Research focus

How can community and primary care nurses support and treat people with hoarding disorder?

Three studies highlight the complexity of hoarding disorder – and the provision of support and treatment
Image shows the contents of a hoarder's home

Three studies highlight the complexity of hoarding disorder and the provision of support and treatment

Hoarding generally defined as having persistent difficulty discarding or parting with possessions is recognised as a psychiatric disorder (American Psychiatric Association 2013) . It has a wide-ranging negative impact on individuals, their families and their community. Three studies highlight the complexity of hoarding disorder, and the provision of support and treatment.

An exploratory study on the lived experiences of hoarding in Singapore

An interpretative approach exploring the lived experience of individuals with hoarding disorder found the reasons for hoarding can be complex, with individuals feeling isolated and stigmatised, and decluttering

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Three studies highlight the complexity of hoarding disorder – and the provision of support and treatment


Picture: Alamy

Hoarding – generally defined as having persistent difficulty discarding or parting with possessions – is recognised as a psychiatric disorder (American Psychiatric Association 2013). It has a wide-ranging negative impact on individuals, their families and their community. Three studies highlight the complexity of hoarding disorder, and the provision of support and treatment.

An exploratory study on the lived experiences of hoarding in Singapore

An interpretative approach exploring the lived experience of individuals with hoarding disorder found the reasons for hoarding can be complex, with individuals feeling isolated and stigmatised, and decluttering causing distress.

The study aimed to identify the reasons for hoarding, as well as the experiences and impact of decluttering and hoarding disorder.

A total of 12 participants diagnosed with hoarding disorder using the clutter image rating scale, took part in interviews that focused on how and when the behaviour started, progression and the consequences associated with it.

Commonly hoarded items included newspapers, clothes and electronic items that were mostly stored in a disorganised way. Explanations for hoarding behaviours included:

  • Complex emotional relationships with items making them difficult to discard.
  • Family influence.
  • Future-proofing.
  • Stressful events. 

Hoarding often resulted in strained relationships between the individuals, their families and neighbours. Decluttering initiated distress, anger and helplessness, and is exacerbated by an individual’s lack of insight into the problems associated with hoarding for themselves, as well as for others.

Raising awareness of hoarding disorder among services working with vulnerable groups and communities may promote more timely and appropriate interventions for those individuals who are affected. 

Subramanian, M, Jeyagurunathan A, Devi F et al (2019) Health and Social Care in the Community. 00:1-11. doi.org/10.1111/hsc.12878

 

Older adult hoarders’ experiences of being helped by volunteers and volunteers’ experiences of helping

An exploration of older people’s and volunteers’ experience of support provision shows that volunteers can provide a flexible and informal approach to hoarding disorder, and develop a helpful therapeutic relationship.

Four older people with hoarding disorder and seven volunteers were recruited through a charity promoting independent living. Volunteers were trained to provide practical and emotional support tailored to meet their client’s goals. Duration and frequency of sessions varied according to client’s needs.

Semi-structured interviews of participants’ experiences identified four main themes:

  1. Building a trusting relationship between the client and volunteers is crucial.
  2. The informal, non-professional status, flexibility of volunteers and client-led focus are key.
  3. Clients experienced increased quality of life and other knock-on lifestyle changes.
  4. Challenges included shame, embarrassment and difficulty in discarding possessions.

The study highlighted the importance of the therapeutic relationship, and flexible informal approach to hoarding disorder and the value of volunteer support.

Ryninks K, Wallace V, Gregory J (2019) Behavioural and Cognitive Psychotherapy. 47, 697-708. doi.org/10.1017/S135246581900016X

Treating hoarding disorder with compassion-focused therapy: a pilot study examining treatment feasibility, acceptability, and exploring treatment effects

Compassion-focused therapy (CBF) may be a potential treatment option for hoarding disorder, a pilot study to evaluate CBF compared with cognitive behavioural therapy (CBT) suggests. Unlike CBT, CFT can improve emotion regulation and self-perception.

A total of 40 people who had not achieved remission one year after completing CBT received either weekly group follow-up sessions of CFT or CBT. Treatment feasibility and acceptability, and pre- and post-treatment effects, symptom severity and related dysfunctions were evaluated.

Retention rate for the CFT group was higher than for CBT; 72% compared with 37%. Treatment sessions were rated as good or excellent respectively. On completion of CFT, 77% responded to treatment; while 62% experienced a clinically significant reduction in hoarding disorder symptoms.  

Following CBT, 23% responded to treatment, with 29% achieving clinically significant symptom reduction.

Chou CY, Tsoh J, Shumway M et al (2019) British Journal of Clinical Psychology. doi: 10.1111/bjc.12228

 

Learning points

  • Developing a flexible and informal therapeutic relationship may be key to supporting individuals with hoarding disorder.
  • Volunteer or peer support can enhance the multidisciplinary team approach to working with clients who have hoarding disorder.
  • Raising professional awareness of hoarding disorder may encourage early intervention, as may public awareness to reduce stigma and encourage individuals to seek help.

Compiled by Sue Davies, independent researcher  

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