Making Decisions About Your Care and Treatment Form

Hoarding is a compulsion to retain an unduly large number of items because:they may be valuable in the futurethey may have sentimental valueit's difficult to decide whether they may be valuable or notit's easier to deal with them laterHoarding stems from a decision making disorder in which the cause of anxiety and distress is losing possessions. Hoarders display a larger than average amount of emotional attachment towards possessions and have more trouble throwing them out.You think hoarding is about piles and piles of garbage, but it's not about piles and piles of garbage. It's about how that person doesn't have the proper decision-making skills or the proper prioritizing skills."When they have to face a decision that isn't meaningful to them, they have signNowly "underpowered" activity in the decision-making part of the brain.[24]Hoarders feel several negative emotions when faced with throwing out or getting rid of their possessions:Patients with hoarding disorder reported more anxiety, sadness, and indecisiveness, as well as feeling "not just right," (P<0.05) and each of these four emotions correlated with the number of personal items shredded:When the emotions were compared with findings on fMRI, there were correlations between hoarding patients' anxiety and hemodynamic activity in the frontal gyrus, while feelings of indecisiveness correlated with activity in the frontal gyrus, insula, and uncus.Their feelings of sadness were linked with increased activity in the frontal and temporal gyrus as well as the ventral striatum, while "not just right" emotions correlated with heightened activity across a range of areas including the frontal gyrus, anterior cingulate cortex, insula, and hippocampus.[23]There is additional psychological and neurological evidence to suggest that hoarding may be its own disease:When asked to decide whether to throw away or keep paper items such as junk mail or newspapers, activity levels in hoarders' anterior cingulated cortex, the part of the brain responsible for decision making, became "excessive," according to the study. Essentially, they become unable to make decisions, Tolin says."People who hoard frequently become stuck in the decision-making process, which makes them less able or less willing to decide whether to keep or discard things," he says. People with OCD didn't show the same level of increased activity.[20]There are multiple causes for compulsive hoarding:Hoarders report the number one reason they keep things is that they genuinely believe they'll need them in the future.Hoarders report undue sentimentality towards objects. Objects mean more to them than they do other people.Hoarders are indecisive. They get stressed out when confronted with decisions. When the decision comes about whether to keep an object or throw it out, they typically keep it, as that's simply easier.Hoarders have difficulty distinguishing what is important. All objects are of equal importance to a hoarder, so they keep them all.Hoarders place undue importance on control of their possessions. They get extremely anxious if people move or discard some of their possessions - even if they haven't interacted with those possessions in years.Hoarders tend to procrastinate. Rather than decide what to do with an object today, they simply store it and claim they'll deal with it later, which they often don't.There is also some evidence that hoarders process information visually rather than categorically. They'll remember something based on where they last saw it, rather than remembering how to file something in a file cabinet. As such, it makes sense for hoarders to have piles of unrelated items and hoarders often have an uncanny memory of where they put something when. Some hoarders are so worried about being disconnected from their possessions that they like to see them at all times. A lot of hoarders have multiple piles around them. Psychologically, it's easier for hoarders to see possessions in piles than organize them in some other manner.Hoarders often fear that they will forget where something is if they can't see it. The result is that they often have things in piles that are visible.Hoarders have difficulty remembering where things are, which is partly why they like to have things where they can see them. This is ironic because the skepticism they have for their own memory is likely partly a function of making unreasonable demands on their memory as it's difficult to remember where a small item is, amidst many many many piles.Hoarding can be spurred by life events which make people feel like they have little control over the future, for example the loss of a loved one.Hoarding has some things in common with the Autism spectrum of diseases:Interestingly, however, when people with hoarding disorder made similar decisions about discarding junk mail that didn’t belong to them, they again showed unusual levels of activity in the anterior cingulate cortex and insula — but in this case, their brain activity was much lower than normal.The paper’s authors note that the reduced activity is a “pattern reminiscent of that seen in patients with autism,” who are often disengaged from others and who, like hoarders, have rigid routines as well as obsessive behavior. The authors suggest that this lack of brain activity could be linked with the “diminished motivation and poor insight frequently observed” in patients who hoard; that is, it may be what allows them to live amidst overwhelming clutter and piles of junk, but fail to clear it out or even be bothered by it.hoarders may feel under-stimulated when examining their cluttered home as a whole, but over-stimulated when asked to make specific decisions about what to keep and what to junk[25]Hoarding has some things in common with OCD, but there are also some differences:"only about 18% of people with hoarding symptoms meet the full criteria for OCD as it is currently defined"[21] OCD is a disease in which people are plagued by obsessive compulsions because of fears that others may view as unreasonable. In some forms of OCD the fear is contamination, so people wash their hands obsessively, etc. Both have elements of a desire for control. With OCD, optimum cleanliness controls ability to avoid germs. Cleaning up controls order in one's apartment. With hoarders, control over possessions is key.Both are linked to procrastination, indecisiveness, perfectionism. "Most people with OCD also share common difficulty with daily activities, such as tardiness, perfectionism, procrastination, indecision, discouragement and family difficulties."[16] "Compulsive hoarding is part of a discrete clinical syndrome that also includes indecisiveness, perfectionism, procrastination, difficulty organizing tasks, and avoidance behaviors."[26] Both can lead to procrastination. OCD can lead to procrastination, simply because it is stressful and imposes unrealistic demands on a person. The effort to make things perfect for cleanliness, orderliness, or to have the right items for the future can be stressful and produce anxiety. That can then generate the need to cope with that anxiety via procrastination, which leads to tardiness. It can create a certain indecision as indecision is a natural product of stress and anxiety. With hoarding the stress of dealing with decisions involving possessions spurs procrastination.Both can be thought of as an extreme response or an unrealistic drive towards perfectionism. With OCD the idea is that one can be completely germ free or completely orderly. With hoarding, it's about not making any mistakes, and not throwing anything out that could be valuable in the future. Perfectionism can be crippling. Obsessive hand washers and order seekers can spend so much time on their obsessions that they have less time for the rest of their life. Some people with OCD simply can't write papers because they want them to be perfect - they're obsessed with perfect order. Hoarding can also be crippling as people's houses can get so filled with stuff that they simply can't move.Both are triggered by stressors and spur soothing behaviors. OCD can be thought of as a compulsions with a trigger. In other words, the fear of germs triggers hand washing. The idea that things are not in perfect order triggers apartment cleaning. Sometimes a thought itself can be self-perpetuating such that someone just continues to think about it. With hoarding, each new object that enters a person's life is a potential trigger that makes them think in a way that can lead to hoarding. Will this thing be needed in the future? How will I feel if this thing is gone? Interestingly, obsessions can also be triggered by stress, and with hoarders, stress can lead to increased hoarding, simply because the hoarder feels even more overwhelmed.Both like reflect brain abnormalities that cause people to ruminate. It's likely that there are some genes that predispose people to be obsessive and lock on to certain thoughts. In OCD grooming or checking behaviors have gone awry.[17] An area of the brain called the basal ganglia is damaged in OCD, and its connections to the orbitofrontal cortex (front part of the brain) and the thalamus (deeper parts of the brain). In hoarding a different part of the brain may be damaged, but there is still an obsessive element that involves distress in very specific circumstances - in this case the decision making associated with throwing something out.Both can be amplified by generalized stress or anxiety, as both are techniques to reduce stress and anxiety. It's arguable that other genes predispose people to have certain fears, or unreasonable beliefs or opinions. OCD-like behaviors reduce stress, so environmental stressors can actually provoke OCD-like behavior as a stress reduction technique. Hoarding is also a stress reduction technique as putting off decisions reduces emotional unpleasantness and stress. Strep throat can actually damage some key brain structures and there is some evidence that damage may contribute to OCD. Specifically the basal ganglia in OCD is thought to be less effective in filtering worries, such that worries turn into compulsions more often.[19]OCD improves with antidepressants and it's possible hoarding may improve with them as well. Because both diseases can stem from anxiety, both could potentially be happened. Genes that dispose people to be vulnerable to fear in general can be an issue; patients with OCD typically respond to drugs that inhibit the reuptake of serotonin which reduces fear levels on balance. Together they likely cause OCD. The degree of obsessiveness on the fears is so intense that compulsive behavior results.Some people argue that hoarding is a subtype of OCD. There are sites that say things like thisThere are four subtypes of OCD:1. Pure obsessions2. Contamination and checking3. Symmetry/ordering/arranging4. Hoarding/saving/collectingHoarders engage in saving/collecting behavior in order to combat obsessive doubts and anxiety-provoking thoughts.Certain medications may help individuals with OCD manage symptoms; however, medication has not proven effective for reducing symptoms associated with hoarding.[1a]Let's compare hoarding with the subtypes of OCD:With OCD emotions trigger obsessions.1. With someone who has pure obsessions, anything that reminds them of that pure obsession will trigger it.2/3. It can be that some form of anxiety triggers things about which a person is commonly anxious. So, if a person gets nervous about a job interview and is generally worried about germs or contamination, the person may begin to wash their hands vigorously. Someone with a different type of OCD who wants perfect order may arrange things in their apartment to make sure everything is symmetrical etc.4. Some people argue that hoarding is a form of OCD. They argue that when people get stressed or anxious, they tend to acquire things - often things that are free or very low in cost, and that when stressed. I would argue that hoarders are actually more stressed by the fact that they don't know what to do when new objects come into their lives. Just as those with OCD perform irrational rituals to soothe anxiety, hoarders simply accumulate items to deal with irrational fears and concerns about the future - the idea that one particular item may be important at some unknown future time.Some people argue that hoarding is a separate condition, that has multiple, complicated triggers. With hoarding you have people who are indecisive in general. They don't know what the future will bring. They are overwhelmed by the process of decision making and so they tend to put things off and procrastinate. They have a bit of perfectionism, and they don't want to make the wrong decision, so instead, they postpone decisions. So when confronted with a new decision about whether to throw out, they decide to keep the item somewhere and deal with it later. They do this repeatedly for lots of items they encounter in life, and their hoard of items builds.Compulsive hoarding is thought to result from problems in one or more of these areas:Information processing. People with compulsive hoarding often have problems such as:• Difficulty categorizing their possessions (for example, deciding what is valuable and what is not)• Difficulty making decisions about what to do with possessions• Trouble remembering where things are (and so they often want to keep everything in sight so they don't forget)Beliefs about possessions. People with compulsive hoarding often:• Feel a strong sense of emotional attachment toward their possessions (for example, an object might be felt to be very special, or a part of them)• Feel a need to stay in control of their possessions (and so they don't want anyone touching or moving their possessions)• Worry about forgetting things (and use their possessions as visual reminders)Emotional distress about discarding. People with compulsive hoarding often:• Feel very anxious or upset when they have to make a decision about discarding things• Feel distressed when they see something they want and think they can't feel better until they acquire that object• Control their uncomfortable feelings by avoiding making the decision or putting it off until later[1b]Interestingly, OCD may be related to a number of other disorders involving unreasonable fears, perfection, and control:These are, body dysmorphic disorder (excessive concern about minor or imagined defects in appearance), hypochondriasis (fear of having a serious disease despite tests and reassurance by medical professionals), binge eating and trichotillamonia (pulling out scalp hair, eyebrows, eyelashes, body hair, even that of others such as children or pets). [18]Excessive praying and religiosity is another related example.Certain personality and neuropsychological factors are thought to underlie hoarding:Hoarding is a complex disorder that is believed to be associated with 4 underlying characteristics.• First there are certain core vulnerabilities including emotional dysregulation in the form of depression or anxiety along with family histories of hoarding and generally high levels of perfectionism.• Second, people who hoard appear to have difficulties processing information. In particular, these difficulties appear as problems in attention (including ADHD-like symptoms), memory, categorization, and decision-making. The areas of the brain that control these functions roughly correspond to the brain regions that have been shown to activate differently in people who hoard.• Third, people who hoard form intense emotional attachments to a wider variety of objects than do people who don’t hoard. These attachments take the form of attaching human-like qualities to inanimate objects, feeling grief at the prospect of getting rid of objects, and deriving a sense of safety from being surrounded by possessions.• Fourth, people who hoard often hold beliefs about the necessity of not wasting objects or losing opportunities that are represented by objects. Additional beliefs about the necessity of saving things to facilitate memory and appreciation of the aesthetic beauty of objects contribute to the problem.Neuropsychological tests show that hoarding is associated with diminished nonverbal attention, greater variability in reaction time, greater impulsivity, and poorer ability to detect target stimuli. Many people with hoarding problems also describe poor memory, and indicate that they keep certain possessions due to fears that they will forget relevant information or lose an important memory if they discard an object. They state that they prefer to leave objects out in the open (e.g. piling important papers on the table), rather than putting them away (e.g. in a filing cabinet) due to fear that they will forget where they placed the item or that they possess that item. Neuropsychological tests of memory functioning have revealed that hoarding individuals show impaired delayed recall (both verbal and visual), and use less effective visual recall strategies, compared to non-hoarding participants 9. Ironically, despite these apparent memory deficits, individuals with hoarding frequently report overtaxing their existing memory capacity by relying on a memory-based approach to finding objects, rather than a category-based approach. In other words, individuals with compulsive hoarding attempt to organize and find items based on visual spatial recall (remembering where an item was last seen) instead of categorical recall (remembering where a certain category of item is usually placed). Difficulty discarding possessions is also thought to result, in part, from problems of executive function (higher-level cognitive functions such as decision-making and categorization). Self-reported indecisiveness has been associated with hoarding in college and community sample. Compared to participants with OCD, hoarding participants reported greater indecisiveness on a self-report measure, and were rated by study clinicians as more indecisive. [2]Here are a few more tidbits on hoarding:Some people develop hoarding tendencies after experiencing a stressful life event that they had difficulty coping with, such as the death of a loved one, divorce, eviction or losing their possessions in a fire, according to The Mayo Clinic. ... Mental health experts also believe the disorder can be triggered by anxiety.Some hoarders seem to feel unable to process all of the things that are part of their daily lives and feel "anxious, overwhelmed and ashamed" as the piles of clutter accumulate around themThese people are often perfectionists and worry about making the right decision about what to do with each possession. The stress of trying to make a decision becomes too much for them, to the point where they avoid having to decide altogether by simply keeping everything.[4]A few more tidbits here:To the compulsive hoarder, each and every item is of value – often an exaggerated value. They believe, with almost religious fervor, that the old newspaper or tin of long-expired sardines, for example, is very valuable and must be hung onto. Even a pile of scribbled notes or rusted paperclips might come in handy, and these are an integral part of the hoarder’s personality – they have become extensions of the hoarder, and cannot be discarded.When faced with the prospect or need (as recommended or directed by a counselor working in conjunction with a cleanup crew) to get rid of these treasured and valued possessions, the compulsive hoarder may experience great anxiety or worry. [5]More here:In order to meet criteria for a diagnosis of compulsive hoarding, a person must experience signNow distress and/or impairment in functioning as a result of their hoarding behavior. Common types of functional impairment include: fire or health hazards caused by excessive clutter, infestations, inability to have guests over to the home, inability to prepare or eat food in the home, inability to find important possessions because of clutter, inability to finish tasks on time, and interpersonal conflicts caused by the clutter.What typically drives compulsive hoarding?• Discarding valuable items that might be needed or useful someday• Losing important information• Making a mistake• Being wasteful• Losing something that reminds a person of a loved one• Not being able to do things as completely or as well as one would likeTypical behaviors seen in compulsive hoarding include:• Saving far more items than are needed or can be used.• Acquisition of more items than can be used.• Avoidance of throwing things away.• Avoidance of making decisions.• Avoidance of putting possessions in appropriate storage areas, such as closets, drawers, or files.• Pervasive slowness or lateness in completing tasks.Compulsive hoarding is part of a discrete clinical syndrome that also includes indecisiveness, perfectionism, procrastination, difficulty organizing tasks, and avoidance behaviors.[9]There's a good personal story here:"Interestingly, when I showed up at [one particular client's] house, what she said to me was, 'When you're here, I'm aware of clutter, and it makes me feel awful. I get depressed; I look at myself as a horrible person. When you leave, I don't notice it anymore.' That is what a number of people have told us."People who hoard tend to live their lives visually and spatially instead of categorically like the rest of us do.[Hoarders use] possessions to make connections between people and to the world at large. ... The advertisement for the tires led to a story about her car, which led to a story about her daughter wanting to drive, and so on.[typical things hoarders save:] stacks of newspapers going back years, newspaper clippings of interesting articles, thousands of books, mountains of clothes, containers of various sorts from previous attempts to organize. ... the piles had no apparent organizational scheme.indecision seemed to stem from a flood of ideas about what might happen if she chose one action over another."If I put my clothes in the drawers, I won't be able to see them, and I'll forget I have them." ... It wasn't that she had a poor memory; she just didn't trust it. ... She was asking too much of her memory, and not surprisingly, she lacked confidence in her recall. ... she was trying to get rid of a pile of newspapers she'd already read. She said she wasn't comfortable discarding them because she couldn't remember the articles she'd read in them. Saving them would be a good substitute for her memory. Her belief that she should remember all this information, much of it unimportant for her daily life, led her to save the newspapers. It also explained why she felt that her memory was poor.Most of us live our lives categorically — at least the part of our lives dealing with objects. Tools are kept in the toolbox; bills to be paid are kept in a special place in the office area and then filed after payment; kitchen utensils go in a drawer. But Irene organized her world visually and spatially, not by category. When I asked her where her electric bill was, she said, "It's on the left side of the pile about a foot down. I remember seeing it at that spot last week, and I think I've piled about that much stuff on top of it."She simply couldn't keep her attention on things that posed a decision-making challenge or seemed boring. ... Not maintaining our attention while performing tedious tasks is certainly common, but it seemed to be especially pronounced in Irene's case.Hoarding appeared to result, at least in part, from deficits in processing information. Making decisions about whether to keep and how to organize objects requires categorization skills, confidence in one's ability to remember, and sustained attention.she kept copious notes on each book she read. Sometimes her notes approached the length of the book itself. She felt the need to collect information until she had a "complete" picture before sitting down to write. For the perfectionist Irene, anything less than perfect meant disgrace. As the end of the term approached, she had written very little, and for the first time in her life, she faced the prospect of failure.Most hoarders are capable of discarding things if they can convince themselves that the object will not be wasted, that it will go to a good home, or, as in this case, that the opportunity it presented is no longer available. But the amount of time and effort involved in attaining this certainty makes it impossible to keep up with the volume of stuff entering the home. Eventually, most hoarders give up and simply let the piles accumulate again.characteristics we had been observing in other hoarders: perfectionism, indecision, and powerful beliefs about and attachments to objects.[10]she collected a lot of the things that she had because of their sentimental attachment.[11]One hoarder talks about hoarding characteristics here:4 keywords that are found when talking about Hoarding are.: Indecisiveness, Perfectionism, Procrastination, Avoidance.reasons of why people hoard:SENTIMENTAL VALUE: MISCONCEPTION: The moment I discard of this item I discard a part of myself. MISCONCEPTION: The moment you throw something away, you let go of that specific part of your life, however insignNow it may be.DECISION MAKING:  The "What If's" that are so typical of OCD are found here too. Those with Hoarding Behavior find it extremely difficult to make decisions, and end up avoiding having to make any by keeping everything. "What if I may need this 1 day? Where is the harm in keeping just this 1 extra thing?" Not having to make the decision of discarding something literally means that they can't make any mistakes while doing so. Sounds simple enough, but how better to avoid making mistakes than to yes, avoid doing things, making decisions. You can't do anything wrong if you don't do anything. Those who don't try can't fail.MISCONCEPTION: The moment I decide to throw something away I may be making the wrong choice.ORGANIZING: MISCONCEPTION: The moment I am unable to know how to categorize an item, I will place it in sight so I will know where it is.RESPONSIBILITY:As you may see in OCD, you also have a tendency for people to feel Hyper-Responsible for what is happening around them and the people they care for. With Hoarding this can result in the accumulation of "Just- In- Case" Objects being carried around with them at all times. But you also have the obligation of HAVING to use a certain item. Discarding seems to be wasting something and this is why so many items will later on be categorized under "Recycling", "Giving Away" and so on. MISCONCEPTION: my object has a use [so] I have to keep/use it so it doesn't get wasted.CONTROL/PERFECTION: when you throw something away, it's gone and once the trash will be picked up you will never be able to find this item again. MISCONCEPTION: The moment you throw something away, you may forget its content or the way it looked and it will be gone forever. [12]More on hoarding behavior:3-part definition of clinical hoarding :The acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value (Frost and Gross, 1993).Living spaces are cluttered enough that they can't be used for the activities for which they were designed (Frost and Hartl, 1996).signNow distress or impairment in functioning caused by the hoarding.Hoarding has three components:Acquiring possessions compulsively - compulsive buying, or collecting free things.Saving all these possessions and never discarding.Not organizing and maintaining all the saved possessions.People who hoard keep things for the same reasons as anyone else:For sentimental value - emotional attachment or to remember an important life event.For utility value - the item is, or could be, useful.For aesthetic value - the item is considered to be attractive or beautiful.Frost and Gross's 1993 study of hoarders found that the most likely justification for keeping an item was future need ("I might need this someday"), followed by lack of wear or damage ("This is too good to throw away"), sentimental saving ("This means too much to me to throw away"), and lastly potential value ("This may be worth something someday"). The difference between people who hoard and people who don't, is that hoarders apply these values to a far larger number of items.[14]More here:they have uncontrollable urges to excessively buy or acquire often unnecessary items. Secondly, they have an inability to discard of these items. Finally, their hoarding behavior interferes with activities of daily living and personal relationships since they no longer have any room in their house. [15]Genetics is a factor in hoardingInstitute of Psychiatry in London in the United Kingdom found that genetics accounted for approximately 50% of the variance in compulsive hoardingThe hoarding prevalence was signNowly higher among men (4.1%) than women (2.1%). This contrasts with the higher number of women seen in clinical practice, perhaps because many more women seek treatment, said Dr. Mataix-Cols. Researchers sent the Hoarding Rating Scale–Self Report (HRS-SR) questionnaire to all 8313 active twins in the registry.[13]Hoarding often comes together with other mental illnesses:Adult ADHD – the inability to focus or control impulses – often contributes to hoarding. Like OCD, many people who hoard have ADHD, but most individuals with ADHD are not hoarders. Individuals with paranoid schizophrenia and bipolar disorder are often hoarders. However, most hoarders do not have schizophrenia or bipolar disorder.Approximately 20% of people with dementia exhibit some degree of hoarding behavior. [1a]it is most often in conjunction with obsessive-compulsive disorder (OCD) and, to a smaller extent, with attention-deficit-disorder (ADD). [5]To get an idea of prevalence: Approximately 3% of the general population has OCD.[1a]The condition is classed as a subtype of obsessive-compulsive disorder (OCD), present in 30 to 40 percent of individuals affected with OCD.[3]a conservative estimate of 2 percent to 2.5 percent of the U.S. population has a stress response that involves holding on to things because having more makes them feel safer and happier, according to Birchall[4]Some experts estimate the number at 1 percent of the population[5]Hoarding & Saving Symptoms are found in 18% to 42% of OCD patients. But most people who Hoard will also exhibit OCD symptoms.Less than 1% of the population Hoards (Non clinical populations are also known to Hoard.). [12]Hoarding can begin at an early age, but gets worse with age.It can occur in children, and we have seen it as young as 3-years old.More apparent in children are extremely intense attachments to objects and the tendency to personify things, applying human-like characteristics to objects.The typical age of onset for hoarding behavior (though not hoarding disorder) is around age 13. At that time the behavior is usually mild and would not be considered a disorder. Hoarding typically progresses to become a moderate problem in the 20’s and 30’s, and a severe problem in the 40’s and 50’s. [2]Here is the profile of a typical hoarder:Hoarders are typically: • Female; unmarried• Living alone; socially isolated• Related to other hoarders• Suffering from anxiety, depressionand/or personality disorder• Lacking insight into the problem or in denial • More entrenched in hoarding as they age[6]The site says that hoarding is more common among females, and that may be because females are more likely to seek treatment.More men are compulsive hoarders than women.[15]Treatment:[Treatment:] cognitive-behavioral therapy (CBT) may be more effective. CBT is more than just talk therapy. It goes beyond talk with the therapist often visiting the hoarder’s home and helping them to think more clearly about their possessions and learn to make decisions about them. This is the case with the Hoarders program on A&E.CBT helps patients to: Gradually confront things they fear in order to feel less afraid Learn healthier ways to cope with stressful situations Become aware of and subsequently change how they think in critical situations[5]Treatment issues:• Denial. Most hoarders see no problem with how they live.• Resistance. Because of the hoarder’s extreme emotional attachment to belongings, forced clean-outs are traumatic. Some hoarders experience catastrophic emotional responses during forced clean-outs and require emergency psychiatric care.• Ineffective. Without ongoing intervention,most dwellings revert back to an uninhabitable state within a relatively short period of time.Guidelines for working with hoarders1. Never remove anything without discussion and obtaining the individual’s permission. Never do a “surprise” clean up.2. Don’t expect miracles overnight. Progress with hoarders is slow. Removing two bags of trash may seem like a drop in the bucket to you, but to a hoarder, it may seem like a great deal3.  Let go of ideal notions of cleanliness. The hoarder may value items that appear to you as worthless or trash. The goal is not to make the home perfect or to reflect your values of cleanliness.4. Establish goals based on minimum safety requirements. [8][1a] http://www.caring.com/articles/c...[1b] http://www.harthosp.org/Institut...[2] http://www.ocfoundation.org/hoar...[3] http://www.livescience.com/7888-...[4] http://www.lifeslittlemysteries....[5] http://www.elementsbehavioralhea...[6] http://www.caring.com/static/hoa...[7] http://www.caring.com/static/hoa...[8] http://www.caring.com/static/hoa...[9] http://psychiatry.ucsd.edu/OCD_h...[10] http://www.npr.org/templates/sto...[11] http://www.npr.org/templates/tra...[12] http://understanding_ocd.tripod....[13] http://www.beachpsych.com/pages/...[14] http://www.squalorsurvivors.com/...[15] http://seamist.hubpages.com/hub/...[16] http://www.brainphysics.com/ocdf...[17] http://psychcentral.com/lib/2006...[18] http://www.anxietycare.org.uk/do...[19] http://www.afocd.org/ocd-info/wh...[20] http://www.usnews.com/news/artic...[21] http://healthland.time.com/2012/...[22] http://healthland.time.com/2012/...[23] http://www.medpagetoday.com/Psyc...[24] http://abcnews.go.com/Health/stu...[25] http://www.newser.com/story/1516...[26] http://psychiatry.ucsd.edu/OCD_h...

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Now more than ever, gays and lesbians are coming out to their parents — and they're doing it when they're quite young. In the families I researched for the book Coming Out, Coming Home: Helping Families Adjust to a Gay or Lesbian Childkids came out to their parents, on average, at age 17, with some coming out as young as 14.This is a good thing — a sign of progress — and it should be applauded. Indeed, it makes sense that gays and lesbians want to come out to their parents. Research findings suggest that for openly gay kids, having a strong relationship with parents is good for their mental health and self-esteem, and may inoculate them from suicidal feelings, substance abuse, and risky sex. For the youth in my book, coming out to their parents (who were not rejecting) gave them a sense of relief and helped solidify their identities as gay men and lesbian women — and some parents found that a son or daughter's coming out actually made their families closer and stronger than ever before.However, despite all of these benefits, sometimes it might not be a good idea for gay or lesbian (or bisexual or transgender) people to come out to their parents. Yes, you read that right — this openly gay writer is actually recommending that sometimes it is best to stay in the closet — and here's why.Despite the evidence that Americans are getting more tolerant of gay and lesbian people, parents still reject their children when they come out — ejecting them from their homes and ceasing all financial support. Some even react with violence. Other parents may feel as if their children died — and they no longer recognize the person they raised from infancy. Kids (and adults) who are considering coming out may have a hard time understanding and coping with these reactions.So, as you can see, the decision to come out is rarely easy and must be approached with caution. Here are some guidelines to help you decide.Consider NOT telling them if:1. They often say things that are anti-gay or homophobic. Have you overheard such remarks — perhaps in reference to someone else? Gay issues, such as bullying, same-sex marriage, and the repeal of "Don't Ask, Don't Tell," have been regular media topics as of late. What have you heard your parents say about these issues?2. They have threatened to hurt you if they ever found out you are gay.Sometimes parents might suspect and mistakenly think their threats will "scare you straight." However, such threats should be taken seriously and factored into your decision of whether or not to come out.3. You are financially and physically dependent on your parents. If you come out, what is the likelihood that your parents will throw you out of the house and/or withdraw all financial support (including money for college)? If the chances of this happening are strong, you might want to consider "holding off" until you have finished school, are financially independent, and have your own place to live.4. You would be devastated if they reacted badly. Could you handle it emotionally if they had a negative reaction? Don't do it if you haven't developed a tough enough skin to hear initial statements, such as "You know, now you are going to hell!" or "I would rather you told me you were a murderer." (Yes, some parents say crazy things like this out of initial shock and worry for you — they often don't mean it and regret it later.)5. Your "gut" says not to. This is a good time to trust your own "inner wisdom."Remember, this isn't a race. Putting it off for now is a decision you can always change in the future. However, if, after carefully considering all of these cautions, you decide to take the plunge, here are some guidelines:Before you tell them:1. Have a worst-case scenario plan. If you are young, and they kick you out of the house and refuse to support you or pay for college, be sure to have a disaster plan to fall back on. Where will you live? How will you get the money you need to live away from home in case you need to?2. Gather your supports. Assemble a network of sympathetic friends, relatives, and, if you are still in school, counselors and teachers — people to lean on if things get bad. Let them know you are planning on telling your parents, and that you'll need them to be available for temporary housing, a listening ear, and emotional support through the process.3. Decide that you will be OK no matter what happens. (You will!)When you tell them:1. Pick a good time and place. There may never be "the perfect time," and if there is one, you might lose your nerve and let the opportunity pass — that's ok, don't sweat it. However, do not tell them in the midst of an argument or a family crisis. You don't want to look like you are doing this to hurt your parents. Also, don't do it during an important family occasion, like a wedding, funeral, or holiday celebration — you don't want to complicate things by stealing anyone's thunder.2. As you come out to your folks, tell them you love them, and that you seek a close, honest, loving relationship with them. (That is why you're doing this, right?)3. Reassure them that you are happy and healthy. Don't try to argue them into accepting you (that rarely works). Instead, show them you are happy and healthy. Among the parents of 65 gay and lesbian youth I interviewed, seeing their children were contented and doing well seemed to assuage parents' feelings of worry, guilt, and mourning.4. Don't expect them to adjust right away. Parents need time to deal with their self-blame, mourning, guilt, and worry. Sometimes when we come out, we expect our parents to go from 0 to 60 with lightning speed. (Remember how long it took you to get used to the idea that you were gay or lesbian?) Keep this in mind, and give them at least a quarter of the time it took for you to adjust.5. Get them educational resources. Try to convince them to contact Parents, Families and Friends of Lesbians and Gays (PFLAG), a support group for parents of gays, lesbians, bisexual, and transgender persons. Their website includes lots of excellent resources (www.pflag.org(link is external)), as well as information on meetings at local chapters.And most importantly....Hang in there! If my personal, clinical, and research experiences are any indication, there is a very good chance that things will get better with time — even with parents who initially say those hateful things. In the meantime, stay optimistic and take good care of yourself — and give yourself credit for having the courage to take the risks necessary to live your life honestly and openly.

Definitely ask for a psychologist referral!  You want someone on your side who can understand your issues and be willing and eager to advocate for you with the beancounters because disability can be rather hard to get some places, like just south of the border in America.Having a psychologist means you have a more qualified specialist filling out your papers (which is a positive for you and for the government), and it means you can be seeing someone who can get to know your issues in greater depth and expertise for further government and non-profit organization provided aid.If seeing a psychologist on a regular basis is still too difficult for you, start with your initial appointment and then perhaps build up a rapport with a good therapist through distanced appointments (like via telephone, if that is easier) until you can be going into a physical office.  It would probably look good on the form if your psychologist can truthfully state that you are currently seeking regular treatment for your disorders because of how serious and debilitating they are.I don't know how disability in Canada works, but I have gone through the process in the US, and specifically for anxiety and depression, like you.  Don't settle for a reluctant or wishywashy doctor or psychologist, especially when it comes to obtaining the resources for basic survival.  I also advise doing some internet searches on how to persuasively file for disability in Canada.  Be prepared to fight for your case through an appeal, if it should come to that, and understand the requirements and processes involved in applying for disability by reading government literature and reviewing success stories on discussion websites.

I know that is hurtful. However, the best thing to do is to forgive and go on. Resentment and anger will only destroy you.“But if ye do not forgive, neither will your Father which is in heaven forgive your trespasses.” Mar_11:26“A person's wisdom yields patience; it is to one's glory to overlook an offense.” Proverbs 19:11"God so love the world that He gave His only Son, that whoever believed in Him should not perish but have eternal life" John 3:16

Departments of education and school districts always have to make decisions about what to include in their curriculum.  There are a lot of life skills that people need that aren't taught in school.  The question is should those skills be taught in schools?I teach high school, so I'll talk about that.  The typical high school curriculum is supposed to give students a broad-based education that prepares them to be citizens in a democracy and to be able to think critically.  For a democracy to work, we need educated, discerning citizens with the ability to make good decisions based on evidence and objective thought.  In theory, people who are well informed about history, culture, science, mathematics, etc., and are capable of critical, unbiased thinking, will have the tools to participate in a democracy and make good decisions for themselves and for society at large.  In addition to that, they should be learning how to be learners, how to do effective, basic research, and collaborate with other people.  If that happens, figuring out how to do procedural tasks in real life should not provide much of a challenge.  We can't possibly teach every necessary life skill people need, but we can help students become better at knowing how to acquire the skills they need.  Should we teach them how to change a tire when they can easily consult a book or search the internet to find step by step instructions for that?  Should we teach them how to balance a check book or teach them how to think mathematically and make sense of problems so that the simple task of balancing a check book (which requires simple arithmetic and the ability to enter numbers and words in columns and rows in obvious ways) is easy for them to figure out.  If we teach them to be good at critical thinking and have some problem solving skills they will be able to apply those overarching skills to all sorts of every day tasks that shouldn't be difficult for someone with decent cognitive ability  to figure out.  It's analogous to asking why a culinary school didn't teach its students the steps and ingredients to a specific recipe.  The school taught them about more general food preparation and food science skills so that they can figure out how to make a lot of specific recipes without much trouble.  They're also able to create their own recipes.So, do we want citizens with very specific skill sets that they need to get through day to day life or do we want citizens with critical thinking, problem solving, and other overarching cognitive skills that will allow them to easily acquire ANY simple, procedural skill they may come to need at any point in their lives?