Animal Hoarding Disorder: A new psychopathology?

Seropositivity for Toxocara spp. in Individuals with Animal Hoarding Disorder in Southern Brazil: An Alarm for Public Health

PURPOSE

Animal hoarding has been associated with unhealthy human, animal and environmental conditions that predispose such individuals to serious life-threatening risks such as arson, malnutrition, cruelty and zoonosis. The study aimed to evaluate the presence of anti-Toxocara spp. antibodies among individuals with animal hoarding disorder in Curitiba, Brazil.

METHODS

65 residences with register of animal hoarder behavior were visited and 11 residences were included in the study, with a total of 19 individuals consenting participation. A short questionnaire was applied to gather information regarding hoarders and their dogs/cats, and serum samples were screened to detect antibodies (IgG) against antigens of Toxocara spp.

RESULTS

Overall, 14/19 individuals (73.7%) presented anti-Toxocara spp. antibodies. In 8/11 (72.7%) households at least one person was seropositive. Seropositivity was higher among women (10/13; 76.9%) than men (4/6; 66.7%). A total of 442 dogs (14-30 dogs; average = 23.3 per household) and 31 cats (1-20 cats; average = 4.8 per household) were observed. To the authors' knowledge, this was the first study to survey occurrences of toxocariasis among animal hoarders. The high population densities of dogs observed during visits, in conjunction with absence of veterinary care and unsanitary conditions, may indicate that situations of high levels of animal infection and soil contamination were present.

CONCLUSION

In summary, the seroprevalence observed in this study indicated that there was a high risk of Toxocara spp. infection among individuals with animal hoarding disorder. Provision of educational programs to reduce the risk of infection in this population is warranted.

Hoarding behaviour: special features and complications in real-world clinical practice

OBJECTIVE

Hoarding behaviour is a common but poorly characterised problem in real-world clinical practice. Although hoarding behaviour is the key component of Hoarding Disorder (HD), there are people who exhibit hoarding behaviour but do not suffer from HD. The aim of the present study was to characterise a clinical sample of patients with clinically relevant hoarding behaviour and evaluate the differential characteristics between patients with and without HD.

METHODS

This study included patients who received treatment at the home visitation program in Barcelona (Spain) from January 2013 through December 2020, and scored ≥ 4 on the Clutter Image Rating scale. Sociodemographic, DSM-5 diagnosis, clinical data and differences between patients with and without an HD diagnosis were assessed.

RESULTS

A total of 243 subjects were included. Hoarding behaviour had been unnoticed in its early stages and the median length in the sample was 10 years (IQR 15). 100% of the cases had hoarding-related complications. HD was the most common diagnosis in 117 patients (48.1%).

CONCLUSIONS

The study found several differential characteristics between patients with and without HD diagnosis. Alcohol use disorder could play an important role among those without HD diagnosis. Home visitation programs could improve earlier detection, preventing hoarding-related complications.

The Complexity of the Human–Animal Bond: Empathy, Attachment and Anthropomorphism in Human–Animal Relationships and Animal Hoarding

Simple Summary

The relationship between humans and animals may have positive effects for both parties, but there are situations in which it has poor or even negative effects for animals or for both humans and animals. Several studies reported the positive effects of this relationship in which both humans and animals obtain physical and psychological benefits from living together in a reciprocated interaction. There is also clear evidence that human–animal relationships may be characterized by different forms and levels of discomfort and suffering for animals and, in some cases, also for people. This work depicts the complex and multifaceted nature of the human–animal relationship; describes the role of empathy, attachment and anthropomorphism in the human–animal bond; shows how these psychological processes are involved in a dysfunctional way in animal hoarding, with highly detrimental effects on animal well-being.

Abstract

The human–animal relationship is ancient, complex and multifaceted. It may have either positive effects on humans and animals or poor or even negative and detrimental effects on animals or both humans and animals. A large body of literature has investigated the beneficial effects of this relationship in which both human and animals appear to gain physical and psychological benefits from living together in a reciprocated interaction. However, analyzing the literature with a different perspective it clearly emerges that not rarely are human–animal relationships characterized by different forms and levels of discomfort and suffering for animals and, in some cases, also for people. The negative physical and psychological consequences on animals’ well-being may be very nuanced and concealed, but there are situations in which the negative consequences are clear and striking, as in the case of animal violence, abuse or neglect. Empathy, attachment and anthropomorphism are human psychological mechanisms that are considered relevant for positive and healthy relationships with animals, but when dysfunctional or pathological determine physical or psychological suffering, or both, in animals as occurs in animal hoarding. The current work reviews some of the literature on the multifaceted nature of the human–animal relationship; describes the key role of empathy, attachment and anthropomorphism in human–animal relationships; seeks to depict how these psychological processes are distorted and dysfunctional in animal hoarding, with highly detrimental effects on both animal and human well-being.

Animal hoarding cases in England: Implications for public health services

Hoarding disorder is characterized by an accumulation of possessions due to excessive acquisition of or difficulty discarding possessions, regardless of their actual value and is estimated to affect 2-6% of the population. Animal hoarding, a distinct subset of hoarding disorder, has a significant public health impact on the humans involved, as well as animal welfare. Individuals exhibit self-neglect, apathy, social withdrawal and object hoarding; living within squalid, deteriorated, structurally unsafe and uninhabitable premises, alongside neglected animals. Cases are complex, costly and impact on a range of responding service providers. Effective case management is poorly understood and researched, with published literature in England particularly sparse. Improving understanding of the characteristics of these cases is the first step in informed case management. This research is the first exploration of the characteristics of animal hoarders in England and the areas where cases were located. Information about prosecutions involving large numbers of animals that were reported in the media was systematically obtained. This identified 66 cases between January 2015 and December 2020. Geospatial analysis exploring characteristics of locations where animal hoarding cases are also reported. Findings were broadly consistent with the international literature in that females (64%), those living alone (71%) and those with a mean age of 49 were well represented. Cats (61.5%) and dogs (60%) were the most commonly hoarded species. There was a mean of 44 animals per case and dead or animals requiring euthanasia found in 53% of cases. Key characteristics of the areas where cases were found highlight urban, densely populated, and high levels of deprivation being the most represented. Evidence of recidivism was evident in 39% of cases, suggesting that prosecution is not an effective rehabilitator. Animal hoarding raises serious implications for Public Health Services, and the lack of current effective case management strategies are discussed.

Evidence to guide ethical decision-making in the management of older people living in squalor: a narrative review

Older people living in squalor present healthcare providers with a set of complex issues because squalor occurs alongside a variety of medical and psychiatric conditions, and older people living in squalor frequently decline intervention. To synthesise empirical evidence on squalor to inform ethical decision‐making in the management of squalor using the bioethical framework of principlism. A systematic literature search was conducted using Medline, Embase, PsycINFO and CINAHL databases for empirical research on squalor in older people. Given the limited evidence base to date, an interpretive approach to synthesis was used. Sixty‐seven articles that met the inclusion criteria were included in the review. Our synthesis of the research evidence indicates that: (i) older people living in squalor have a high prevalence of frontal executive dysfunction, medical comorbidities and premature deaths; (ii) interventions are complex and require interagency involvement, with further evaluations needed to determine the effectiveness and potential harm of interventions; and (iii) older people living in squalor utilise more medical and social resources, and may negatively impact others around them. These results suggest that autonomous decision‐making capacity should be determined rather than assumed. The harm associated with squalid living for the older person, and for others around them, means a non‐interventional approach is likely to contravene the principles of non‐maleficence, beneficence and justice. Adequate assessment of decision‐making capacity is of particular importance. To be ethical, any intervention undertaken must balance benefits, harms, resource utilisation and impact on others.

Sociodemographic, income, and environmental characteristics of individuals displaying animal and object hoarding behavior in a major city in South Brazil: A cross-sectional study

Background and Aim: Hoarding cases have not been researched in depth in developing countries, such as Brazil. This study aimed to describe the characteristics of people with hoarding behavior in Curitiba, Brazil. Materials and Methods: A cross-sectional study was conducted based on complaints about hoarding situations received by the City Hall. The data on sociodemographic, income, and environmental characteristics of individuals displaying animal and object hoarding behavior were obtained and analyzed using descriptive statistics and multiple correspondence analyses. Results: Out of the 113 hoarding cases reported, 69 (61.06%) were fully assessed. Most of the participants (43; 62.32%) were women, and it was observed that most of the animal hoarding cases were women (p=0.02). The average age was 62.47 years old, and most of them (44; 63.76%) had studied up to the middle school level. People associated with object hoarding belonged to the lower income category (p=0.031). In most cases, the homes had an unpleasant odor (45; 65.21%), and this was prevalent in cases involving women (p=0.004) and animals (p=0.001). The risk of fire (24 [34.78%]) and landslip (9 [13.04%]) was more frequent in the case of object hoarding (p=0.018 and 0.021, respectively). Conclusion: The description of characteristics of individuals with hoarding behavior may assist in understanding the magnitude of this public health problem in Brazil and shed light on the need to develop studies on the health conditions of people and animals that live in these situations.

Hoarding and Animal Hoarding: Psychodynamic and Transitional Aspects

Hoarding is a disorder that has only recently begun to be understood by researchers and clinicians. This disorder has been examined from a biopsychosocial perspective and has features that overlap with obsessive-compulsive disorder as well as some unique characteristics. Hoarding disorder is widespread and maybe related to the evolution of collecting and storing resources among humans and other animals. While there have been a number of non-analytic theories related to hoarding and its treatment, psychoanalytic thinkers have rarely described the disorder or explored its underlying psychodynamics. Beginning with Freud, it is possible to understand hoarding in relationship to the vicissitudes of the anal stage of development. However, loss of a loved object, especially loss of the mother, can play an important role in the development of hoarding behavior in adults. The hoarding of inanimate items, examined from a developmental object-relations perspective, appears to involve transitional phenomena. Animal hoarding also involves transitional phenomena, but animals, which can serve as animated transitional objects, also have a repetition compulsion function. These psychodynamic characteristics are relevant for establishing a working transference with the analyst or therapist, in order to promote positive therapeutic outcomes.

Psychopathological Comorbid Symptoms in Animal Hoarding Disorder

The main goal of this research is to describe the psychopathological symptoms comorbid to animal hoarding disorder. This is a cross-sectional study with a sample of a 33 individuals sample diagnosed with animal hoarding disorder. For data collection, a Sociodemographic Data questionnaire and a Semi-Structured Clinical Interview were used, based on the DSM-5 Level 1 Cross-Cutting Symptom Measure. The sample consisted of 24 women (72.7%) and 9 men (27.30%), with a prevalence of 64% of the elderly. The mean number of self-reported animals per residence was 41.12 (DP = 24.41), totaling 1357 animals: 915 (68%) dogs, 382 (28%) cats, and 50 (4%) ducks. The results indicated animal hoarding disorder the comorbid psychopathological symptoms of depression (36%), anxiety (36%), memory deficits (27%), mania (21%) and obsessive-compulsive disorder (18%). The analyses revealed a higher occurrence of these symptoms among participants who had hoarded animals for over 20 years.

Mental health of animal hoarders: a study of consecutive cases in New South Wales

Objective The aim of this study was to review animal hoarding cases referred to the Royal Society for the Prevention of Cruelty to Animals (RSPCA) in New South Wales (NSW) to examine mental health factors that influence the development of animal hoarding and to consider strategies for dealing with such cases. Methods Data were gathered by RSPCA inspectors regarding consecutive cases referred to the agency over 2 years. Result Details were provided about animals and 50 identified hoarders (11 male, 39 female; mean age 57 years) on 48 properties. The mean number of animals per case was 53 (range 6-300). Fifteen participants (30%) were known to have had involvement with mental health or social services. Mental health factors appeared to contribute to animal hoarding in well over 50% of cases. Severe and moderate squalor were observed in 52% and 21% of dwellings assessed respectively, many with accumulated rubbish. Conclusions Animal hoarding is largely attributable to psychological and psychiatric problems. It is recommended that clinical services work alongside animal welfare inspectorates, assessing (and, where appropriate, treating) such problems. What is known about the topic? Animal hoarding is believed to be partly attributable to the hoarders having psychiatric or psychological problems, but relevant mental health assessment of hoarders is not usually arranged. Recidivism after removal of animals is nearly 100%. What does this paper add? The study confirms that animal hoarders commonly have mental health issues. However, RSPCA inspectors are not expected to screen for such issues or refer cases to mental health clinicians. What are the implications for practitioners? There is good reason to develop clinical services to help animal hoarders deal with their psychological or psychiatric problems.

Cognitive performance of individuals with animal hoarding

BACKGROUND

The purpose of this study was to characterize the cognitive performance of individuals with animal hoarding.

METHODS

This is a cross-sectional study, in which 33 individuals between the ages of 29 to 84 (M = 61.39; SD = 12.69) with animal hoarding have been assessed. The participants completed a neurocognitive battery including measures of general cognitive functioning, visual memory and organization, verbal fluency, and verbal reasoning.

RESULTS

Data suggest that individuals with animal hoarding have high rates of cognitive deficits related to visual memory and verbal reasoning.

CONCLUSIONS

Based on the performance tests used, we can suggest the existence of cognitive difficulties related especially to the executive functions of individuals with animal hoarding in this sample.

Pharmacotherapy for Hoarding Disorder: How did the Picture Change since its Excision from OCD?

This brief review deals with the various issues that contributed to the creation of the new Diagnostic and Statistical Manual condition of hoarding disorder (HD) and attempts at reviewing its pharmacotherapy. It appears that after the newly founded diagnosis appeared in the literature as an autonomous entity, distinct from obsessive-compulsive disorder, drug trials are not being conducted and the disorder is left in the hands of psychotherapists, who on their part, report fair results in some core dimensions of HD. The few trials on HD specifically regard the serotonin-noradrenaline reuptake inhibitor venlafaxine, and, possibly due to the suggestion of a common biological background of HD with attention-deficit/hyperactivity disorder, the psychostimulant methylphenidate and the noradrenaline reuptake inhibitor atomoxetine. For all these drugs, positive results have been reported, but the evidence level of these studies is low, due to small samples and non-blind designs. Regretfully, there are currently no future studies aiming at seriously testing drugs in HD.

A novel approach to welfare interventions in problem multi-cat households

BACKGROUND

Thousands of injured, stray and relinquished cats are received at the RSPCA Greater Manchester Animal Hospital each year. A significant and challenging proportion of these cats are confiscated from multicat households by RSPCA Inspectors, due to the owners' inability to care for them. These households share many characteristics of animal hoarding, including poor owner compliance with suggested welfare improvements and recidivism. The relatively poor adoption potential of animals from such households are a perennial problem for the charity. The aim of this study was to determine if offering female cat neutering assistance to multi-cat owners significantly improved colony welfare.

RESULTS

Ten multicat households with a history of public complaint to the RSPCA were recruited. An RSPCA veterinary surgeon (VS) initially assessed the overall welfare of each household's cat population, individual cat welfare and the living environment. All entire female cats aged over 8 weeks were neutered and basic animal care education provided. Follow up visits were completed two and 12 months later to reassess welfare parameters and population numbers. The total number of cats was 176 across ten households (range 7-33, median 16). All owners consented to having all entire female cats spayed. At the first visit, mean individual cat welfare scores ranged from 5.4-8.7/ 16 across the 10 households, where 16 represented best possible welfare. Overall household mean welfare scores were significantly improved at both the 2 month and 12 month revisits (p = 0.011 and p = 0.01 respectively) when compared to the initial visits. By the end of the study period, three out of the ten households had voluntarily relinquished all of their cats, and overall there was a 40% reduction in the number of cats.

CONCLUSIONS

Animal hoarding has previously been an intractable welfare concern with little evidence informing intervention techniques. These results show that positive veterinary engagement on site, focused on preventative care and population control, can yield significant improvement in welfare scoring systems in relatively short timescales. Promptly collecting and neutering all female cats at a site, combined with advice and support, show promise in improving welfare.

A description of 17 animal hoarding case files from animal control and a humane society

This study describes 17 publicly available cases of animal hoarding, a special manifestation of hoarding disorder. The cases, which included court documents, animal service documents, photographs, and newspaper clippings, were reviewed by Masters-level clinicians and a veterinarian in private practice. The veterinarian rated the animals in the case files for possible neglect. Over half of the homes had signs of object hoarding. The most commonly hoarded animals were cats, dogs, and rabbits. The majority of animals in the cases reviewed required veterinary care. Individuals with animal hoarding often lack insight about the condition of their animals and require community intervention.

Animal hoarding: The challenge for mental health, law enforcement, and animal welfare professionals

Animal hoarding has been considered a significant problem by animal welfare and law enforcement professionals for over a century. However, it has only been recognized as an indication of a mental disorder in the last decade. I review the different forms that animal hoarding can take and the current understanding of the prevalence, demographics and possible etiology of this disorder. Conventional animal cruelty laws have often been inadequate to respond to animal hoarding cases until they reach levels that may involve serious harm to animals and people. I document how prosecution of such cases can be difficult and often does not adequately consider the mental health issues underlying the problem or the high likelihood of recidivism. Attempts to solve these problems by enacting new laws specifically addressing animal hoarding have been controversial and ineffective. I explore new approaches that coordinate a variety of community resources in response to hoarding cases that offer the best opportunity to respond to both the human and animal problems associated with animal hoarding.