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Understanding the multiple layers of complexity associated with hoarding and children

Published online by Cambridge University Press:  12 October 2020

Jordana Muroff
Affiliation:
1Boston University School of Social Work, Boston University, Boston, MA, USA
Suzanne Chabaud
Affiliation:
2 Obsessive Compulsive Disorder Institute of Greater New Orleans, Metairie, LA, USA
Eric A. Storch
Affiliation:
3 Baylor College of Medicine, Houston, TX, USA
Corresponding
E-mail address:
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Abstract

Type
Guest Editorial
Copyright
© The Author(s) 2020. Published by Cambridge University Press

We are delighted to introduce this Special Issue on ‘Hoarding and Children’ for the journal Children Australia. To our knowledge, this is the first time a special issue of a journal has been dedicated to this vital topic which includes a collection of articles and reflections representing comprehensive literature reviews and data-driven studies, as well as perspectives from a multitude of constituencies and stakeholders.

Hoarding disorder (HD) was first defined as the ‘acquisition of and failure to discard possessions that appear to be useless or of limited value’ (p. 367) by Frost and Gross (Reference Frost and Gross1993). Since then, it has been added to the Diagnostic Statistical Manual, 5th edition (DSM-5; American Psychiatric Association, 2013) as a distinct disorder under the umbrella of obsessive-compulsive and related disorders. The prevalence rate of hoarding is 2%–5% of the population (Iervolino et al., Reference Iervolino, Perroud, Fullana, Guipponi, Cherkas, Collier and Mataix-Cols2009; Samuels et al., Reference Samuels, Bienvenu, Pinto, Murphy, Piacentini, Rauch, Fyer, Grados, Greenberg, Knowles, McCracken, Cullen, Riddle, Rasmussen, Pauls, Liang, Hoehn-Sari, Pulver and Nestadt2008) and its impact is even greater, negatively affecting individuals with HD, their children and other family members some of whom live in the home, neighbours and the broader community. Hoarding is associated with family strain, social isolation, occupational and financial difficulties, housing instability, the worsening of health conditions, safety risks (e.g., falls, fire hazards) and could result in the removal of children and elders from the home (Harris, Reference Harris2010; Mataix-Cols et al., Reference Mataix-Cols, Frost, Pertusa, Clark, Saxena, Leckman, Stein, Matsunaga and Wilhelm2010; Rodriguez et al., Reference Rodriguez, Herman, Alcon, Chen, Tannen, Essock and Simpson2012; Tolin et al., Reference Tolin, Frost, Steketee and Fitch2008a, Reference Tolin, Frost, Steketee, Gray and Fitch2008b).

While the number of studies focused on hoarding has increased greatly over the past 20 years, few of these studies have specifically focused on children and adolescents, as most have included adult samples. Yet, the age onset for hoarding is typically during adolescence – approximately 16.7 years old (Zaborski et al., Reference Zaboski, Merritt, Schrack, Gayle, Gonzalez, Guerrero, Dueñas, Soreni and Mathews2019) – and the prevalence estimates of hoarding among adolescents is about 2% (Ivanov et al., Reference Ivanov, Mataix-Cols, Serlachius, Lichtenstein, Anckarsater, Chang, Hellner Gumpert, Lundström, Långström and Rück2013). Consideration of prevalence estimates, age of onset, social and economic impairment and safety risks highlight that youth may be negatively impacted by hoarding through personal attachment, difficulty letting go and engagement in hoarding behaviour, and/or living in a home with a hoarding parent/caregiver.

This Special Issue examines childhood hoarding as well as the experiences of children of parents/caregivers who hoard, through literature reviews, case examples for illustration, personal reflections from adult children of hoarding parents (COHP), as well as commentaries from providers and advocates with expertise in multilevel interventions (clinical, community, policy, etc.)

This Special Issue starts with a focus on enhancing understanding of childhood hoarding, and relevant assessment and intervention methods. Dr. Soreni and colleagues’ paper provides a comprehensive review of the literature on the phenomenology of hoarding in childhood, including clinical features and other factors (e.g., symptoms, development, attachment, information processing, comorbidity, family, social functioning) as well as a brief client vignette. A fundamental paper by Dr. Højgaard and colleagues reviews specific and non-specific hoarding assessments for children and adolescents as well as cognitive behavioural and pharmacological treatments for children and adolescents with HD and youth with obsessive-compulsive disorder (OCD) with hoarding symptoms. They also emphasise the need for early identification and prevention utilising developmentally appropriate and validated assessments and evidence-based interventions.

Several papers also specifically focus on adult COHP and family functioning. Dr. Neziroglu and colleagues’ detailed review of the literature focused on the effects of parental hoarding on their adult children’s psychological, relational and social functioning and discuss potential clinical interventions for these adult children. An important empirical study conducted by Ms. Davidson, Dr. Ayers and team explored the association between hoarding severity with family and social functioning among adults receiving treatment for HD.

Contributions also include reflections based on lived experience as a family member of someone with hoarding. Ms. Garrett shares her compelling reflections on the lived experiences of COHP from childhood through adulthood, specifically describing perspectives on the environmental, social and psychological effects, as well as emphasising the need for research and programme and policy development to enhance understanding, identify and better serve this population. An anonymous contribution features a powerful and thoughtful personal reflection, portraying the personal experiences and perspectives, over decades, of an adult child of a parent with hoarding. Finally, a commentary and personal account by Ms. Crawford provides a picture of what it is like to be the child of someone with a hoarding problem who subsequently has had a professional career in the management and response to animal hoarding. This account highlights the similarities and differences between hoarding of objects and of animals, and the need to develop much stronger responses to the children of people who hoard animals. All of these accounts demonstrate how challenging HD is for the children of people who hoard and are moving in their portrayal of lived experiences.

Several works emphasise and illuminate the need for additional research as well as programme and policy efforts. Drs. Guzick and Storch’s keen suggestions for future research include studies on children with hoarding behaviours and children of parents with HD, as well as the generation of developmentally relevant cognitive behavioural therapy (CBT) models, assessments and evidence-based interventions. Dr. Whomsley discusses what has been learned about hoarding difficulties among adults and, given knowledge about child development and attachment theory, how this can be applied to clinical care of youth who exhibit problems with hoarding. Dr. Chabaud strongly advocates for children of parents who hoard, summarising the results from her survey of adult COHP, and emphasising the need for public policy and programming to support the efforts at protection, prevention and intervention for hoarding. Through her exceptional commentary, Dr. Bratiotis reflects on minimising the risks and negative effects of hoarding on children and families, through multidisciplinary, evidence-based and compassionate approaches and interventions addressing multiple levels (e.g., individual, family, organisation, community, policy), including policies to increase availability and access to services. Together, these papers represent the current knowledge regarding children and hoarding and existing gaps.

The finalisation of this Special Issue occurred during the COVID-19 global pandemic. ‘Stay at home’ orders/advisories and social distancing measures seem to highlight the critical nature of understanding and addressing hoarding experiences among children. This is crucial from multiple standpoints, including the effect of the pandemic on child and family mental health and the development or exacerbation of childhood hoarding behaviours and/or the effects of children being confined to cluttered homes for extended periods of time due to pandemic related restrictions. While such restrictions have been aimed at reducing the spread of COVID-19, they also may have unintended consequences. While not explicitly addressed in the articles and commentaries which were submitted just prior to the escalation of such restrictions, the pandemic highlights and accentuates existing structural barriers, gaps in services and other inequities. Future research and other efforts to understand and address children and hoarding will need to consider this added layer of complexity.

It is our hope that researchers, practitioners and those they serve will find this special issue to be informative and useful. We would like to thank the editorial team of Children Australia for this outstanding opportunity to share these extraordinary and timely contributions that will stimulate advancement in the areas of children and hoarding.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). American Psychiatric Association.Google Scholar
Frost, R. O., & Gross, R. C. (1993). The hoarding of possessions. Behaviour Research and Therapy, 31, 367381.CrossRefGoogle ScholarPubMed
Harris, J. (2010). Household hoarding and residential fires. Presented at International Congress of Applied Psychology, Melbourne, Australia.Google Scholar
Iervolino, A. C., Perroud, N., Fullana, M. A., Guipponi, M., Cherkas, L., Collier, D. A., & Mataix-Cols, D. (2009). Prevalence and heritability of compulsive hoarding: a twin study. American Journal of Psychiatry, 166(10), 11561161. doi: 10.1176/appi.ajp.2009.08121789 CrossRefGoogle ScholarPubMed
Ivanov, V.Z., Mataix-Cols, D., Serlachius, E., Lichtenstein, P., Anckarsater, H., Chang, Z., Hellner Gumpert, C., Lundström, S., Långström, N., & Rück, C. (2013). Prevalence, comorbidity and heritability of hoarding symptoms in adolescence: a population based twin study in 15-year olds. PloS One, 8(7), e69140. https://doi.org/10.1371/journal.pone.0069140 CrossRefGoogle ScholarPubMed
Mataix-Cols, D., Frost, R. O., Pertusa, A., Clark, L. A., Saxena, S., Leckman, J. F., Stein, D. J., Matsunaga, H., & Wilhelm, S. (2010). Hoarding disorder: A new diagnosis for DSM-V? Depression and Anxiety, 27, 556572.10.1002/da.20693CrossRefGoogle ScholarPubMed
Rodriguez, C. I., Herman, D., Alcon, J., Chen, S., Tannen, A., Essock, S., & Simpson, H. B. (2012). Prevalence of hoarding disorder in individuals at potential risk of eviction in New York City: a pilot study. The Journal of Nervous and Mental Disease, 200, 9194.10.1097/NMD.0b013e31823f678bCrossRefGoogle ScholarPubMed
Samuels, J. F., Bienvenu, O. J., Pinto, A., Murphy, D. L., Piacentini, J., Rauch, S. L., Fyer, A.J., Grados, M.A., Greenberg, B.D., Knowles, J.A., McCracken, J.T., Cullen, B., Riddle, M.A., Rasmussen, S.A., Pauls, D.L., Liang, K-Y., Hoehn-Sari, R., Pulver, A.E., & Nestadt, G. (2008). Sex-specific clinical correlates of hoarding in obsessive-compulsive disorder. Behavior Research and Therapy, 46(9), 10401046. doi: 10.1016/j.brat.2008.06.005 CrossRefGoogle ScholarPubMed
Tolin, D. F., Frost, R. O., Steketee, G., & Fitch, K. E. (2008a). Family burden of compulsive hoarding: results of an internet survey. Behaviour Research and Therapy, 46(3), 334344.10.1016/j.brat.2007.12.008CrossRefGoogle ScholarPubMed
Tolin, D. F., Frost, R. O., Steketee, G., Gray, K. D., & Fitch, K. E. (2008b). The economic and social burden of compulsive hoarding. Psychiatry Research, 160(2), 200211. doi: 10.1016/j.psychres.2007.08.008 CrossRefGoogle ScholarPubMed
Zaboski, B. A., 2nd Merritt, O. A., Schrack, A. P., Gayle, C., Gonzalez, M., Guerrero, L. A., Dueñas, J.A., Soreni, N., & Mathews, C. A. (2019). Hoarding: A meta-analysis of age of onset. Depression and Anxiety, 36(6), 552564, doi: 10.1002/da.22896 CrossRefGoogle ScholarPubMed
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