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Helping The Hoarders
Helping The Hoarders

AIR DATE: October 15, 2012

Public officials are calling it the worst case of hoarding in southern Nevada history. Now Kenneth Epstein has been removed from his Sun City Summerlin home, where he had been living among 40 tons of garbage including five refrigerators filled with rotting food and five dead cats.  

Beyond the mere accumulation of clutter, hoarders’ fear of discarding objects can lead to unsanitary living conditions and social isolation. While Epstein’s case is extreme, hoarding affects between two and five percent of the population.

Dr. Christiana Bratiotis is the Assistant Professor of Social Work at the University of Nebraska, and co-author of The Hoarding Handbook: A Guide for Human Services Professionals:

Usually how are hoarders exposed? Is it through a family member? Is it neighbors calling complaining about code violations, or is there some other way?

Typically cases of this severity are brought to light through the involvement of public officials, which is true in this case. Sometimes it is a concerned family member, or a friend, or a faith community member who says, “Oh I haven’t seen this person in awhile, and I’m quite concerned.” But often, cases of hoarding go unacknowledged for decades of life, which really is the time period during which the amassing of this amount of possessions occurs. This is not a problem that occurs overnight. Typically we find that people like this gentleman don’t have visitors to their home for sometimes decades at a time. So no one has actually been inside the residence to see the condition of the home.

When someone finally approaches them to help, how do they generally tend to react?

It’s important to remember that hoarding disorder is a mental illness. This is not a problem of laziness, or lack of morality or standards. This is, in fact, an illness, and so sometimes people don’t have great awareness or insight into their problem as a symptom of their illness, so they may not actually see the situation in the same way. We know from some of our neurobiological research that the visual perception on the part of people with hoarding is different. So they don’t always see the space, and often are not troubled by what’s going on in the space in the same way that others are. And sometimes they become very defensive about letting anyone in. They’re quite worried about what officials or well-meaning family members might do with their possessions, and they’re very concerned about keeping control of these objects.

How does someone accumulate 80 thousand pounds of trash, and trash in advanced states of decay at that?

We know that there is brain abnormality in functioning, so there is neurobiology involved.  There are genetic predispositions for this problem. There are also very strong attachments to objects, and beliefs about those objects, as well as strong emotions, and it’s very difficult for someone or a group of professionals going into a house like this to make sense of the fact that each and every item in there was probably there for a certain reason. We’re talking about everything from accumulated animal feces, to paper and clothing and those kinds of things. For someone with a hoarding problem, it is that each and every object is imbued with some special some kind of meaning, and perhaps they have some difficulty about making decisions about what do with things, and so they just let them pile up. After an accumulation of 20 or 30 years, those piles get quite enormous and it becomes very difficult to maintain a home. In those conditions, people then fear inviting someone in to make repairs to the home or to keep it clean, because they can’t risk having someone like an official see the condition of the home. They’re very concerned about what will happen in those cases. Then we have not only the volume of possessions, which is the hoarding, but we also have the presence of squalor, which is really filth or degradation from neglect.

In the media, they’re calling the case the worse ever seen in southern Nevada. Is this about as extreme as any case you have every heard about, or is this a fairly typical case, although maybe a little bit severe in terms of hoarding?

Certainly from a diagnostic perspective we would say this is on the severe end of both hoarding and squalor. It is important to note that like all mental illnesses, hoarding is on a continuum, and there are very mild cases and these are often the cases where people voluntarily seek mental health treatment, and they are not the kind of cases where public officials and others need to become involved … I would certainly put this on the severe end.

How does someone get help?

The research evidence suggests that a specialized form of cognitive behavioral therapy is the treatment that has shown the greatest efficacy. People respond best with an outpatient course of therapy, typically lasting about 26 weeks, working to help the person not acquire additional items and to practice getting rid of the items that they do have. .. We do hear people say things like possessions mean more to them than their relationships with people, or that they actually think of their relationships with objects as being as important as their relationships with people. The idea of him being separated from his possessions and the immediate crisis response, and it sounds like he is cooperating and that the city of Las Vegas is providing him some support tough this process, which is critically important ... If the gentleman goes back into his own home without any mental health treatment, it is very likely that he is going to re-accumulate possessions, sometimes more than the first time and sometimes quicker than the first time, especially because he will want to regain control over this situation where he is now out of control, he is not in control. So this specialized cognitive therapy is the treatment that is recommended.



    comments powered by Disqus
    This is a challenging story. I think Ruth's right that it raises complex ethical questions about how appropriate it is to identify Mr Epstein by name in the media, and how far authorities should go in compelling a hoarder to clear out their hoard. Clearly, where there are risks to neighbours, animals or children, the state has a duty to act but this should be limited to what is required to remove that risk. How someone chooses to live is their own concern if they're not endangering others...unless they are considered to be unfit to make decisions about their own welfare. I help people all over the world declutter and create homes they love (I provide a free masterclass at and I see people at various places on the spectrum of clutter facing inappropriate judgement and interference, as well as caring an appropriate support. To clarify, I'm not taking a position on what is appropriate for Mr Epstein (what I know about the case is limited to what I've read online), just raising the ethical issues.
    Rachel PapworthOct 16, 2012 03:23:50 AM
    Thank you for these insights and for the title of your book, which I am interested in reading. My mother was a hoarder and none of the family could understand it. We cleaned and neatly stored things in her house and removed trash several times, and within two weeks it was back the way it was. She was livid and highly territorial each time, until she finally moved into assisted living. That last time she simply walked away and let us remove everything so the house could be repaired and sold. The hoarding severely damaged the house that she and my father worked so hard to own, yet she defended her "castle" and refused to let anyone in to make repairs. And yes, there were multiples of everything, all in slippery plastic bags, trails through the house, and dog refuse. It was a very difficult situation, and at the time we were told by a psychologist that hoarding was a recognized psychological problem, and that we should expect her condition to worsen greatly, and that there was no treatment or cure. I'm glad to hear that progress has been made since then, because everyone deserves respect, especially in trying circumstances. My heart goes out to this gentleman and his family.
    DJ, Las VegasOct 15, 2012 19:01:38 PM
    While I understand the newsworthiness of the complex issues relating to hoarding, is it necessary (or even legal) to reveal this man's identity in the media?
    RuthOct 12, 2012 22:11:18 PM
    His name is a matter of public record; he owns the property. And, now he has been arrested. That makes two public records.
    JamesOct 13, 2012 08:27:40 AM
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