Compulsive Hoarding: Current Research and Theory

Compulsive hoarding has emerged as a treatment refractory and impairing psychological disorder. Although promising research over the past decade has substantially furthered an understanding of hoarding, the etiology, diagnostic status, and associated features of this phenomenon are not yet completely understood. This article reviews current research on hoarding, including comorbidity and diagnostic issues, theoretical models, and treatment approaches. A cognitive–behavioral model of compulsive hoarding (R. O. Frost and G. Steketee, 1998) is presented, including the proposed information-processing deficits, beliefs and cognitions, and excessive emotional attachment to possessions. In addition, existing treatment approaches that target the cognitive and behavioral components of acquisition, difficulty organizing, and avoidance of discarding are described. Future directions for compulsive hoarding research are suggested to improve diagnostic clarity, refine therapeutic techniques, and enhance treatment response.     

Treating Elders With Compulsive Hoarding: A Pilot Program

Hoarding among elderly clients can have serious health and safety consequences, including death. Because medications and standard behavioral treatments have yielded limited benefits for people with serious hoarding problems, we employed a specialized cognitive behavioral treatment (CBT) based on Frost and colleagues' model of hoarding problems. Of 11 elderly clients who met screening criteria for hoarding at a community mental health center, 6 completed an average of 35 sessions of therapy administered by a B.A.-level therapist trained and supervised in CBT methods. Treatment consisted of weekly home visits that included motivational interviewing, organizing and decision-making skills, cognitive therapy regarding hoarding and related beliefs, and practice sorting, discarding, and not acquiring. Modest improvement was evident in ratings of clutter, risky situations in the home, and functioning. Clients were generally satisfied with treatment. Challenges in treating hoarding in elderly clients include health and safety risks as well as reduced physical capacity that required problem-solving strategies.     

Ethical Considerations for the Treatment of Youth in Foster Care

Mental health clinicians treating youth in foster care face several ethical challenges, such as competence for treating youth in foster care, understanding who can provide informed consent, and confidentiality. However, few articles have addressed these ethical concerns or provided recommendations for clinicians on how to navigate these issues. This article presents a brief summary of the foster care system, an overview of the major ethical challenges clinicians may encounter when treating youth in foster care, areas of the American Psychological Association’s Ethics Code, Code of Ethics of the National Association of Social Workers, and American Counseling Association Code of Ethics most germane to the treatment of youth in foster care, and general recommendations for clinicians treating this population.     

Elucidating the Relation of Hoarding to Obsessive Compulsive Disorder and Impulse Control Disorders

Hoarding has historically been conceptualized as a symptom of Obsessive Compulsive Disorder (OCD); however, data demonstrate important differences between hoarding and OC symptoms (for discussion, see Grisham et al. Anxiety Disorders, 19, 767‑779. 2005). Hoarding has also been observed in disorders besides OCD, including specific Impulse Control Disorders (ICDs; e.g., kleptomania, trichotillomania, pathological gambling, compulsive buying). Therefore, the current study tested the hypothesis that hoarding would be as strongly related to symptoms of ICDs as it is to OCD and that these relationships would be medium to strong in magnitude. Results from an undergraduate sample showed hoarding behaviors were strongly related to symptoms of OCD, moderately related to symptoms of compulsive buying, and more modestly related to symptoms of pathological gambling, trichotillomania, and kleptomania. Finally, findings suggest indecisiveness may be a particularly important underlying feature in hoarding behaviors. These results support the consideration of hoarding outside the confines of OCD.

Insight-Related Challenges in the Treatment of Hoarding

Compulsive hoarding is a chronic and debilitating condition that has proven difficult to treat. The cognitive behavioral approaches that have otherwise been successful for people suffering from obsessive-compulsive disorder do not work very well for hoarding (Abramowitz, Franklin, Schwartz, & Furr, 2003). Many have suggested that this is due to the ego-syntonic nature of the symptoms and the accompanying lack of insight. This paper describes several challenges related to insight that limit the effectiveness of traditional cognitive behavioral approaches for compulsive hoarding. Problems with anosognosia, overvalued ideation, and defensiveness that characterize hoarding are described and suggestions offered for dealing with them.     

Treatment of Deaf Clients: Ethical Considerations for Professionals in Psychology

Providing therapy to deaf clients raises important ethical considerations for psychologists related to competence; multiple relationships and boundary issues; confidentiality; assessment, diagnosis, and evaluation; and communication and using interpreters. In evaluating and addressing these, psychologists must consider the American Psychological Association’s Ethics Code and other relevant issues (e.g., Americans with Disabilities Act) necessary to provide ethical treatment. The current article provides background, ethical considerations, principles and standards relevant to the treatment of deaf clients, and recommendations to support psychologists, training programs, and the field. Psychologists have the responsibility to guarantee that the benefits of mental health treatment are fairly and justly provided to this traditionally underserved population.     

Ethical Considerations for Psychologists Providing Treatment to Arab Americans

Given the recent increase in hate crimes against Arab Americans, there are growing concerns over the mental health needs of Arab Americans and a pressing need for psychologists’ competence in treating this group. Although there are several clinical guidelines for other health care professions, there remains a paucity of information on the ethical issues that may arise for psychologists treating this Arab Americans. This article briefly provides background information on Arab Americans, highlights elements of Arab culture that might influence psychological treatment, discusses ethical issues that might arise when psychologists provide services to Arab Americans, and provides recommendations to address these issues.     

老年发展的伦理考量

老年人的发展是人的发展的伦理应然和社会发展的伦理必然.老年人的发展包括老年人的健康发展、角色发展、认知发展和价值发展等四个主要方面.我们要通过构筑适合老年人生存发展的社会伦理环境和幸福生活的家庭伦理环境,发展老年教育和社会保障事业,开发老年人力资源,促进老年人的全面发展.     

Ethical Considerations in Psychotherapeutic Systems

Theoretical Medicine and Bioethics - In the process of individual psychotherapy, the client and the therapist work together towards clarifying the client's problems, unlocking vicious circles,...     

骨科手术中的临床伦理问题

骨科收治病种复杂,急症多,治疗方法较多、涉及患者肢体功能和美观,因此,它的伦理问题显得复杂.作者总结了医患之间在入院及诊治全过程中可能出现的伦理问题,并提出解决问题的初步方法.以期了解骨科诊疗过程中的伦理问题,来促进医疗行为的规范、体现骨科诊疗中的人性关怀,促进骨科医生个人的成长和骨科医学的发展.     

Ethical Considerations in Family Therapy Research

In this article, significant ethical issues that arise in the conduct of family therapy research are considered and four major areas are emphasized: (a) the researcher's responsibility to protect the rights of research participants, (b) confidentiality and informed consent, (c) the researcher's values, and (d) methodology. In each area, parallels are drawn between the ethical issues facing family clinicians and those facing family researchers.     

人类增强技术的伦理考量

人类增强技术作为利用高新技术提高人类机体功能或能力的一种技术干预手段,是对人类身体进行的一种技术上的改变,这必然在“人是什么”、社会公平、安全与自主权等方面引发一定的社会伦理问题。而这正是对“人是目的,而不仅仅是手段”这一绝对律令的违背。由此需要对人类增强技术进行全面的评估,从坚守“增强底线原则”、相关法规的制定和加强伦理审查等方面采取有效对策,预防或减少不良后果的产生。这样才能保证人类增强技术的发展做到有效性与合理性、真理性与价值性、安全性与效益性的完美统一。     

开展活体器官移植的伦理学思考

活体器官移植起源于器官移植技术的最初阶段,目前已经成功开展了肾脏,肝脏,肺脏、小肠、脾脏等器官的活体移植手术,事实表明该技术不仅有其科学依据,而且有其伦理学依据,即以人类自身伟大的奉献精神来关爱他人。但开展这一技术时务必需要遵循知情自愿原则,生命价值原则,利益和风险并存原则。当然在积极肯定这一技术的同时,也应该看到这一技术也存在一些伦理学方面尚未解决的问题。     

Using Art in Counseling: Ethical Considerations

Various mental health professionals use, on occasion, drawings and other types of art in therapy, but relatively little has been written on the ethics surrounding this technique. The authors take the position that artwork should be viewed as equivalent to verbal communication. Such equivalency gives rise to a variety of ethical issues that encompass confidentiality, documentation, ownership, research, publication, and display of artwork.     

Ethical Considerations in Crisis and Humanitarian Interventions

The need for professionals to volunteer their time in crisis situations and to reach across time and culture in the service of humanitarian interventions will likely not abate in the near future. This article provides readers with multiple venues for considering the ethical dimensions present in crisis and humanitarian interventions. Core ethical concerns common to helping situations are magnified in crisis work. In addition, issues unique to the nature of volunteer and crisis work must also be considered. Using hypothetical case examples, bioethical principles, and ethical decision-making models, helping professionals are encouraged to go beyond their particular ethical codes in contemplating ethically and clinically sensitive volunteering.     

Processes in Group Cognitive and Behavioral Treatment for Hoarding

Processes that emerge in the course of group treatment, such as universality and mutual aid, have been posited to promote therapeutic change (e.g., Yalom, 1995); however, they have received relatively little attention in the group cognitive behavioral treatment (CBT) literature (Rose, 2004). Group CBT interventions have been successful in alleviating symptoms of mood and anxiety disorders, such as major depression and obsessive-compulsive spectrum disorder (e.g., Anderson & Rees, 2007; Himle et al., 2001). A specialized group CBT protocol has been developed to treat hoarding (Muroff et al., 2009; Steketee & Frost, 2007), characterized by excessive clutter in the home, difficulty discarding objects that appear of little value, and often excessive acquisition, resulting in significant distress and/or impairment (Frost & Hartl, 1996). Individual (Tolin, Frost, & Steketee, 2007) and group (Muroff et al.) CBT for hoarding have shown promising effects. An examination of group process factors relevant to hoarding, however, is critical in order to further understand and tailor group interventions for this complex problem. The current paper characterizes four group processes specific to group CBT for hoarding: (a) universality or inclusion may reduce stigma and shame about having hoarding; (b) cohesion seems to support attendance and to provide positive peer pressure to motivate change; (c) the opportunity to give mutual aid seems to instill hope and motivate change; (d) social contact and socializing may reduce social isolation, a characteristic of this population. Discussion includes specific case examples illustrating these group processes and their potential complexity, within the context of group CBT for hoarding. Recommendations are advanced for future directions in evaluating group CBT for hoarding, particularly the formal study of group process variables with this population.     

Advances in the Cognitive Behavioural Treatment of Obsessive Compulsive Disorder

The aim of this paper is to highlight key advances in the cognitive-behavioural treatment of obsessive compulsive disorder over the course of Professor Lars Göran Öst's illustrious career. The paper will focus on three specific areas of interest: the treatment of obsessions, compulsive checking, and the fear of contamination. It will also highlight recent advances concerning the broader need to ensure that treatment is acceptable. An increase in acceptability could result in improvements in completion rates so that more patients benefit from the recent improvements in the science and therapy for this disabling disorder.     

Ethical Considerations of Multiple Roles in Forensic Services

Attorneys increasingly rely on the services of mental health practitioners. Although some practitioners lack training, the promise of professional rewards lead some to accept opportunities with resulting ethical quandaries. Due to significant differences between the objectives of traditional mental health services and expert testimony, problems occur when clinicians venture into forensic services. Attorneys and judges, unfamiliar with mental health specialties, may seek to press a mental health practitioner into multiple roles. Although not all multiple roles are ethically inappropriate, caution demands careful parsing of particular roles: (a) academic/behavioral science expert; (b) fact witness as a treating therapist; (c) expert witness based on a clinically oriented assessment; (d) pretrial and/or trial consultant; and (e) professional critic of other experts. Possible ethical issues and risks associated with accepting multiple roles are identified and strategies for avoiding or minimizing harm or exploitation are discussed.     

纳米认知增强技术的伦理考量

纳米认知增强技术是在纳米尺度上对大脑进行直接干预,从而提升正常个体认知功能的技术。该技术以其在微观环境下的高效和精准而独得宠爱,但也可引发安全和风险、自主和尊严、公平与正义以及“过时人”方面的伦理问题。在该技术的开发和将来应用过程中,必须遵循生命伦理原则,并从风险评估、伦理审查、研发主体和使用主体的道德约束和责任感、监管体系、社会价值导向和舆论环境等多角度、全方位入手,实施积极有效的对策,以使其始终沿着促进人类福祉的道路发展。