Code Cast Podcast Ep. 2 | Is Hoarding A Disease?

Code Cast Podcast Ep. 2 | Is Hoarding A Disease?


Hi, welcome to Code Cast, the podcast
where we get to talk all things Code. This is a space where we, the Austin Code
Department, get to have a candid conversation about Code related topics
that matter to you. Subject matter experts are here to provide the best
information right to your ears so, let’s get started. After ten seasons on TV, it
is very likely that you have seen or heard of the show: Hoarders, and in this episode of Code Cast we will deep dive into a disease that literally buries the
sufferer in its symptoms. The Austin Code Department wanted to take a closer look
into the cause of the disorder to share with all of us in hopes to raise
awareness and shed light into the disease that quietly affects millions of
Americans. To speak about the topic of hoarding as Doctor Marc Kruse, PhD, Psychologist with the Austin Fire Department and Emergency Medical Services, who will talk
to us today about hoarding as a disease. Thank you Dr. Kruse for taking
the time to talk to us today about hoarding. Can you give us an overall
explanation of what hoarding is. Yes, thank you for the opportunity to talk
with you today. When we think about hoarding there’s kind of four essential
components. First, we see the individuals who hoard have what we call persistent
difficulty partying with possessions regardless of whether they actually have
any value or not. Second, the difficulty in getting rid of stuff
is really based on this belief that they need to save the items and they have
significant distress that even the idea of getting rid of the stuff that they
have. Third, the difficulty in parting with possessions results in what we call
the accumulation of stuff so much so that it begins to clutter active living
areas which reduces their ability to use those spaces. For example, the kitchens
might be so cluttered with stuff that you can’t actually go in there and cook
in them or the bedrooms might be so full of stuff that they can’t actually sleep
in their beds. Fourth, this hoarding causes either clinically significant
distress or results in significant impairment
in someone’s life and that can be social impairment it can be occupational
impairment or in some cases it can be impairment in the ability to provide a
safe living environment for themselves or for other people. Okay,
its hoarding and then considered a disease? Yes, hoarding is actually recognized as a disorder by the American Psychiatric
Association. We know that it’s associated with a number of other diseases
including things like obsessive-compulsive disorder major
depression disorder, generalized anxiety disorder and a few other things but it
is considered its own disorder. Have you heard or know that if it affects one gender more than the other? It’s really pretty interesting we believe and this is hard because a lot of people don’t spontaneously endorse these things a lot
of people who suffer from hoarding are really quite embarrassed about it but we
believe that we think that males are slightly more likely to be hoarders. Although when we look at the people who eventually do seek treatment, women are
much more likely to actually seek treatment. Is there any telling
signs for the general audience, like I am I able to spot someone that has a
hoarding behavior or that is there anything that kind of signals to people
that they’re experiencing this or that they’re possibly going through something
like this? Yeah like we just talked about a lot of
people really try to hide hoarding from other people and there is a significant
amount of embarrassment that’s associated with it and often times it’s
because they’ve received negative feedback from people in the past and so
it can really be difficult for people on the outside
to have a true understanding of how much hoarding is going on some of the signs
that we might see is that you might have someone who you’re friends with and they
won’t invite you over to their home there’s always a reason for it always an
excuse for it and even if you go and pick that person up they’re going to be
waiting outside for you and even if you urgently need to use the restroom
there’s there’s going to be an excuse for why you can’t go inside. Other things
that we might see is we might see some of the signs of people having kind of an
excessive preoccupation with acquiring new items.
For example, if if at the end of a a staff kind of get-together
someone’s going around and making sure that they’re saving all of the plates
and all the napkins and things that we might not view as having much value, not wanting those to be discarded. We might also see people have a hard time
in their own office space getting rid of things that don’t matter. They might not
want to see other people who are trying to recycle old newspapers or
magazines there’s just this preoccupation with kind of acquiring
stuff based on the belief that there might be some value. I can see that. I
could see that for somebody who’s not willing to let go of things that they
haven’t home for them that loss of parting even externally could
affect them. Yeah, absolutely and and if you have a belief that these things are
really valuable you’re gonna try to acquire them. What I imagine from the environment that a hoarder lives in. You know descriptively
I can imagine just a place that’s highly saturated with things and we perceive
that as being perhaps overwhelming. What is the perception from a hoarder when they’re in that environment? Is there any any data that can tell you or what are
some of the commentaries that you can’t let people collected about this? Yeah I
think it’s overwhelming but it’s overwhelming from a different
perspective I think if you or I walk into a hoarder’s home, someone is
who’s really gathered a lot of stuff we are overwhelmed by the amount of stuff.
Then when we start getting a closer look we’re overwhelmed by amount of
things that we consider to have really low value what we might consider to be
junk or what we might consider to be trash in some instances. We get
overwhelmed by the sheer amount of stuff. Whereas, I think people who are
struggling with hoarding they’re more overwhelmed by the emotional attachment
to things and sometimes the the more full their space gets then the worry
becomes how to kind of acquire additional space or what they’re
gonna do when they run out of space and so and so they are also overwhelmed but
it’s overwhelming from a different perspective I think that’s when it
becomes more obvious to perhaps the neighbors when they start looking for
things to hide outside in the shed or in the garage or that’s when it starts
spilling out of the house on the back porch and under the the crawlspace, and it
becomes a little bit more public. People start realizing that that’s
perhaps not what they’re used to consider normal in their own environment.
Yes, and even for folks who are considering trying to reduce or trying
to prioritize, by the time they get to that point it really has become an
overwhelming task you know I know that my wife gets frustrated when things
build up on my bathroom counter and sometimes it’s easier just to ignore
that part of the house when they walk by but if you can imagine an entire house
that’s full in some cases from ceiling to floor and so much so that
people have to kind of almost build little pathways to be able to walk
through the house. It really is an overwhelming the experience to try to
meaningfully organize that. I notice that you said when they become aware and try to you know fix the problem per se so that’s my next question do you
realize do you know that typically do they seek treatment like do they
acknowledge the fact that it is a problem and then is it is it typical for
them to seek treatment or is it still such a personal hidden and embarrassing
thing that they don’t? So it’s really is that’s a great question so we
believe that that about 75% of people who mean by diagnostic criteria for order
for a hoarding disorder will mean diagnostic criteria for at least one
other behavioral disorder but the most likely of those being either mood or
anxiety disorders. So we think about half of people who struggle with hoarding
meet diagnostic criteria for a major depressive disorder. Generalized anxiety
disorder is another one that’s very prevalent. Social phobia can be another
we see a lot as well as obsessive-compulsive disorder. So
sometimes when people seek treatment they’re not talking about the hoarding
originally again because there’s a lot of shame associated with that and so
they might come in to help resolve these other issues to seek assistance for
depression but it might not be what they initially talked about. So sometimes
we’ll work with a client for a period of time and then discover through the course as they begin to feel more comfortable that they’ll start opening
up with that. Usually it starts off with really kind of very minor
acknowledgement. “Oh I need to clean up my house,” which is something that many of us kind of talked about needing to do and struggling with and it’s and it’s not
until you really get into a deeper relationship that you ever really truly understand
what we’re talking. That can be facilitated when we have family members
who will be a part of the process who will help us recognize how significant
things are. It’s difficult for us to kind of get an idea you know is it the
hoarding that’s leading to the depression? Is it the depression that’s
leading to the hoarding? Or is it a third variable it’s contributing to both? You can certainly imagine if someone has concerns about social evaluation and
things like that they’re not gonna want to invite
somebody over into this environment. In my brief research that I was doing, I saw
that there was a relationship perhaps mentioned more on my research than in
the real world settings as far as OCD and the relationship between OCD and
hoarding can you talk a little bit about that? So hoarding used to be
considered just a subtype of OCD and so there really was that this there’s this
you’re right there’s the strong association between the two disorders.
Obsessive-compulsive disorder refers to the idea that we have these obsessive
thoughts and because we have these obsessive thoughts we engage in a
behavior compulsively to try to reduce the anxiety behind that. So from a
hoarding perspective, the obsessive thought that we would think about is
that this item has some sort of intrinsic value or even you can go into
some sort of almost a magical thinking parent and where people believe that if
they get rid of this item something bad is going to happen. If I get rid of this
box of medical supplies from 1972 it’s going to lead to some sort of a medical
emergency and I’m not going to prepare to handle it and so you can imagine that
when people have these cognitions these thoughts about their stuff they
don’t want to get rid of it because it’s not worth it. It’s also associated to
something else like I said you know it could be something that’s valuable then
it might it might present itself needed at some point right and it’s that
anxiety of like what if I don’t have it in the future right. I’m not sure if
you’ve ever had any experience working with folks, a lot of times people
from previous generations like folks who went through the Great Depression. You
know and in my wife’s grandmother who passed away several years ago but she
was known for driving to multiple grocery stores around town in order to
save eight cents on a pound of grapes. Never mind she spent four dollars and
gas over to get there but so there are some generational things and there’s
some kind of early life influences where where we get taught these messages that
some things we need to have that we need to keep them. If you’ve ever gone without
there’s a fear of what it’s going to be like to go without again and so some of
these experiences can kind of exacerbate these things and certainly those
are other factors that we want to kind of take in mind too because if you’re
gonna just go into a hoarders home and get rid of all of their stuff you’re
gonna cause a lot of distress if you don’t do the work to try to challenge
some of these thoughts and to try to give people different ways of thinking. So what are some of those approaches to help assist someone who’s suffering from this disease?
Yeah so the most effective treatment that we have for hoarding is something
called Cognitive Behavioral Therapy (CBT) and cognitive behavioral therapy has been
shown to be effective for a lot of behavioral health disorders including
depression in most anxiety disorders and so there’s there’s kind of three main
areas that we look at with CBT that’s actually call it CBT Cognitive
Therapy. The first thing that you want to do is you want to actually
try to implement things that prevent the acquisition of new materials. So if
if you’re feel as though you have this desperate need to to acquire a certain
amount of something and somebody comes in and throws a whole bunch of away
there’s gonna be a desire to kind of go and get more and so you want to actually
do some kind of response prevention to do that. Another thing that you want to
do is you want to identify what what are these thoughts that you have about
discarding this and making this donation to charity and to not have this in your
possession. What are the thoughts that are associated with that. Again, if
the belief is that if I get rid of this something bad is going to happen, or if
something bad happens I’m going to become compared and unable to handle it
then you want to be able to kind of challenge those thoughts and look at is
their objective information that suggests this. Its true, if you have this
medical kit from 1972 it might help but if you can’t access it because you don’t
know where it is it’s not really finding the mean so you want to be able to kind
of look at those as well. Then, there’s also some other forms of
treatment as well so Motivational Interviewing is one that’s been
demonstrated that has some effectiveness. Motivational Interviewing is designed to help people balance this this thing between making a change in
their life which there might be some benefit to the ambivalence about the
fear so see with that. So you know we have this drive to both make changes for
our growth and to stay exactly the same and so motivational interviewing really can
help people really kind of evaluate what are their for making the changes. You know if you tell someone they have to do something
oftentimes their initial reaction is gonna be that they don’t want to and
I’ll try to push that away but if you can get people talking about the reasons
why they want to make changes then that might actually lead to those changes
being made so motivational interviewing has been shown to be really effective to
help people quit alcohol to make changes in fitness and diet and all sorts of
stuff and it’s shown some effectiveness when people according. Another thing
that we try to encourage people to do is skills based training. For some
folks there is just this inability to distinguish between those
items that have some potential value and have no value at all and so skills
based training to help people prioritize and organize and kind of sort things
under that. Then for some people especially if there is an underlying
depression or obsessive-compulsive disorder
they might be able to work with a psychiatrist to identify medications
that can actually help improve their treatment and get them better. Is it okay for a family member to step
in and try to help someone that’s going through this, and an attempt to remove
items? I heard you just say several angles to kind of have that discussion
and one of them is like maybe start talking to them about not acquiring
anymore and then something you know to just kind of make an assessment as to
how what is your attachment to your current items. I hear those points but
as a family member who would like to step in and and take action you know is
that a good thing to do or do you think you could trigger something deeper for
somebody in aversion to having that family member even come around?
Well it depends on how they do it yeah and so certainly we want family
members to support the person getting the help they need in order to kind of
go about this process in a meaningful way. If somebody is not living in a safe
environment then something needs to be done for their health and for the health
of their neighbors, for other people who may live in the home. If you were
to walk into a person’s home and in kind of a very kind of inflammatory way and I
just start coming up with shovels and just start throwing a whole bunch of
stuff away I can see my mom doing something like that. I think it’s
something that most people would fear that if somebody finds out you know
someone’s gonna come in right get rid of everything. It’s that reinforcement
of all the shame that this is something bad the people should be embarrassed by. It reinforces all those things that make people not likely to reach out
for help. This is what is gonna happen if I
tell someone about this they’re gonna take all my stuff and if they take all
my stuff there’s the possibility that some really bad things might happen. So yes, we want family members to be involved but we want
family members to be involved in a productive way. Working with the
behavioral health expert to help kind of first of all make sure that the
behavior that’s where it has a clear idea then how significant the problem
really is because a lot of clients will will understate what they’re actually
going through. Then to be a partner some to help to help go through the process. One of the things that we want
to make sure that we do is that you know you can do something called like an
Intensive Exposure where you just throw everything away or you can do it in a
graduated process and when you do in the graduated process it gives the
opportunity for the person just to understand that getting rid of things
isn’t leading to the bad outcomes. We want to associate those
two things that they don’t have to acquire new items in order to feel safe,
not to feel prepared, to feel protected whatever it is that their concerns are.
The storyline makes sense you know to have that conversation with
someone if you realize I imagine that I have like a family member that is
experiencing this type of hoarding behavior it would be a good to
first acknowledge that this is going on, to have a conversation, a healthy
conversation, a friendly conversation, as to you know why are you acquiring and
holding on to these things, and slowly in digestible bites kind of
introduce tips to not add more and then try to kind of find the root of it and
try to help. I think that would be something that is doable for people
until eventually you can get professional help or encourage them to
get professional help. So I think some of those tips could be valuable to
people to just know that there are some things that they could do to help. If you can get people to acknowledge that that they would like to
make a reduction. So even if you can get someone to say “oh be nice if I could get
rid of ten percent” or “it would be nice if I could sleep on my own bed again.” It depends on the level of severity that they’re at and then that allows
that door to become open. Well, what are some of the things that well
you know mom or dad or brother or sister or aunt or uncle, that we don’t need (items). What are some things that we know okay we don’t need. We don’t need
this. All right well I guess anything any of the coupons that have expired, even if it’s something small, with that. This idea of making these
graduated steps, they give the person opportunity to feel successful and to
also feel as though they have some control, because if you take that control
away from them then it’s likely to lead to them feeling more
distressed as opposed to this. So, lets talk about the healing process is there a healing process for hoarders? With any type of treatment that’s the goal. You want people to feel less tied to these possessions that is one of
the Big goals that we have. We want them to to establish their own identity outside
of kind of a collector of these possessions. So the extent to which
you can remove the emotional attachment to that is one of the signs that we look
for. Other signs that we’re going to be looking for, we’re gonna be looking
for evidence that people are doing better behavior, they’re engaging more
social things. They’re taking other steps to take care of themselves
and you really want people to be able to start utilizing and seeing the
benefits that they make these changes for that. I’m assuming that just like
there is a healing process there’s possibility to relapse. Yeah, anytime
stressors get increased and and again it’s every person it’s gonna
be a little bit different. You can imagine someone for whom this provides
an opportunity to have some control over your life experiences. If all of a
sudden they lose their job or a marriage ends or an emotional trigger, that might, kind of, reinvigorate that desire to control some aspect of their life. We want to be mindful of what
those areas are and then be able to to provide someone with maybe a
different coping strategy that might be a healthier or at least less destructive
to their wellbeing. What is some resources available in
Austin for people who are experiencing hoarding or anybody who would like to
know more information or to reach out or where to start?
To find help here in Austin Texas? Well, the good news is that we have a lot
of psychologists who are really very well trained in helping people deal with
anxiety disorders. I graduated from the University of Texas at Austin where we
have some incredible researchers doing some great work and they’ve provided a
lot of really good training. People like Dr. Michael Telch and people like Dr.
Jasper Smiths have done some incredible work in the anxiety field. What
you want to make sure that you do is you want to get someone who is actually
trained in cognitive behavioral therapy someone who has work has some experience
doing exposure treatments ideally someone who has experienced successfully
helping someone deal with hoarding in the past, so they get an idea of what is
it that actually takes. A lot of the type of therapy that we do, people
come to our office and we see them once a week, and then or once every two weeks,
and then they go about their business the rest of the time, and for a
lot of people it can be very effective but for something like this you really
do need to kind of get out into the home and to make a commitment to help the
person. Again the more responsibility that we can get the individual
to take into making decisions to donate things, to throw away things, to recycle
things, the more ownership they have over the better outcome we’re going to see. So I’d recommend working with a trained professional who is CBT
experienced, who’s experienced with the exposure types of therapies and ideally
have dealt with hoarders, people who struggle with hoarding in the past. Is there anything that you’d like to conclude with? I’m really excited the Austin Code
Department is looking into this issue and trying to provide education. Not only
for our employees but our community to help people identify these concerns and
then try to help people get these assistance they need to deal with it so as just a quick reminder, hoarding refers to not only be kind of a
accumulation of a great number of things regardless of their their actual value,
but the significant distress thats associated with the idea of getting rid of it. We believe that about two to five percent of the population suffers from
some form of hoarding disorder and so the chances are pretty good that someone
that you know is struggling with this and if you know someone who’s struggling
with hoarding there are a couple of things we want you to to bear in mind. First of all, it is an actual disorder and there are actual treatments for it.
There’s really effective treatments and we strongly encourage people who are
thinking about making changes to work with someone who’s training of cognitive
behavioral therapy. The second, if you’re a family member of someone who is
struggling with hoarding, we want you to reach out to them and to let the person
know that you love them and that you care about them and to begin the process
of trying to get them to think about how might they want their lives to be a
little bit differently. It can really be very traumatic to go into someone’s home
and to remove a whole bunch of items from them
that they believe have some significant value. So instead, we want to talk with
them about identifying what their goals are and then you can be the support to
help them get connected the resources to make that happen. The Austin Code Department aims to preserve the quality of life of all Austinites. Unfortunately, hoarding is a disease that
affects not only the person, their family and friends, but also neighbors and
communities. I hope this podcast has shed light and provided tools to address this
quiet disease. I want to thank dr. Marc Kruz, PhD for joining us today and giving us his advice about hoarding. Please share this podcast topic with
someone you feel may benefit from it and stay tuned for a future podcast from the
Austin Code Department. *Code Cast podcast music playing* You’ve reached the end of another
episode of code cast the podcast, to learn more about today’s topic, or
additional resources and materials, check out www.AustinTexas.gov/code Until next time!

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