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Helping The Hoarders


Public officials are calling it the worst case of hoarding in southern Nevada history. Now Kenneth Epstein has been removedfrom his Sun City Summerlin home, where he had been living among 40 tons of garbage including five refrigerators filled with rotting food and five dead cats.  

Beyond the mere accumulation of clutter, hoarders’ fear of discarding objects can lead to unsanitary living conditions and social isolation. While Epstein’s case is extreme, hoarding affects between two and five percent of the population.

Dr. Christiana Bratiotis is the Assistant Professor of Social Work at the University of Nebraska, and co-author of The Hoarding Handbook: A Guide for Human Services Professionals:

Usually how are hoarders exposed? Is it through a family member? Is it neighbors calling complaining about code violations, or is there some other way?

Typically cases of this severity are brought to light through the involvement of public officials, which is true in this case. Sometimes it is a concerned family member, or a friend, or a faith community member who says, “Oh I haven’t seen this person in awhile, and I’m quite concerned.” But often, cases of hoarding go unacknowledged for decades of life, which really is the time period during which the amassing of this amount of possessions occurs. This is not a problem that occurs overnight. Typically we find that people like this gentleman don’t have visitors to their home for sometimes decades at a time. So no one has actually been inside the residence to see the condition of the home.

When someone finally approaches them to help, how do they generally tend to react?

It’s important to remember that hoarding disorder is a mental illness. This is not a problem of laziness, or lack of morality or standards. This is, in fact, an illness, and so sometimes people don’t have great awareness or insight into their problem as a symptom of their illness, so they may not actually see the situation in the same way. We know from some of our neurobiological research that the visual perception on the part of people with hoarding is different. So they don’t always see the space, and often are not troubled by what’s going on in the space in the same way that others are. And sometimes they become very defensive about letting anyone in. They’re quite worried about what officials or well-meaning family members might do with their possessions, and they’re very concerned about keeping control of these objects.

How does someone accumulate 80 thousand pounds of trash, and trash in advanced states of decay at that?

We know that there is brain abnormality in functioning, so there is neurobiology involved.  There are genetic predispositions for this problem. There are also very strong attachments to objects, and beliefs about those objects, as well as strong emotions, and it’s very difficult for someone or a group of professionals going into a house like this to make sense of the fact that each and every item in there was probably there for a certain reason. We’re talking about everything from accumulated animal feces, to paper and clothing and those kinds of things. For someone with a hoarding problem, it is that each and every object is imbued with some special some kind of meaning, and perhaps they have some difficulty about making decisions about what do with things, and so they just let them pile up. After an accumulation of 20 or 30 years, those piles get quite enormous and it becomes very difficult to maintain a home. In those conditions, people then fear inviting someone in to make repairs to the home or to keep it clean, because they can’t risk having someone like an official see the condition of the home. They’re very concerned about what will happen in those cases. Then we have not only the volume of possessions, which is the hoarding, but we also have the presence of squalor, which is really filth or degradation from neglect.

In the media, they’re calling the case the worse ever seen in southern Nevada. Is this about as extreme as any case you have every heard about, or is this a fairly typical case, although maybe a little bit severe in terms of hoarding?

Certainly from a diagnostic perspective we would say this is on the severe end of both hoarding and squalor. It is important to note that like all mental illnesses, hoarding is on a continuum, and there are very mild cases and these are often the cases where people voluntarily seek mental health treatment, and they are not the kind of cases where public officials and others need to become involved … I would certainly put this on the severe end.

How does someone get help?

The research evidence suggests that a specialized form of cognitive behavioral therapy is the treatment that has shown the greatest efficacy. People respond best with an outpatient course of therapy, typically lasting about 26 weeks, working to help the person not acquire additional items and to practice getting rid of the items that they do have. .. We do hear people say things like possessions mean more to them than their relationships with people, or that they actually think of their relationships with objects as being as important as their relationships with people. The idea of him being separated from his possessions and the immediate crisis response, and it sounds like he is cooperating and that the city of Las Vegas is providing him some support tough this process, which is critically important ... If the gentleman goes back into his own home without any mental health treatment, it is very likely that he is going to re-accumulate possessions, sometimes more than the first time and sometimes quicker than the first time, especially because he will want to regain control over this situation where he is now out of control, he is not in control. So this specialized cognitive therapy is the treatment that is recommended.





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