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Hoarding Disorder and Eviction Risk in a New York City Population
In Session With Carolyn Rodriguez, MD:
Hoarding Disorder and Eviction Risk in a New York City Population
Assistant Professor of Clinical Psychiatry, Columbia University Department of Psychiatry; New York State Psychiatric Institute
First published in Psychiatry Weekly, Volume 7, Issue
9, on May 7, 2012
Q: How can hoarding disorder affect housing status?
A: Hoarding disorder (HD) is characterized by difficulty discarding objects of minimal worth, which results in clutter that impairs the normal use of living spaces. HD affects 2%–5% of the population and can cause significant distress and impairment, as well as fire hazards and pest problems.1
HD may contribute to eviction and homelessness.2 We conducted a pilot study that assessed the prevalence of HD in a population seeking help from a non-profit eviction prevention organization in New York City, Eviction Intervention Services (EIS). The participants (n=115) were older than 18 and English- or Spanish-speaking. We evaluated clients with a face-to-face interview, along with a clinician-administered assessment for hoarding diagnosis and a self-rating assessment for hoarding severity. The participants’ average age was 44 years; 82% were female, 57% were Hispanic, and 70% had 1 or more children at home. Twenty-two percent of subjects met the criteria for HD (n=25), and there was a very high agreement between the clinician-administered and the self-rating assessments. Only half of HD subjects were receiving any type of mental health care.
Of those subjects with confirmed HD, 32% were threatened with eviction, 44% had a history of prior legal proceedings, and 20% were evicted from their home 1 or more times. The overall prevalence of HD in this sample was 22%, which is 5–10 times greater than in the general population (estimated to be 2%–5%). We were surprised to find that the rates of current and past eviction proceedings were greater in the non-HD subset than those of the HD subset. We speculate that those with HD were contacting EIS prior to actually getting an eviction notice, possibly because of anxiety about potentially losing their possessions.
Embarrassed by their hoarding, individuals rarely seek treatment and keep the problem hidden. Only in emergencies (eg, a water leak or pest infestation) does this problem come to the attention of a landlord or family member. We believe that the point when individuals with hoarding reach out for help related to housing issues is a great time to identify, engage, and motivate them for treatment.
Q: Is there a consistent sociodemographic profile for people with HD?
A: Although there is no “typical” profile, some studies of individuals with HD suggest that a majority tend to be older individuals. In our clinic, we often see individuals who are employed, articulate, well-dressed, and whose friends, family, and neighbors would be very surprised to know that they have HD. Hoarding behaviors represent a significant safety risk for the individual and community, and treatments are available, including SSRI medication, and specialized cognitive behavioral therapy.
Disclosure: Dr. Rodriguez received grant support for this work from the NIMH (T32 MH015144-3), and the New York State Office of Mental Health Policy Scholar Program Fellowship.
References:
1. Mataix-Cols D, Frost RO, Pertusa A, et al. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety. 2010;27:556-572.
2. Tolin DF, Frost RO, Steketee G, Gray KD, Fitch KE. The economic and social burden of compulsive hoarding. Psychiatry Res. 2008;160:200-211.