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A Psychological Perspective on Hoarding

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Hoarding is now being recognised as a distinct mental health difficulty of its own, with specific issues affecting access to services and psychological intervention. It can have a huge impact on a person's ability to function independently and can carry a high level of risk for themselves and others.

This report provides information, guidance and recommendations for people working with those with hoarding difficulties. It is intended to be read by clinical or counselling psychologists, and used as a resource by those working both within NHS, social care and/or independently, providing information on what hoarding is, and the evidence for psychological intervention.

 

Contents

Executive Summary

What is hoarding?

DCP recommendations

Part 1: What is hoarding and how do we recognise it?

Key points:

  • A definition of hoarding
  • People and possessions
  • Acquiring possessions - collecting or hoarding?
  • Living with possessions
  • Is hoarding part of obsessive compulsive difficulties
  • Co-presenting difficulties
  • Characteristics of hoarding difficulties
  • Digital possessions
  • Animals
  • The difficulties associated with labelling hoarding as a mental health problem
  • Social and cultural influences
  • Why hoarding matters
  • Prevalence rates of hoarding

Part 2: How hoarding can affect people's lives

Key points:

  • Self-neglect
  • Families
  • Housing
  • Accidents and fire
  • Financial costs

Part 3: Assessment of hoarding difficulties

Key points:

  • Assessment
  • Measures
  • Involving others: carers and other services
  • Formulation
  • Cognitions
  • Information-processing difficulties
  • A case example using a CBT approach
  • A case example using an integrative approach
  • Statutory powers

Part 4: Psychological therapies and interventions

Key points:

  • Assessment
  • The value of reflective practice
  • Quality of life and recovery versus 'cure'
  • Individual therapy
  • Group work
  • Working with carers and family members
  • Working with other agencies
  • NICE, BPS and other guidance

Part 5: Evaluation of how we are doing and future directions

Key points:

  • Effective interventions: a review of the evidence
  • Challenges
  • The role of the clinical psychologist
  • Research
  • Supervision
  • Continuing professional development and training
  • Hoarding and the media
  • Governance
  • Service design and workforce planning

Conclusions

References

Resources

Appendix A: DSM-5 diagnostic criteria for hoarding disorder

 

Series:

SKU: PUB-CAT-1708

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