Hoarding
Placement helps nursing students encounter a mental disorder in a real-life situation. This occurred to me in my first placement in the community. My mentor and I went to see a Lady in her house. The woman was younger than I expected; she was 52 years old. The mentor had informed me earlier about her condition. I had never before experienced a patient with a hoarding disorder. Therefore, during this visit, I came face to face with the actual look of a patient suffering from this disorder.
When we entered the house, I was astonished by the mess in the house. The lady had literary kept all her possessions in the house, and it looked messy. Unlike me, my mentor looked much unperturbed by the condition of the house. I tried to catch a glance of her, and she looked indifferent about the pile of clutter in the Lady's house. She was professional and not judgmental like I was (Holmes, 2015). After the end of the appointment with the patient, we left the house and got to our car; it was then that the mentor decided to discuss the case. She advised me that I should never judge people because of their behaviors; there is always an underlying condition that drives them to act the way they do.
While discussing the case with the mentor, various elements of care emerged. My mentor emphasized that being non-judgmental is critical in helping patients with hoarding disorder regain normal lives. The provider of care must always have hope that things may turn out well one day (Holmes, 2015). Therefore, he or she must never give up a client; instead, he or she must try different approaches with the hope that one may work. The mentor cautioned me against forceful clearance of the house in my future dealing with a client with a hoarding disorder.
An insight into the nature of the disorder would help me understand the pathogenesis of the condition; only then, can I empathize and feel compassionate towards the client. Treating people with hoarding respectfully and with their dignity goes a long way in ensuring a positive response from the client. On the contrary, my reaction when we entered the house was judgmental and subjective. I failed to take into account the nature of the disease. It is crucial therefore to be objective about the issue and express positive attitudes.
Usually, a patient with this disorder does not see hoarding as an issue they need to resolve (National Health Service (NHS), 2015). The mentor highlighted that as a prospective psychiatry nurse, it is expedient to reflect constantly on the problem of hoarding and consider all aspects of the disorder. In addition, the mentor advised me to be mindful of my values, as well as stereotypes when dealing with people with hoarding problems (Holmes, 2015). These beliefs and values can shape our judgment which can affect my assessment of the patient. A nurse should appreciate the value that the patient places on the clutter he or she hoards in the house. However, the care provider should be able to anticipate the risks to the patient, such as fire, and the clutter of used items (Holmes, 2015). The carer must ensure that the patient feels respected and understood. Of note, they must believe that the respect extends to their items, which they have accumulated in the house.
The hoarding disorder lacks clear symptoms to focus the treatment on. As a professional, I learned that focusing the treatment on improving the quality of life of the sufferer is paramount. In this light, the carer should aid the patient in seeing the risks of piling unused items in the house to make her desire to change things (Holmes, 2015). The professional should try to make him, or her appreciate the eviction threat or risk of his or her children being taken away from them. It is expedient to find out from the client the change that they can manage by determining the values that they hold dear and how they envision their lives socially and for their family. This presents the best way to engage the patient as it minimizes the chances of direct disagreement. Dealing with changes is as important as prescribing treatments for the primary condition responsible for the hoarding behavior, such as obsessive-compulsive disorder (OCD) (Pertusa et al., 2008) and dementia (Hwang et al., 1998).
The mentor confided to me that treating the hoarding disorder requires significant creativity and leadership, besides adhering to the NMC code of ethics. The National Institute for Health and Clinical Excellence [NICE] (2005) guidelines may be useful for those hoarding persons with Obsessive Compulsory Disorder (OCD) as an underlying condition. The treatment for this psychological problem is Cognitive Behavioral Therapy (CBT) (NHS, 2014). On top of this therapy, the professional handling such patients should refer to the guidance of the organization, they are working for because it elucidates risk management, as well as health and safety issues (Holmes, 2015).
Despite its association with OCD, hoarding is a distinct mental health issue. The American Psychology Association (APA) (2013) has included the condition in the DSM-5. To effectively help people with hoarding problems recover, professionals such as I, need to view it as a disease of the mind like other major disorders such as schizophrenia, depression, and bipolar among others. It is important to appreciate the complex relationship between the hoarding person and his or her possession (Pertusa et al., 2010). I learned that understanding and acknowledging the value that hoarding people place on their clutter of possession is paramount to initiating change and ultimate recovery; wherefore, the drive to change the situation must start from the patient. Of supreme importance to dealing with people with hoarding, the difficulty is an assumption of a non-judgmental attitude. In this regard, I have learned that respecting and treating such people increases the chance for them to cooperate and perceive the risks involved with hoarding and the need to get rid of the clutter.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders
(5th edn.). Arlington, VA: American Psychiatric Publishing NEED.
Holmes, S. (2015). A psychological perspective on hoarding .Leicester :British Psychology Society.
Hwang, J.-P., Tsai, S.-J., Yang, C.-H., Liu, K.-M., Ling, J.F. (1998). Hoarding behavior in dementia: A preliminary report. American Journal of Geriatric Psychiatry, 6(4), 285–289.
National Health Service (2014). Compulsive hoarding: NHS choices
National Health Service (NHS). (2015, June 19). Hoarding disorder .
National Institute for Health and Clinical Excellence (2005). Obsessive-compulsive disorder. Clinical Guideline 31. London: NICE.
Pertusa, A., Bejerot, S., Eriksson, J., Fernandez de la Cruz, L., Bonde, S., Russell, A. & Mataix-Cols, D. (2012). Do patients with hoarding disorder have autistic traits? Depression and Anxiety, 29, 210–218.
Pertusa, A., Frost, R.O. & Mataix-Cols, D. (2010). When hoarding is a symptom of OCD: A case series and implications for DSM-V. Behaviour Research and Therapy, 48, 1012–1020.
