How could you solve that problem? 00:41:39.055 --> 00:41:42.115 Helping them think through some other strategies for solving their 00:41:42.115 --> 00:41:44.575 problems beyond hanging onto the item. 00:41:45.895 --> 00:41:49.435 Part of the treatment includes practicing letting go of things. 00:41:49.435 --> 00:41:53.215 Often there's the fear that if I let go of this, I won't be able to stop 00:41:53.215 --> 00:41:57.475 thinking about it, and it's gonna be so stressful, I will never recover. 00:41:57.625 --> 00:41:59.515 And that's a genuine fear. 00:41:59.995 --> 00:42:04.765 And so often we talk about doing an experiment where we let go of an item and 00:42:04.765 --> 00:42:08.515 we say, okay, so write down how long you think you'll be thinking about this item. 00:42:08.845 --> 00:42:13.135 Write down where your stress level is from a zero to 10, and then we'll 00:42:13.135 --> 00:42:17.275 check in 15 minutes later and say, okay, I want you to think back. 00:42:18.175 --> 00:42:19.855 Are you still thinking about that item? 00:42:20.245 --> 00:42:21.835 And where's their stress level at now. 00:42:22.135 --> 00:42:26.275 And often it decreases much more quickly than the person anticipates. 00:42:26.275 --> 00:42:31.175 So once they start to learn and experience that the stress and anxiety of letting 00:42:31.175 --> 00:42:33.005 something go doesn't last forever. 00:42:33.365 --> 00:42:35.585 It becomes easier to let go of other things. 00:42:36.845 --> 00:42:40.865 Challenging beliefs through different cognitive therapy strategies. 00:42:40.865 --> 00:42:45.125 Again, thinking through, is this special, is this really unique? 00:42:45.125 --> 00:42:46.895 How many of these do you have? 00:42:47.645 --> 00:42:50.285 What about this particular collection of items? 00:42:50.285 --> 00:42:51.635 So say you collect spoons. 00:42:51.935 --> 00:42:54.365 What's most important to you in your spoon collection? 00:42:55.115 --> 00:42:59.255 And maybe it's from certain states or I want one from every state. 00:42:59.255 --> 00:43:01.655 And okay, you have three from Colorado. 00:43:01.715 --> 00:43:03.305 Which one do you like the best? 00:43:03.755 --> 00:43:06.965 And helping them think through and challenge the beliefs that, 00:43:06.965 --> 00:43:09.305 no, I need every single spoon 'cause they're so special. 00:43:10.475 --> 00:43:14.645 And then having strategies to maintain their gains and prevent relapse. 00:43:14.645 --> 00:43:20.555 So again with, something like a clean out there's a lot of progress very quickly, 00:43:20.945 --> 00:43:26.945 but if there's not strategies in place to help them maintain and keep working 00:43:26.945 --> 00:43:31.355 on the incoming stuff again 'cause even if people aren't going out and acquiring 00:43:32.075 --> 00:43:36.095 things, like mail and food and clothing tend to still come into the home. 00:43:36.095 --> 00:43:39.890 So how do we manage that so that we don't get back to a place of excessive clutter? 00:43:42.995 --> 00:43:46.205 But really the community support is critical. 00:43:46.805 --> 00:43:51.185 Again, this is a situation that affects multiple systems, housing, 00:43:51.185 --> 00:43:56.045 social services, hauling services, healthcare, family, peers, 00:43:56.405 --> 00:43:57.905 certainly mental health treatment. 00:43:58.445 --> 00:43:59.900 And it can impact multiple people. 00:44:00.575 --> 00:44:02.975 That's, something that's unique about hoarding disorder. 00:44:03.275 --> 00:44:07.145 With something like depression or anxiety, someone can often hide it 00:44:07.955 --> 00:44:11.915 quite well and people may not even be aware that they're experiencing it. 00:44:11.975 --> 00:44:18.475 But with hoarding, there's this very external visible symptom of clutter. 00:44:18.595 --> 00:44:22.255 And that does impact the people who live with them and it can impact 00:44:22.315 --> 00:44:24.355 their neighbors and the community. 00:44:24.625 --> 00:44:29.995 So really we, this is a group effort and it's been great to collaborate with 00:44:30.535 --> 00:44:34.945 some of the local police departments and Jeffco code enforcement and just 00:44:34.945 --> 00:44:40.825 to have an option so that if someone us mental health professionals are generally 00:44:40.825 --> 00:44:44.655 not going out to people's homes and coming across people, we are waiting for 00:44:44.655 --> 00:44:47.085 people to come to us or be sent to us. 00:44:47.385 --> 00:44:50.805 And so the people who have the eyes and ears on the community can really 00:44:50.805 --> 00:44:52.665 be that bridge into treatment. 00:44:53.415 --> 00:44:59.475 But again, we wanna avoid shaming language or telling people things like, oh, I 00:44:59.475 --> 00:45:01.725 can't believe this has gotten this bad. 00:45:01.725 --> 00:45:03.675 Or, how can you live like this? 00:45:03.675 --> 00:45:07.185 Or sometimes we think that shaming language will motivate people and 00:45:07.185 --> 00:45:11.320 it does not, it actually does the opposite effect people get defensive 00:45:11.380 --> 00:45:13.120 and dig their heels in even more. 00:45:13.630 --> 00:45:19.810 So again it's, offering those reflections of, I can see this is pretty cluttered in 00:45:19.810 --> 00:45:21.520 here and I'm worried about your safety. 00:45:21.910 --> 00:45:25.900 I'm wondering if I can put you in touch with some folks I know 00:45:25.990 --> 00:45:29.800 that have worked with people who experience clutter like this. 00:45:30.340 --> 00:45:35.350 And and then likewise too, when you see that the person has made 00:45:35.350 --> 00:45:40.060 an effort, has made progress, reinforcing that, praising that. 00:45:40.720 --> 00:45:45.700 So often we'll hear people say I cleaned off the table so 00:45:45.700 --> 00:45:47.050 my family could have dinner. 00:45:47.380 --> 00:45:52.780 And all I heard was it's about time and why didn't you clean off this part too? 00:45:52.780 --> 00:45:58.750 And and the person's made a positive step, but has gotten shamed for it. 00:45:59.650 --> 00:46:03.430 And that's not how we reinforce behavior change. 00:46:03.430 --> 00:46:07.450 So really offering praise for the efforts for the changes that you see. 00:46:08.230 --> 00:46:14.520 And then just being that non-judgmental, respectful person that can just have an 00:46:14.520 --> 00:46:18.180 honest conversation about the impacts this is having on that person's life. 00:46:18.870 --> 00:46:20.670 So there's some great books out there. 00:46:20.670 --> 00:46:23.880 I've got a stack right here, so I'll show you so you can see. 00:46:24.570 --> 00:46:26.160 The first one is called stuff. 00:46:26.190 --> 00:46:31.330 It's by that's by Gai Steketee and Randy Frost. 00:46:32.500 --> 00:46:35.080 This is great if you're just interested in more about hoarding 00:46:35.080 --> 00:46:41.710 disorder and how it came about and the origins, and a nice good overview. 00:46:42.550 --> 00:46:47.950 For therapists, there's these treatment that work series that are 00:46:47.950 --> 00:46:49.660 put out in collaboration with samhsa. 00:46:49.660 --> 00:46:53.410 So there's a handbook on treatment for hoarding disorder 00:46:53.410 --> 00:46:54.490 that's great for therapists. 00:46:56.165 --> 00:46:57.485 The Hoarding Handbook. 00:46:57.635 --> 00:47:01.415 A Guide for Human Service Professionals would be great for someone like 00:47:01.415 --> 00:47:04.805 Adult Protective Services Workers or Housing Authority Workers. 00:47:05.195 --> 00:47:09.545 This is really for those members of the community who are often working with 00:47:09.545 --> 00:47:12.965 clients with hoarding disorder, but may or may not be in a place where they 00:47:12.965 --> 00:47:14.975 can actually address it themselves. 00:47:15.305 --> 00:47:17.135 So the Hoarding Handbook is great for that. 00:47:18.700 --> 00:47:23.800 Buried in Treasures, great book for people with hoarding disorder or for 00:47:23.800 --> 00:47:28.450 anyone who just it's a great read for mental health professionals as well. 00:47:28.450 --> 00:47:31.000 There's different exercises you can try with your clients. 00:47:31.000 --> 00:47:34.870 Similarly for families, just to get a better understanding of why people hoard 00:47:34.870 --> 00:47:36.670 and how to support someone who hoards. 00:47:37.300 --> 00:47:40.810 So this Buried in Treasures book is, also what the group we do is based 00:47:40.810 --> 00:47:42.850 on, and it's an excellent resource. 00:47:44.820 --> 00:47:46.350 Decluttering at the speed of life. 00:47:46.350 --> 00:47:49.650 This is written by a woman, Dana White, who struggled with clutter. 00:47:49.650 --> 00:47:53.250 I don't know that she would necessarily have met the criteria for hoarding 00:47:53.250 --> 00:47:59.430 disorder but she provides the strategies that have been helpful for her in 00:47:59.430 --> 00:48:01.080 getting rid of the excessive clutter. 00:48:01.080 --> 00:48:04.440 She has a blog, and I think actually the digital copy of 00:48:04.440 --> 00:48:06.150 this is like a dollar 99 today. 00:48:06.150 --> 00:48:10.620 So if you have a Kindle or a Nook or a e-reader it's on sale today. 00:48:10.620 --> 00:48:15.720 But this is great if maybe you're someone who struggles with clutter and you're 00:48:15.720 --> 00:48:20.610 not wanting the preachy, therapist, or feels like it would be preachy 00:48:20.610 --> 00:48:23.885 to have the expert book out there. 00:48:24.035 --> 00:48:26.885 This is from someone who's been there, done that, experienced it. 00:48:26.885 --> 00:48:28.955 So I think that can be a great resource. 00:48:29.315 --> 00:48:32.585 And then the last one that fell off is called Digging Out. 00:48:33.335 --> 00:48:37.025 And this is great for family members of people with hoarding disorder, how to 00:48:37.025 --> 00:48:41.285 support them, how to set boundaries, how to do some harm reduction strategies. 00:48:41.705 --> 00:48:45.965 And actually the author of this book is gonna be at the online 00:48:45.965 --> 00:48:48.155 hoarding training that I'm gonna mention here in a little bit. 00:48:50.915 --> 00:48:57.130 So the workshop that I mentioned we, have it here at Jefferson Center, but the 00:48:57.130 --> 00:48:59.500 facilitator's manual is available online. 00:48:59.500 --> 00:49:03.550 So if you again, if you are living in an apartment building and 00:49:03.760 --> 00:49:08.080 there's a few people that struggle, with clutter, you could self-lead 00:49:08.170 --> 00:49:09.670 a Buried Treasure's workshop. 00:49:10.270 --> 00:49:14.380 It's certainly helpful to have a mental health professional who's got some 00:49:14.380 --> 00:49:18.370 training in using the CBT techniques and motivational interviewing strategies. 00:49:18.820 --> 00:49:19.990 But it's not required. 00:49:20.350 --> 00:49:24.430 And the research shows that even groups led by non-professionals 00:49:24.520 --> 00:49:25.720 have good outcomes. 00:49:25.720 --> 00:49:30.310 So I would definitely encourage you to either look for a workshop in your area 00:49:30.310 --> 00:49:32.020 or think about starting one yourself. 00:49:34.180 --> 00:49:37.960 In terms of finding local resources, the international OCD Foundation is 00:49:37.960 --> 00:49:44.140 really the go-to place for resources and the reason it's the international OCD 00:49:44.140 --> 00:49:49.420 Foundation is because for a long time hoarding disorder was lumped in with OCD. 00:49:49.420 --> 00:49:52.600 There was a thought that there was the compulsion to save or 00:49:52.600 --> 00:49:54.800 the obsession with acquiring. 00:49:55.790 --> 00:50:00.680 But research since then, including scans of the brain shows that 00:50:00.950 --> 00:50:04.460 it's a pretty distinct diagnosis, both based on level of insight. 00:50:04.790 --> 00:50:08.900 People with OCD consistently know that it's a problem and it 00:50:08.900 --> 00:50:10.820 consistently causes distress. 00:50:10.820 --> 00:50:14.300 Whereas with hoarding disorder, sometimes you have that low insight where people 00:50:14.300 --> 00:50:17.720 don't think it's a big deal and they don't know why everyone's on their case. 00:50:18.980 --> 00:50:24.020 But then also just the different brain functions and where how different parts 00:50:24.020 --> 00:50:27.560 of the brain are functioning is different between OCD and hoarding disorder. 00:50:27.560 --> 00:50:31.730 But that's where the workaround hoarding disorder grew up. 00:50:31.730 --> 00:50:36.430 And so they also have great resources so you can find a provider based on 00:50:36.430 --> 00:50:38.410 your insurance, based on your location. 00:50:38.950 --> 00:50:41.740 Who has training in working with hoarding disorder? 00:50:42.460 --> 00:50:44.590 They have a conference every year. 00:50:44.590 --> 00:50:47.740 It was supposed to be in Seattle this year, and of course that's not happening. 00:50:48.250 --> 00:50:51.430 But they've shifted it to an online training and so 00:50:51.430 --> 00:50:53.050 the link is extremely long. 00:50:53.560 --> 00:50:56.470 And I know we're gonna be sending that out in a follow-up email. 00:50:57.175 --> 00:51:01.585 You could also just Google I-O-C-D-F annual hoarding disorder meeting. 00:51:02.185 --> 00:51:05.875 It's coming up next weekend, Friday August 14th. 00:51:05.875 --> 00:51:07.975 That evening they're gonna screen a movie. 00:51:08.395 --> 00:51:12.715 And then Saturday, August 15th will be the day of webinars. 00:51:12.715 --> 00:51:14.215 And there's a track for professionals. 00:51:14.215 --> 00:51:17.665 There's a track for people with hoarding disorder and their sessions 00:51:17.665 --> 00:51:19.375 specifically for family members. 00:51:19.885 --> 00:51:23.335 And it's the people who have written all the books, like these are the 00:51:23.335 --> 00:51:25.790 experts and you have access to them. 00:51:25.790 --> 00:51:31.580 I went to the in-person conference last year in Austin and it was phenomenal. 00:51:31.580 --> 00:51:35.660 They are so supportive and respectful, and there's not a lot of people doing 00:51:35.660 --> 00:51:39.080 work on hoarding disorders, so they are eager to share their knowledge 00:51:39.080 --> 00:51:40.490 and their information with you. 00:51:41.180 --> 00:51:46.370 It's $25 for community members $75 if you're a healthcare professional that 00:51:46.370 --> 00:51:48.530 wants the continuing education credits. 00:51:49.040 --> 00:51:51.890 But I would highly encourage you if this is something that's impacting 00:51:51.890 --> 00:51:55.640 your life or you wanna learn more about, that is a fantastic resource 00:51:55.640 --> 00:51:56.960 that's coming up very quickly. 00:51:59.350 --> 00:52:05.140 So I want to give a shout out to the Jefferson Center Speakers Bureau. 00:52:05.140 --> 00:52:08.680 Again, that's where we are able to offer community education like 00:52:08.680 --> 00:52:12.820 this, and so it's a free service that we provide to our community as 00:52:12.820 --> 00:52:14.590 part of our mission as a nonprofit. 00:52:15.370 --> 00:52:18.670 All presentations are given by a licensed mental health professional, 00:52:18.670 --> 00:52:20.440 and we have a variety of topics. 00:52:20.440 --> 00:52:25.960 Everything on managing anxiety, building resilience, topics related to raising 00:52:25.960 --> 00:52:30.850 kids and parenting, and managing with COVID, dealing with social isolation. 00:52:31.240 --> 00:52:35.260 There's a broad range of existing topics and presentations we have on 00:52:35.260 --> 00:52:39.220 deck, and then we can certainly custom create something if there's a group 00:52:39.520 --> 00:52:41.230 you'd like us to come present to. 00:52:43.120 --> 00:52:44.950 So some different ways to stay involved. 00:52:45.250 --> 00:52:48.740 Certainly going to our website, jcmh.org/get-involved. 00:52:48.810 --> 00:52:52.020 Donations are always appreciated, especially in this time of COVID, 00:52:52.440 --> 00:52:53.850 we're all doing more with less. 00:52:54.750 --> 00:52:58.560 Your financial contributions help support programs like this. 00:52:59.130 --> 00:53:01.740 Attending a mental health first aid class, attending one of our other 00:53:01.740 --> 00:53:05.580 webinars or online events would just encourage you to do that. 00:53:06.810 --> 00:53:08.940 So this is my contact information. 00:53:09.480 --> 00:53:13.020 You are certainly welcome to email me if you have questions. 00:53:13.020 --> 00:53:16.260 If you're interested in our next Buried in Treasures group. 00:53:16.260 --> 00:53:17.430 It's a six month group. 00:53:18.180 --> 00:53:23.670 So we don't offer it very often because it runs for quite a long time. 00:53:23.880 --> 00:53:27.300 Really treatment for hoarding disorder usually takes a minimum of nine to 00:53:27.300 --> 00:53:29.820 12 months to have a lasting impact. 00:53:29.820 --> 00:53:32.730 So we have many people who are coming through the group twice. 00:53:33.240 --> 00:53:35.400 But if that's something you might be interested in or if you 00:53:35.400 --> 00:53:38.310 have additional questions please feel free to reach out to me. 00:53:38.310 --> 00:53:42.150 I'm always happy to field those and provide any information 00:53:42.150 --> 00:53:42.955 that I can to be helpful. 00:53:45.030 --> 00:53:49.050 So with that, I see we have a few minutes for questions and answers, 00:53:49.050 --> 00:53:53.160 so I would be happy to take any, if you wanna put those in the chat box. 00:53:54.390 --> 00:53:55.410 We'll go through those now. 00:53:56.850 --> 00:53:58.860 Julia: Amy, thank you so much. 00:53:59.190 --> 00:54:03.030 We do have a couple of questions, but before we get to them, I want to 00:54:03.030 --> 00:54:07.050 remind everyone that if you wanna talk one-on-one with a therapist to ask 00:54:07.050 --> 00:54:10.770 questions or get resources you can send a private message to us in the 00:54:10.770 --> 00:54:15.630 chat and we'll get you connected in a few minutes once the webinar is over. 00:54:16.380 --> 00:54:18.660 So Amy, like I said, we do have a couple of questions. 00:54:18.900 --> 00:54:21.240 So the first one we got was, 00:54:23.685 --> 00:54:25.185 so the first one we got was. 00:54:25.725 --> 00:54:29.445 Do you frequently find compulsive shopping as a part of this disorder? 00:54:30.525 --> 00:54:30.975 Amy Miller: Yes. 00:54:30.975 --> 00:54:35.955 That would tie in with that excessive acquiring, which again is about 60% 00:54:35.955 --> 00:54:37.755 of people with hoarding disorder. 00:54:38.895 --> 00:54:42.705 Definitely in our group the group members will often describe it 00:54:42.705 --> 00:54:45.195 as the acquiring frenzy, right? 00:54:45.195 --> 00:54:48.135 They get into the store, they see an amazing deal, and it's 00:54:48.135 --> 00:54:50.865 like it hijacks their brain, and this is how they describe it. 00:54:50.865 --> 00:54:53.055 It hijacks their brain and they can't stop thinking about 00:54:53.055 --> 00:54:54.615 it, and they have to have it. 00:54:55.590 --> 00:54:56.940 Until it comes home with them. 00:54:56.940 --> 00:55:00.000 And then often they get at home and they're discouraged or they're 00:55:00.000 --> 00:55:02.730 frustrated, or they're, they don't know what to do with it. 00:55:02.730 --> 00:55:06.840 And so that, that piece can be frustrating after the rush is gone. 00:55:06.840 --> 00:55:13.350 But certainly in the moment it can be very powerful, that desire to acquire. 00:55:13.350 --> 00:55:17.520 So that's part of the workshop is learning to go in often with 00:55:17.520 --> 00:55:18.900 the support buddy at first. 00:55:19.020 --> 00:55:22.410 Before COVID there was an exercise where you could go with someone 00:55:22.410 --> 00:55:26.190 else in the group and support each other in not acquiring. 00:55:26.280 --> 00:55:29.430 Going into the store and walking out of the store without anything. 00:55:29.650 --> 00:55:32.850 Because we all need to shop, we need to buy groceries, we need to buy clothes. 00:55:33.570 --> 00:55:36.720 Those are things that are necessities and we can't avoid them forever. 00:55:37.050 --> 00:55:41.790 So part of the group's goal is to help people, again, have some strategies so 00:55:41.790 --> 00:55:45.750 that they can think through purchases in a thoughtful way, rather than getting 00:55:45.750 --> 00:55:48.060 hijacked by that acquiring frenzy. 00:55:50.025 --> 00:55:50.535 Julia: Great. 00:55:50.925 --> 00:55:52.305 And our next question is. 00:55:52.575 --> 00:55:55.725 If you have two hoarders in the same home, is treatment better 00:55:55.725 --> 00:55:58.335 performed individually or as a couple? 00:55:58.425 --> 00:56:00.735 And how do you get them both on the same page? 00:56:01.665 --> 00:56:03.765 Reducing clutter at the same time? 00:56:04.685 --> 00:56:06.935 Amy Miller: Yeah, that can be really challenging. 00:56:08.525 --> 00:56:10.835 I would say go with what you can get. 00:56:10.835 --> 00:56:14.255 If you can get both people on board, that's fantastic. 00:56:14.885 --> 00:56:17.975 If not, if there's one person who's a little bit more motivated, 00:56:17.975 --> 00:56:19.175 I would start with them. 00:56:19.595 --> 00:56:22.055 What we wanna avoid is the finger pointing. 00:56:22.145 --> 00:56:27.425 That can happen in those situations where say it's a husband and a wife, and the 00:56:27.425 --> 00:56:29.165 husband will say it's all her stuff. 00:56:29.225 --> 00:56:32.345 Her stuff's causing all the clutter she needs to get rid of it. 00:56:32.345 --> 00:56:33.395 My stuff is fine. 00:56:33.665 --> 00:56:36.095 And the wife might say the same thing about the husband. 00:56:36.485 --> 00:56:41.855 And part of it is helping them have a conversation about, okay, 00:56:41.855 --> 00:56:46.415 I'm gonna own the responsibility I have for my possessions. 00:56:46.955 --> 00:56:49.925 I can't force them to do anything they don't wanna do. 00:56:49.925 --> 00:56:52.085 I can't force them to get rid of anything. 00:56:52.355 --> 00:56:57.675 All I can do is manage my own responsibility and maybe I'll be a 00:56:57.675 --> 00:57:01.905 good example, or maybe it will inspire them to wanna to work on their stuff. 00:57:02.385 --> 00:57:04.905 Maybe it won't, I don't have any control over that. 00:57:05.835 --> 00:57:11.385 But I am gonna own the part of, the problem that I am contributing to. 00:57:12.135 --> 00:57:17.035 So it's definitely challenging and it can be the self-reinforcing cycle, but I would 00:57:17.035 --> 00:57:19.165 say if you can get both on board, great. 00:57:19.464 --> 00:57:22.375 If not go with the person who's willing to work with you. 00:57:24.144 --> 00:57:26.274 Julia: Great and our next question is. 00:57:26.935 --> 00:57:31.194 Could you talk a little bit about if there's free or low cost services that 00:57:31.194 --> 00:57:33.354 people can access for clutter removal? 00:57:33.564 --> 00:57:38.214 And to tack onto that, do you have advice for funding to 00:57:38.214 --> 00:57:39.654 assist people with cleaning? 00:57:40.615 --> 00:57:41.874 Amy Miller: Yeah, absolutely. 00:57:42.984 --> 00:57:47.085 There is some funding, at least in the Denver Metro area from Dr. Cog, the 00:57:47.085 --> 00:57:52.004 Denver Regional Council of Governments which houses the Area Agency on Aging. 00:57:52.004 --> 00:57:55.730 So the Area Agency on Aging has provided some funding for Clutter Cleanouts. 00:57:55.730 --> 00:58:01.935 And so Seniors Resource Center, if you go to SRC Seniors Resource 00:58:01.935 --> 00:58:07.214 Center aging.org has funding to help with clutter, clean outs. 00:58:07.754 --> 00:58:10.935 So that's a fantastic resource that's made a huge difference. 00:58:12.960 --> 00:58:14.520 What was the second part of that question? 00:58:15.390 --> 00:58:19.830 Julia: It was mainly about what, are some services that offer clutter removal? 00:58:19.890 --> 00:58:20.069 Yep. 00:58:21.000 --> 00:58:21.420 Amy Miller: Yeah. 00:58:21.420 --> 00:58:24.360 So for those questions, I would definitely refer you to your 00:58:24.360 --> 00:58:26.190 local area Agency on Aging. 00:58:26.190 --> 00:58:30.900 So Dr. Cog has their own information and assistance line because 00:58:30.930 --> 00:58:34.560 part of the Older Americans Act funding, at least if you're 60 plus 00:58:36.930 --> 00:58:40.710 is given to the area agency on agings to provide services to 00:58:40.710 --> 00:58:42.029 older adults in the community. 00:58:42.029 --> 00:58:46.710 So they often have subcontractors that can help with cleaning and 00:58:46.710 --> 00:58:48.180 housekeeping and things like that. 00:58:48.450 --> 00:58:51.569 And Jeffco Seniors Resource Centers, often the one we refer to. 00:58:52.350 --> 00:58:55.799 But your local area agency on aging can let you know what programs 00:58:55.799 --> 00:58:56.970 are available in your area. 00:58:59.235 --> 00:58:59.565 Julia: Great. 00:59:00.645 --> 00:59:02.385 The next question we got was. 00:59:02.955 --> 00:59:06.765 Are there other mental health providers in the Denver metro area that offer 00:59:06.765 --> 00:59:08.895 similar support groups and services? 00:59:09.495 --> 00:59:13.545 Because Jefferson Center Services, Jefferson County, Gilpin, and Clear 00:59:13.545 --> 00:59:17.025 Creek, so how would I help someone outside of that service area? 00:59:17.985 --> 00:59:18.405 Amy Miller: Yeah. 00:59:18.675 --> 00:59:19.395 It's tough. 00:59:19.425 --> 00:59:21.045 It's, there are not a lot. 00:59:21.420 --> 00:59:22.140 Of us out there. 00:59:22.140 --> 00:59:25.980 And that was part of the reason Jefferson Center decided to put the money in 00:59:25.980 --> 00:59:30.660 the effort and the staff power into creating the service line is that there's 00:59:30.660 --> 00:59:32.640 not a lot in the Denver metro area. 00:59:32.910 --> 00:59:36.720 I would refer you back to the International OCD Foundation website. 00:59:37.410 --> 00:59:41.460 And you can list or you can search I, there are a handful. 00:59:41.490 --> 00:59:45.900 I will say, I think there's a couple in Lakewood maybe one up in the, like the 00:59:45.900 --> 00:59:48.120 Boulder, Broomfield, Lewisville area. 00:59:48.630 --> 00:59:52.170 But that search tool's gonna have the most up to date information. 00:59:52.890 --> 00:59:56.250 And we will help you find the person who's, closest to you that can work with 00:59:56.250 --> 00:59:57.930 your insurance and things like that. 00:59:58.259 --> 01:00:02.430 But yeah, it's a very underserved diagnosis. 01:00:02.490 --> 01:00:05.760 Partially because it wasn't actually a diagnosis and there was no way 01:00:05.760 --> 01:00:11.880 to get reimbursed for treatment until the DSM five came out in 2013. 01:00:11.880 --> 01:00:13.880 So there's still a lot we're learning about it. 01:00:13.880 --> 01:00:18.620 There's still a lot in terms of services that that are lacking 01:00:18.980 --> 01:00:20.780 especially in rural areas. 01:00:20.780 --> 01:00:22.790 But even here in the Denver Metro, there's not a lot. 01:00:24.800 --> 01:00:26.060 It's a work in progress. 01:00:26.060 --> 01:00:28.370 But that website's a great resource. 01:00:30.440 --> 01:00:33.620 Julia: And Amy too, I know we've been doing a lot with telehealth 01:00:33.620 --> 01:00:34.760 and virtual appointments. 01:00:34.760 --> 01:00:39.260 So is that an option too for people who might live outside of our service area? 01:00:39.260 --> 01:00:42.200 If they wanted help from Jefferson Center, could they get virtual help? 01:00:43.220 --> 01:00:43.430 Amy Miller: Yeah. 01:00:43.430 --> 01:00:47.150 If it's specific to hoarding disorder I'd encourage you to send me an email. 01:00:47.360 --> 01:00:51.380 With Jefferson Center, we are the mental health center for those three counties 01:00:51.380 --> 01:00:54.380 and so those are our priority areas. 01:00:55.730 --> 01:01:00.115 But again, since there's is a scarcity of professionals working 01:01:00.115 --> 01:01:01.465 with folks with hoarding disorder. 01:01:01.465 --> 01:01:06.235 I'd encourage you to email me and we can certainly try to set something up. 01:01:06.235 --> 01:01:07.375 Telehealth has been great. 01:01:07.375 --> 01:01:09.025 We've been able to do Zoom sessions. 01:01:09.025 --> 01:01:11.545 That's how we're doing our current Buried in Treasures group. 01:01:12.055 --> 01:01:17.065 People are zooming in and it's been really great in a lot of ways. 01:01:17.065 --> 01:01:23.365 We can actually do some in person decluttering sessions and do some 01:01:23.365 --> 01:01:26.935 work in the moment as opposed to when someone comes into our office. 01:01:26.935 --> 01:01:29.845 So that certainly has expanded some options. 01:01:30.685 --> 01:01:33.475 And then, yeah, if you're outside our regular service area, just send 01:01:33.475 --> 01:01:36.955 me an email and and we'll figure out what the right path is for you. 01:01:37.705 --> 01:01:38.695 Julia: Great, thank you. 01:01:38.935 --> 01:01:41.755 I think we have time for maybe one or two more quick questions. 01:01:42.025 --> 01:01:43.675 So we did have somebody ask. 01:01:43.855 --> 01:01:46.465 Is hoarding disorder hereditary? 01:01:47.950 --> 01:01:50.380 Amy Miller: There is definitely a genetic component. 01:01:50.380 --> 01:01:54.340 So it's similar to really if you think of any sort of condition, whether 01:01:54.340 --> 01:02:00.070 that's heart disease or depression or diabetes, there's a genetic component. 01:02:00.130 --> 01:02:07.180 And so certainly a hereditary factor can increase the risk of someone developing 01:02:07.180 --> 01:02:10.750 hoarding disorder, but it's not a guarantee that just because a parent 01:02:10.750 --> 01:02:13.540 had it the child is gonna develop it. 01:02:15.190 --> 01:02:18.910 And then there's also some pieces that are hard to separate from the genetics, right? 01:02:19.030 --> 01:02:23.140 If, you grew up in the home with your biological parents, they may also 01:02:23.140 --> 01:02:27.880 have some learned behaviors around keeping things and saving things. 01:02:27.915 --> 01:02:31.270 And so it's a behavior you've learned as opposed to a genetic 01:02:32.140 --> 01:02:34.030 trait that you've inherited. 01:02:34.960 --> 01:02:40.930 So there's a, I don't love using gun metaphors there's this expression 01:02:40.930 --> 01:02:44.320 for a lot of different conditions that genetics loads the gun and 01:02:44.320 --> 01:02:46.390 your environment pulls the trigger. 01:02:46.840 --> 01:02:49.180 And that certainly seems to be true for hoarding disorder. 01:02:49.180 --> 01:02:52.660 There's a genetic component that can make you more vulnerable, and then 01:02:52.660 --> 01:02:56.560 something like trauma or learned behaviors around saving or growing up 01:02:56.560 --> 01:03:01.090 in poverty or different things like that can make it more likely that 01:03:01.090 --> 01:03:04.120 genetic risk factor will express itself. 01:03:04.295 --> 01:03:04.645 Julia: Great. 01:03:05.890 --> 01:03:11.320 And one one final question is collecting food considered hoarding? 01:03:12.250 --> 01:03:13.660 Amy Miller: Great question. 01:03:13.870 --> 01:03:14.260 Oh boy. 01:03:14.260 --> 01:03:18.280 And don't, didn't all of us go out and buy a bunch of pasta and rice 01:03:19.180 --> 01:03:20.800 and canned food during the pandemic? 01:03:21.130 --> 01:03:22.600 Yeah, this is a great question. 01:03:22.600 --> 01:03:28.330 So again it comes down to is collecting that food having a negative impact? 01:03:28.330 --> 01:03:31.210 So can you financially afford the food you're buying? 01:03:31.210 --> 01:03:36.250 Do you have a place to store it or is it starting to creep into other living 01:03:36.250 --> 01:03:38.860 areas and making those areas unusable? 01:03:41.400 --> 01:03:43.770 Are you collecting more than you can use? 01:03:43.830 --> 01:03:46.770 Is it going bad before you're able to eat it? 01:03:48.450 --> 01:03:52.230 Those are the two main factors is can you afford it, do you have a place 01:03:52.230 --> 01:03:56.550 to store it, and are you eating it in a timely manner before it goes bad? 01:03:57.060 --> 01:04:02.160 And if if those three areas are covered, it's probably not considered hoarding. 01:04:02.820 --> 01:04:06.300 The other piece too, and again this is what makes hoarding disorder unique 01:04:06.300 --> 01:04:10.380 from something like a collector, is with hoarding disorder it's all types 01:04:10.380 --> 01:04:12.120 of objects that tend to be collected. 01:04:12.180 --> 01:04:17.970 Whereas with a collector you might, maybe, you experienced hunger as a 01:04:17.970 --> 01:04:19.740 child or as an adult for that matter. 01:04:19.920 --> 01:04:24.030 And there's a comfort that having a lot of food gives you, but other items 01:04:24.030 --> 01:04:27.930 you don't have that level of attachment to, and the food isn't getting in the 01:04:27.930 --> 01:04:32.040 way of your relationships, your ability to use your home, things like that. 01:04:32.970 --> 01:04:39.135 Or a collector might be really into collecting, model cars or model airplanes 01:04:39.135 --> 01:04:42.345 or mugs or whatever the case might be. 01:04:42.345 --> 01:04:46.215 But if those collections aren't causing financial distress and 01:04:46.215 --> 01:04:49.905 they're not encroaching on the ability to use the living areas of 01:04:49.905 --> 01:04:54.105 the home then it's, then it wouldn't really fall into hoarding disorder. 01:04:55.455 --> 01:04:56.355 There's that piece too. 01:04:56.355 --> 01:05:00.615 If it's just the food it, seems to be less likely to be hoarding disorder. 01:05:01.845 --> 01:05:06.855 But potentially that would, take a little more assessment to tease out specifically. 01:05:08.445 --> 01:05:08.805 Julia: Great. 01:05:09.135 --> 01:05:13.125 Amy, thank you so much for the presentation today, and thank 01:05:13.125 --> 01:05:14.685 you everybody who's attended. 01:05:15.495 --> 01:05:19.125 Just to end, no matter what you're facing in life, like if you're feeling 01:05:19.125 --> 01:05:22.575 overwhelmed, worried, or stressed, Jefferson Center is here for you. 01:05:22.605 --> 01:05:26.505 We are open, accepting new clients and accessing care is easier than 01:05:26.505 --> 01:05:27.770 ever with virtual appointments. 01:05:28.365 --> 01:05:32.475 You can visit our website jcmh.org or follow us on Facebook for 01:05:32.475 --> 01:05:34.065 more resources and information. 01:05:34.335 --> 01:05:36.175 You can also reach us by calling (303) 425-0300. 01:05:36.242 --> 01:05:38.012 Thank you everybody and have a great day.