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Journal of Social Service Research


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Hoarding in the Community: A Code Enforcement and


Social Service Perspective
a b a c
Joseph F. McGuire , Lauren Kaercher , Jennifer M. Park & Eric A. Storch
a
University of South Florida, Department of Psychology , Tampa , FL
b
University of South Florida, Rothman Center for Neuropsychiatry , Tampa , FL
c
University of South Florida, Departments of Pediatrics, Psychiatry, and Behavioral
Neurosciences , St. Petersburg , FL
Published online: 05 Mar 2013.

To cite this article: Joseph F. McGuire , Lauren Kaercher , Jennifer M. Park & Eric A. Storch (2013) Hoarding in the
Community: A Code Enforcement and Social Service Perspective, Journal of Social Service Research, 39:3, 335-344, DOI:
10.1080/01488376.2013.770813

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Journal of Social Service Research, 39:335344, 2013
Copyright c Taylor & Francis Group, LLC
ISSN: 0148-8376 print / 1540-7314 online
DOI: 10.1080/01488376.2013.770813

Hoarding in the Community: A Code Enforcement


and Social Service Perspective
Joseph F. McGuire
Lauren Kaercher
Jennifer M. Park
Eric A. Storch
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ABSTRACT. Hoarding behaviors endanger individuals and their communities. Although there is
a growing literature on clinically referred and elderly hoarders, there is limited information about
hoarding behaviors beyond these contexts. This study examines the frequency, characteristics, and
outcomes of cases involving hoarding encountered by code enforcement officials and social service
staff. Prior to an in-service training, 236 social service staff members completed a 43-item survey
about their experiences with cases involving hoarding. Respondents reported encountering between
two and three cases per year. Although these hoarding cases were estimated to cost more than $3,700 in
cleaning fees, 83% of respondents reported having received no prior training on dealing with hoarding.
Survey responses suggested that hoarding situations were difficult to resolve and involved multiple
community agencies. Collectively, hoarding behaviors appear to be a problem regularly encountered by
social service members, who often serve as the initial point of contact. Along with increased training,
future research is needed to develop and evaluate collaborative interagency protocols to manage this
multifaceted problem. Empirically informed interagency protocols may facilitate the timely referral of
community hoarders to mental health professionals and may lead to improved outcomes.

KEYWORDS. Compulsive hoarding, community health, animal hoarding, social service, interagency
management

Compulsive hoarding is a mental health con- sessions; 3) living spaces sufficiently cluttered so
dition that is characterized by: 1) the acquisition as to preclude activities for which those spaces
of a large number of possessions that appear to be were designed; and 4) significant distress or im-
useless or of limited value; 2) the inability and/or pairment in functioning caused by hoarding be-
subsequent failure to discard these acquired pos- haviors (Frost & Hartl, 1996). Epidemiological

Joseph F. McGuire, MA, is a doctoral student at the University of South Florida, Department of Psychology,
Tampa, FL.
Lauren Kaercher, BA, is a Research Assistant at the University of South Florida, Rothman Center for
Neuropsychiatry, Tampa, FL.
Jennifer M. Park, MA, is a doctoral student at the University of South Florida, Department of Psychology,
Tampa, FL.
Eric A. Storch, Ph.D., is the All Childrens Hospital Guild Endowed Chair and Professor at the University
of South Florida, Departments of Pediatrics, Psychiatry, and Behavioral Neurosciences, St. Petersburg, FL.
Address correspondence to: Joseph F. McGuire, University of South Florida, Department of Psychology,
4202 E. Fowler Ave., PCD 4418G, Tampa, FL 33620 (E-mail: jfmcguire@mail.usf.edu).
335
336 J. F. McGuire et al.

studies suggest that somewhere between 2.3% reached a treatment-seeking threshold. Indeed,
and 14% of the general population have a sig- there is a marked discrepancy between the report
nificant problem with hoarding (Pertusa et al., of symptom onset and the average age among
2010). When present, severe hoarding behaviors treatment-seeking individuals (4854 years of
can cause economic and social burden to indi- age; Saxena, Brody, Maidment, & Baxter, 2007;
viduals (Tolin, Frost, Steketee, Gray, & Fitch, Steketee, Frost, Tolin, Rasmussen, & Brown,
2008) and result in a diminished quality of life 2010). For those individuals who complete treat-
(Saxena et al., 2011). Distinct from many other ment, both cognitive-behavioral therapy (Ayers,
mental health conditions, hoarding behaviors not Wetherell, Golshan, & Saxena, 2011; Steketee
only pose a concern to the individual, but also et al., 2010; Tolin, Frost, & Steketee, 2007) and
present a considerable risk to the surrounding psychopharmacology have been reported to pro-
community (Frost, Steketee, & Williams, 2000). duce modest reductions in hoarding-symptom
Early accounts of hoarding suggested that severity (Saxena et al., 2007). Timely referrals
these behaviors often occurred in older adults for treatment that occur closer to symptom onset
(1525%; Marx & Cohen-Mansfield, 2003). may bolster the modest reductions in hoarding-
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Although a concern in older adults, hoarding symptom severity offered by current treatments.
behaviors have been reported to develop much As mental health professionals primarily en-
earlier in life. Indeed, self-identified adult counter severe hoarding cases mandated to treat-
hoarders reported that their hoarding symptoms ment, there likely exists a spectrum of hoarding
often developed prior to 20 years of age (Tolin, cases that remain unexamined. As an alterna-
Meunier, Frost, & Steketee, 2010). As such, tive to relying primarily on reports from men-
there appears to be a spectrum of saving and/or tal health professionals, information provided
hoarding behaviors that develop and eventually by other professionals who encounter hoarding
cause impairment in functioning (Frost & cases with community settings may offer use-
Gross, 1993; Grisham, Frost, Steketee, Kim, & ful insights. Because environmental and health-
Hood, 2006). Although hoarding behaviors are related risks posed by hoarding cases are often
suggested to occur across the spectrum of devel- brought to the attention of social service and
opment, there has been minimal examination of governmental agencies (e.g., social service agen-
hoarding behaviors in childhood through early cies, code enforcement, and health departments),
adulthood (Coles, Frost, Heimberg, & Steketee, these agencies can provide a new perspective on
2003; Storch et al., 2007, 2011). the severity and characteristics of hoarding cases
Aside from examinations in elderly or ag- in the community.
ing populations, treatment-seeking samples have Several research reports have relied upon
served as another cornerstone for information third-party informants to gather information on
on hoarding behaviors. Clinically referred and hoarding behaviors (e.g., family members, nurs-
treatment-seeking samples have yielded infor- ing staff, and physicians). Frost and colleagues
mative findings that have helped to character- recognized the utility of community profession-
ize hoarding phenomenology (see Grisham & als perspective and examined the frequency
Norberg, 2010, for a review). Alternatively, it is and nature of hoarding complaints encountered
mentionable that few hoarders seek treatment of by the health department in Massachusetts dur-
their own volition for a variety of factors (e.g., ing a 5-year period (Frost et al., 2000). Of the
limited insight, awareness, proximity of service health department officials responding to the
providers; see Tolin, 2011, for further detail). For mailed surveys (n = 88), 64% reported encoun-
instance, clinical referrals and treatment-seeking tering at least one hoarding complaint in the past
behaviors are often precipitated at the request 5 years, with most complaints lodged by neigh-
of family members, threat of eviction, or pend- bors, police, or fire department officials (Frost
ing housing condemnation (Tolin, Fitch, Frost, et al., 2000). Respondents described hoarders as
& Steketee, 2010; Tolin et al., 2008). As such, having poor insight into the sanitation of their
cases presenting for clinical treatment may have home, with less than a third of these cases indi-
chronic and persistent symptoms and/or may ex- cating cooperation with health department offi-
hibit greater severity than cases that have not cials to resolve the situation (Frost et al., 2000).
Hoarding in the Community 337

Similarly, Steketee and colleagues interviewed ing cases encountered by participants within the
social service providers working with elderly past year. Finally, we explored outcomes from
adults to assess hoarding behaviors in rela- these cases in detail to understand the current
tion to functional impairment, cognitive deficits, role of mental health professionals and other so-
and other physical and psychological conditions cial service agencies (e.g., health departments,
(Steketee, Frost, & Kim, 2001). Health care animal control) in these cases.
providers (n = 44) reported that elderly hoard-
ers were predominantly unmarried women who METHOD
lived alone, and they described them as hav-
ing poor insight into their symptoms and being Participants
resistant to change. Furthermore, Tolin and col-
leagues used an Internet survey to elicit infor- Participants attended one of two in-service
mation from families and friends of individu- trainings conducted in the state of Florida that
als with hoarding problems (Tolin, Fitch, et al., were led by study authors (J. F. M. and E. A. S.).
2010). Informants rated the individuals hoard- In-service trainings provided information about
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ing severity and level of insight and estimated the psychological model of hoarding behaviors,
the individuals response to the same questions informed attendees about family and environ-
(Tolin, Fitch, et al., 2010). More than half of mental contexts of hoarding cases, and offered
the 558 respondents reported that their respec- strategies and resources to help manage hoard-
tive individuals had poor-to-delusional insight ing situations. Respondents included 197 code
into hoarding behaviors, and they believed the enforcement officials (years of work experience,
individuals would likely underreport hoarding M = 10.1, SD = 7.18) and 39 adult social service
severity. Across these examples, third-party in- workers (years of work experience, M = 6.6,
formants appear to provide useful information SD = 7.13).
that may have been overlooked had only men-
tal health practitioners or hoarders themselves
Procedures
provided responses. Prior to the in-service training, participants
In summary, there is a spectrum of hoard- were invited to complete a 43-item survey about
ing behaviors that are reported to exist, with their professional experience with hoarding. Sur-
few examinations of hoarding behaviors going veys were passed out to all in-service training at-
beyond clinically referred and aging popula- tendees. Attendees who were interested in partic-
tions. Third-party informants who may often en- ipating completed the survey items, while those
counter hoarding cases in a community setting attendees who declined to participate did not
can provide detailed information on hoarding complete the survey. This survey was modeled
cases that may be unavailable to mental health after the one used by Frost et al. (2000), in-
professionals. In the present study, social service cluded both multiple-choice and free-response
staff members and code enforcement officials questions, and was approved by the local in-
responded to a survey about their professional stitutional review board. In an attempt to cal-
experiences with individuals with hoarding be- ibrate respondents responses about hoarding
haviors. This report investigates the frequency, situations, the survey provided a definition of
severity, and characteristics of hoarding situ- compulsive hoarding outlined by Frost & Hartl
ations encountered by these community-based (1996). The survey began with a question about
professionals. Furthermore, this report explores the frequency of cases encountered by the re-
the training received by these professionals and spondent that met criteria for the definition of
outcomes from their reported hoarding cases. compulsive hoarding within the past 12 months
First, we examined the frequency, cost, and res- (1 item). This question was followed by several
olution of hoarding cases identified in the com- questions that assessed the nature and resolution
munity. Second, we investigated the previous of encountered hoarding cases (6 items). Addi-
training on hoarding received by code enforce- tional questions focused on the financial costs
ment officials and adult social service workers. associated with hoarding and the respondents
Third, we examined the characteristics of hoard- previous training on hoarding (6 items). If the
338 J. F. McGuire et al.

participant reported professionally encountering Prevalence of Hoarding


a hoarding case, then the participant was invited
to complete detailed questions about their most There was no difference between the per-
recent hoarding case. These included questions centage of code enforcement and DCF social
about the personal characteristics of the reported service staff that encountered a hoarding situa-
hoarder, descriptions of the home environment, tion in the previous 12-month period (p > .05).
ratings of severity, and resolution of the case (30 As such, code enforcement responses were used
items). A copy of the survey used is available to estimate hoarding prevalence rates. Accord-
from the authors by request. ing to the Florida Association of Code Enforce-
ment, approximately 2,500 enforcement officers
serve the state population of more than 18 mil-
Analysis
lion people (M. Caskie, personal communica-
Data analyses were conducted using IBM tion, September 29, 2011). Census data estimate
Statistical Package for the Social Services that approximately 14,800,000 of these residents
Version 19 software. Descriptive statistics were are older than 18 years of age (U.S. Census
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calculated to ascertain the frequency, cost, Bureau, 2010). Applying the distribution of case
resolution, and reoffense of hoarding cases. frequency reported by this sample of code en-
As the total number of social service staff was forcement officers (zero cases = 25%; one case
unavailable for the Department of Children = 20%; two cases = 24%; three cases = 12%;
and Families (DCF), only code enforcement four cases = 7%; five cases = 5%; six cases
responses were used to estimate the statewide = 7%), it was estimated that 4,900 cases meet-
prevalence of hoarding. Descriptive statistics ing criteria for compulsive hoarding are encoun-
were provided on respondents who profession- tered by code enforcement annually in Florida.
ally encountered a case involving hoarding Given this approximation, the 12-month preva-
within the past year. Respondents who omitted lence rate was calculated to be 33 per 100,000.
any survey items were removed from analysis Applying the estimated median cost of clutter
using pairwise/listwise deletion. removal for these cases, costs associated with
removing accumulated clutter totaled more than
RESULTS $8.3 million per year ($18.2 million per year if
average cost is applied).
Frequency, Cost, Resolution,
and Reoffense of Hoarding
Service Training
On average, respondents encountered be-
tween two and three cases that met criteria for Despite frequent encounters with hoarding,
compulsive hoarding during a 12-month period. respondents disclosed that their respective de-
Approximately two thirds of respondents (67%) partments did not have a standardized protocol
reported encountering between one and five in- for managing a hoarding situation (see Table 1).
stances during the past year (see Table 1). Col- Moreover, most respondents indicated they had
lectively, respondents reported that the average not received training on hoarding prior to the cur-
cost for clutter removal per case was $3,733. rent in-service training. For those respondents
Although not mutually exclusive, responses to who reported receiving prior training, the most
hoarding situations included materials being re- common response was an attendance of a similar
moved, referrals for counseling services, legal educational seminar.
action, fines, and eviction. As more than a third
of cases required a year or more to resolve,
hoarding cases encountered in nonclinical set- Characteristics of Individuals
tings appear to be a challenge. Indeed, difficulty With Hoarding Behaviors
resolving hoarding situations may help explain
why 52% of respondents reported encountering Of the 236 respondents, 81% (n = 191) pro-
a repeat hoarding offender within the past year. vided detailed information about a professional
Hoarding in the Community 339

TABLE 1. Frequency, Duration, Resolution, Reoffense, and Estimated Cost and Training on
Hoarding (N = 236)

N (%)

Frequency of Hoarding Case Encountered


Zero 57 (24%)
One 43 (18%)
Two 51 (22%)
Three 34 (14%)
Four 19 (8%)
Five 11 (5%)
Six or more 21 (9%)
Duration Until Hoarding Case Resolved
Less than 1 month 5 (2%)
Between 1 and 3 months 37 (16%)
Between 4 and 7 months 25 (11%)
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Between 8 and 12 months 29 (12%)


More than 12 months 33 (14%)
Situation not resolvable 60 (25%)
Nonapplicable or missing 47 (20%)
Responses and Resolutions to Hoarding Situation
Clutter/materials removed 113 (48%)
Referred for counseling 83 (35%)
Legal action 59 (25%)
Fines levied 53 (22%)
No resolution 39 (17%)
Eviction 40 (17%)
Other actions taken 32 (14%)
Nonapplicable or missing 22 (9%)
Encountered Repeat Offenders of Hoarding
Yes 123 (52%)
No 59 (29%)
Nonapplicable 44 (19%)
Previous Training on Hoarding Provided by Department
Yes 37 (15%)
Educational seminar 25 (68%)
Educational coursework 8 (22%)
Pamphlet 5 (14%)
Other 4 (11%)
No 196 (83%)
No response or missing 6 (2%)
Existence of a Departmental Protocol to Address Hoarding
Yes 23 (9%)
No 200 (85%)
No response or missing 13 (6%)
Mean (SD ) Median (Range)
Estimated Cleaning and/or Trash Removal Costs $3,733.00 ($6,478) $1,700 ($0$50,000)

More than one response could have been endorsed.

encounter with hoarding that occurred within the et al., 2010), hoarding cases frequently involved
past 12 months. Across these community en- women more often than men. Although most
counters, the most common demographic char- individuals engaged in hoarding behaviors ap-
acteristics included being aged 46 to 75 years peared to be retired or unemployed, some re-
old (73%), Caucasian, and unmarried (64%; see mained employed or received disability services.
Table 2). Consistent with previous third-party In approximately 95% of the reported cases, in-
informants (Steketee et al., 2001; Tolin, Fitch, dividuals who hoarded were reported to be either
340 J. F. McGuire et al.

TABLE 2. Characteristics of Hoarders not receiving any mental health service or having
(N = 191) an unknown treatment status.

N (%)
Detailed Characteristics of Hoarding
Age
Younger than 30 years of age 7 (4%)
Situations
3145 years 12 (6%)
4560 years 66 (34%) Participants indicated hoarding complaints
6175 years 73 (38%) originated from multiple sources, which in-
75 years or older 22 (12%)
Not indicated or missing 11 (6%)
cluded neighbors, strangers, and local officials
Gender (e.g., fire department, police; see Table 3). In-
Female 96 (50%)
Male 76 (40%)
stances of hoarding were characteristically re-
Not identified or missing 19 (10%) ported to be in single-family homes that were
Race located in suburban neighborhoods and were de-
White/Caucasian 165 (86%)
Black 9 (5%) scribed as extremely cluttered. Most often, the
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Asian 1 (0.5%) clutter was reported to cause moderate-to-severe


Hispanic/Latino 1 (0.5%)
Other 2 (1%)
interference in daily functioning. Respondents
Unknown, not identified or missing 13 (7%) reported that most to nearly all of each encoun-
Marital Status tered home was difficult to walk through because
Single 60 (31%)
Married/significant other 37 (19%) of clutter. Across these reported situations, cases
Divorced 26 (14%) frequently presented fire and health risks to oc-
Widowed 36 (19%)
Unknown, no response or missing 32 (17%) cupants, as well as health risks to the surrounding
Employment Status residential community (see Table 3).
Employed 31 (16%)
Unemployed 45 (24%)
Retired 60 (31%)
On disability 27 (14%)
Hoarding of Animals
Student 1 (0.5%)
Unknown or missing 27 (14%) Hoarding of animals was frequently reported
Rationale for Hoarding across cases. When hoarding of animals was re-
No explanation 80 (42%)
Emotional attachment 48 (25%) ported (n = 129), it regularly occurred alongside
Memory-related concerns 17 (9%) hoarding of inanimate objects as well (51%).
Desire for control 9 (5%)
Responsibility for items 23 (12%)
Although hoarding of inanimate objects alone
Other rationale offered 16 (8%) (without animals) occurred in 47% of the cases,
Insight Into Behavior animal hoarding alone appeared infrequently
No insight 56 (29%)
Little insight 74 (39%) (2%).
Moderate insight 35 (18%)
Insightful 16 (8%)
No response or missing 10 (5%) Insight and Motivation to Change
Motivation to Change Behavior
No motivation to change 63 (33%)
Little motivation to change 68 (36%)
Similar to other studies utilizing third-party
Some motivation to change 40 (21%) informants (Tolin, Fitch, et al., 2010), individ-
Moderate motivation to change 9 (5%)
Very motivated to change 2 (1%)
uals who hoarded were reported to have little
No response or missing 9 (4%) to no insight into their behaviors (see Table 2).
Mental Health Treatment Status Additionally, most individuals did not provide
Yes 10 (5%)
No 77 (40%) any rationale for their hoarding behaviors. For
Unknown or missing 104 (55%) those who attempted to justify their hoarding
Social and Community Contacts
No friends or community involvement 48 (25%)
behaviors, emotional attachment and a sense
Few friends/little community involvement 57 (30%) of obligation toward hoarded items (e.g., ani-
Some friends/some community involvement 17 (9%) mals) were the most commonly endorsed rea-
Regular friends/regular community involvement 11 (6%)
Unknown or missing 58 (30%) sons. Respondents also indicated that individu-
als who hoarded expressed little to no motivation

More than one response could have been endorsed. to change their current behaviors.
Hoarding in the Community 341

TABLE 3. Characteristics of Community TABLE 4. Case Resolution (N = 191)


Hoarding Reports (N = 191)
N (%)
N (%)
Resolution to Hoarding Cases
Initiation of Hoarding Complaints Hoarding not removed 35 (18%)
Neighbor or fellow tenant 102 (53%) Hoarding removed 87 (46%)
Stranger 71 (37%) Eviction 14 (7%)
Fireman or policeman 48 (25%) Legal action taken 30 (16%)
Social service agency 29 (15%) Fine levied 19 (10%)
Relative 21 (11%) Referred to mental health services 53 (28%)
Service person visiting home (e.g., nurse) 18 (9%) Other action taken 44 (23%)
Friend or acquaintance 17 (9%) Family Involvement in Resolution
Anonymous or unknown 9 (5%) Yes 34 (18%)
Family member or roommate 6 (3%) Some involvement 41 (21%)
Type of Residence No 98 (51%)
Single-family home 131 (69%) No response or missing 18 (9%)
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Duplex 5 (2%) Response Team Involved in Resolution


Apartment or condo 14 (7%) Yes 87 (46%)
Mobile home 34 (18%) Very resistant to response team 24 (28%)
Other housing 5 (3%) Some resistance to response team 19 (22%)
No response or missing 2 (1%) Minimal cooperation with response team 28 (32%)
Type of Neighborhood Cooperation with response team 14 (16%)
Urban 45 (23%) No response 2 (2%)
Suburban 114 (60%) No 87 (46%)
Rural 29 (15%) No response or missing 17 (8%)
No response or missing 3 (2%) Agencies Involved in Resolving the Case
Level of Clutter Animal welfare 52 (27%)
Not at all cluttered 1 ( < 1%) Mental health 56 (29%)
Somewhat cluttered 9 (4%) Fire department 53 (28%)
Moderately cluttered 23 (12%) Police department 86 (45%)
Extremely cluttered 156 (82%) Department of Aging 58 (30%)
No response or missing 2 (1%) Child welfare 12 (6%)
Interference Justice system 40 (21%)
No interference 14 (7%)
More than one response could have been endorsed.
Mild interference 20 (11%)
Moderate interference 60 (31%)
Severe interference 56 (29%)
Extreme interference 34 (18%) levied (see Table 4). Notably, less than 30% of
No response or missing 7 (4%) these detailed case reports indicated that the of-
Much of Home Was Difficult to Walk Through
None 4 (2%)
fenders were referred to mental health services.
Some 28 (15%) Family members of individuals who hoarded
Much 26 (14%) were reported to be mostly uninvolved in ad-
Most 58 (30%) dressing the situation (see Table 4). In approx-
All or nearly all 55 (29%)
No response or missing 20 (10%)
imately half of the reported cases, a response
Hazards and Risks of Hoarding team (e.g., clutter removal service) was used to
No risk present 4 (2%) resolve the situation, with most hoarding offend-
Fire risk 140 (73%) ers exhibiting minimal to no cooperation. Along
Health risk to occupants 140 (73%)
Health risk to residential community 108 (57%)
with response teams, multiple agencies (e.g., an-
Other hazard and/or risk (e.g., falling) 16 (8%) imal welfare, mental health, fire department, de-
partment of aging) were reported to be involved

More than one response could have been endorsed.
in resolving cases with hoarding (see Table 4).

Situational Resolution DISCUSSION


Multiple outcomes were reported for cases in- The present study describes the frequency,
volving hoarding that included clutter being re- cost, and resolution of hoarding cases encoun-
moved from the property, legal action, and fines tered by code enforcement and social service
342 J. F. McGuire et al.

staff in community settings. Most sampled pro- to resolve for several reasons. First, individuals
fessionals encountered at least one hoarding case who hoard are reported to exhibit resistance and
during the past year of service, which yielded may threaten violence when attempts are made
a projected annual prevalence rate of 33 per to discard their hoarded items (Frost et al., 2000;
100,000 people. This estimation is substantially Warren & Ostrom, 1988). As such, social service
lower than rates reported by epidemiological and code enforcement staff may be placed in
studies (see Pertusa et al., 2010) but is consistent difficult confrontational situations with no for-
with other reports from social service samples mal preparation. Second, respondents reported
(Frost et al., 2000). As described cases were re- that many hoarders (25%) experienced extreme
ported to be extremely cluttered with individuals emotional attachment to their possessions. This
experiencing moderate-to-severe interference in substantial attachment may likely cause hoarders
daily functioning, it may be that a limited spec- to not want to part with their revered possessions
trum of hoarding behaviors was captured in this regardless of levied fines and impairment experi-
sample. Indeed, a baseline level of severity was enced. Third, and most importantly, respondents
needed to bring these cases to the attention of indicated that they had received minimal training
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community professionals, and as a result, these on dealing with hoarding, and most did not have
projected prevalence rates are likely an underes- a standardized organizational protocol to follow
timation of the true occurrence of the spectrum in dealing with these complex cases. The mini-
of hoarding that occurs within community set- mal training and a lack of standardized protocols
tings. may impede social service staffs ability to suc-
For these reported cases, clutter removal fees cessfully navigate and resolve these complicated
were estimated to be $3,700 per case, which situations. Thus, there appears to be a clear need
yields an annual estimated cost of $8.5 million. for improved formal training opportunities for
Although costly, these total expenses are likely social service staff. As only one third of reported
an underestimation of the true cost of hoarding cases received referrals to mental health profes-
for two reasons. First, as mentioned before, the sionals, future training opportunities should em-
prevalence rates in the sample were lower than phasize the timely referral of hoarding cases to
those that have been reported in epidemiological mental health professionals. Moreover, as mul-
studies. As cases increase, so would the antici- tiple agencies were reported to be involved in
pated costs. Second, the projected costs only in- hoarding cases, the development of empirically
clude clutter removal fees and do not account for informed interagency protocols may help social
case worker time and other relevant costs (e.g., service staff resolve hoarding cases.
legal fees, costs to landlords, additional costs to Beyond highlighting the cost, prevalence,
service providers). Indeed, community reports and need for interagency collaborations, these
that have incorporated these broader costs have findings offered two unique perspectives on
found markedly higher costs for hoarding be- cases of hoarding outside of clinical settings.
haviors. For example, the San Francisco Task First, respondents reported that individuals who
Force on Compulsive Hoarding (SFTFCH) esti- hoarded frequently acquired inanimate and an-
mated that hoarding collectively costs $6.43 mil- imate items, but rarely acquired animate items
lion per year to local landlord and social service only. As some diagnostic questions remain about
providers (SFTFCH, 2009). Moreover, neither the potential symptom subtype of animal hoard-
this report nor the SFTFCH estimation took into ing (Frost, Patronek, & Rosenfield, 2011), these
account the financial burden placed on individ- findings suggest that animal hoarding rarely oc-
uals (e.g., health care, mental health care, job curs by itself and is likely included in the natu-
loss) or the additional costs associated with re- ral phenomenology of hoarding behaviors. Fur-
solving hoarding cases (e.g., safety costs, legal ther examination of animate hoarding by itself
and police costs, animal rescue costs). is needed to identify any distinct clinical fea-
Respondents found hoarding cases difficult tures that may accompany this infrequent form
to resolve and reported a likely chance of re- of hoarding behavior. Second, hoarding situa-
offense. These cases may have been difficult tions were reported to pose considerable health
Hoarding in the Community 343

and fire risks to both individuals and their greater encounter hoarding cases in community environ-
communities. If community awareness is raised ments. This firsthand perspective is particularly
about the health and environmental risks asso- notable as most previous hoarding research has
ciated with hoarding, community members may occurred within the context of clinical patients
become more invested in bringing those indi- and elderly individuals. Second, the sample of
viduals who hoard to the attention of appro- respondents was considerably larger than previ-
priate officials in a timely fashion. Along with ous research reports using social service profes-
the development of interagency hoarding proto- sionals (88 health officers; Frost et al., 2000).
cols, timely case identification from community Finally, the survey items provided detailed in-
members may lead to more timely referrals to formation about agencies involved in hoarding
mental health professionals. cases and about the resolution of hoarding cases.
Although these findings are informative, the This information is important because it high-
present study has several limitations. First, the lights that current training and approaches to
sample was derived from code enforcement offi- managing hoarding cases are not yielding de-
cials and DCF staff from the state of Florida and sired outcomes.
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may not be representative of the U.S. popula- Hoarding is likely a chronic disorder, which
tion. This limitation is balanced by the fact that if left untreated, may result in repeated offenses
this study is one of the first to provide statewide- or more serious consequences (e.g., condemned
level information on hoarding behaviors from a home, eviction, health outcomes). Overall, this
large sample of respondents. Second, the survey study provides important information on hoard-
nature of this study was susceptible to certain bi- ing behaviors beyond clinical settings. In addi-
ases (e.g., nonresponse bias, voluntary response tion to providing prevalence, severity, and costs
bias). Third, we were unable to objectively eval- associated with community hoarding cases, this
uate the severity of hoarding cases with a psy- study highlights the minimal training and nonex-
chometrically validated instrument (e.g., Clut- istent agency protocols available to profession-
ter Image Rating Scale; Frost, Steketee, Tolin, als who regularly encounter this problem. As
& Renaud, 2008). Beyond descriptive compar- multiple agencies were reported to be involved
isons, the incorporation of standardized ratings in hoarding cases, future research is needed to
would prove useful when comparing severity of develop and evaluate collaborative interagency
clinical and community hoarding cases. Future protocols to manage hoarding cases. The de-
research studies should attempt to rectify these velopment and evaluation of interagency proto-
shortcomings when sampling social service pro- cols can provide a systematic and empirically
fessionals. Finally, this report focused on in- informed approach to addressing challenging
dividuals who hoarded possessions within the hoarding situations encountered in the commu-
community. Although these individuals exhib- nity. Furthermore, as there was limited involve-
ited hoarding behaviors, it is important to note ment and referral to mental health professionals
that these cases may not have all met the pur- reported in the current study, the development of
posed diagnostic criteria for hoarding disorder. interagency protocols may facilitate timely refer-
Indeed, there may be several other reasons that rals of hoarding cases to mental health profes-
account for the accumulation of these hoarded sionals. Timely mental health intervention may
items such as general medical conditions or reduce the current discrepancy between symp-
other mental disorders (e.g., brain injury, psy- tomatic onset and treatment and could result in
chosis, chronic alcoholism). However, because improved outcomes for hoarding cases. More-
the third-party informants had no medical, psy- over, such therapeutic intervention may serve
chiatric, or psychological training, it would be as an important step in reducing the reoffense
exceptionally difficult to rule out these alterna- rate of hoarding in community cases. Indeed,
tive explanations for hoarding behaviors. Coun- improved mental health outcomes of hoarders
terbalancing these limitations, this study had present an added benefit as they may reduce costs
several strengths. First, this study provided the associated with hoarding behaviors (e.g., fewer
perspective of many professionals who regularly repeat offenses) and may decrease the likelihood
344 J. F. McGuire et al.

of health and fire risks to individuals and com- Pertusa, A., Frost, R. O., Fullana, M. A., Samuels, J., Steke-
munities alike. tee, G., Tolin, D., . . . Mataix-Cols, D. (2010). Refin-
ing the diagnostic boundaries of compulsive hoarding:
A critical review. Clinical Psychology Review, 30(4),
ACKNOWLEDGEMENTS 371386.
San Francisco Task Force on Compulsive Hoarding. (2009).
Beyond overwhelmed: The impact of compulsive hoard-
The authors would like to thank the Florida
ing and cluttering in San Francisco and recommenda-
Department of Children and Families (DCF) and tiosn to reduce negative impacts and improve care. Re-
the Florida Association of Code Enforcement trieved from http://www.sfaa.org/pdf/hoarding-report-
(FACE) for their participation in this project, 2009.pdf
with special thanks to Mark Caskie (FACE) Saxena, S., Ayers, C. R., Maidment, K. M., Vapnik, T.,
and Judith Stauffer (DCF) for their coordina- Wetherell, J. L., & Bystritsky, A. (2011). Quality of
tion efforts. The authors would also like to ac- life and functional impairment in compulsive hoarding.
Journal of Psychiatric Research, 45(4), 475480.
knowledge and thank Dr. Randy Frost for his
Saxena, S., Brody, A. L., Maidment, K. M., & Baxter, L. R.,
contributions to the educational training materi-
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Jr. (2007). Paroxetine treatment of compulsive hoard-


als and feedback on a previous iteration of the ing. Journal of Psychiatric Research, 41(6), 481487.
manuscript. Steketee, G., Frost, R. O., & Kim, H.-J. (2001). Hoarding by
elderly prople. Health and Social Work, 26(3), 176184.
Steketee, G., Frost, R. O., Tolin, D. F., Rasmussen, J., &
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