Prevalence of Hoarding Disorder in Individuals at Potential Risk of Eviction in New York City

Although the provision of publicly funded health and mental health services to homeless persons has expanded greatly in the past decade, primary prevention of homelessness has received relatively little attention (O’Connell et al., 2005). Evictions are a major proximate cause of homelessness, and numerous studies show that evictions primarily result from tenants’ nonpayment of rent (Stenberg and van Laere, 2009; Van Laere et al., 2009). However, evidence also suggests that, for some housed persons, untreated mental health problems may also increase eviction risk by contributing to behaviors that jeopardize continued tenancy (Crane et al., 2005; Van Laere et al., 2009). Hoarding disorder (HD; Mataix-Cols et al., 2010) is one mental health condition that may precipitate homelessness by placing housed individuals at risk of eviction (Mataix-Cols D, Grayton L, Bonner A, Luscombe C, Taylor PJ, van den Bree M. A putative link between compulsive hoarding and homelessness: A pilot study [submitted for publication]; Tolin, et al., 2008). Also known as “compulsive hoarding syndrome” (Saxena, 2008), HD is defined as persistent difficulty in discarding personal possessions of limited value, which results in clutter that precludes normal use of living spaces and causes clinically significant distress or impairment (Frost and Gross, 1993; Frost and Hartl, 1996; Mataix-Cols et al., 2010). Once considered a subtype of obsessive-compulsive disorder (OCD), HD is now considered a separable syndrome and has been proposed as a new diagnostic category in DSM-V (Mataix-Cols et al., 2010; Phillips et al., 2010). Epidemiological surveys estimate a 2% to 5% prevalence of HD in the general population (Iervolino et al., 2009; Mataix-Cols et al., 2010; Samuels et al., 2008). Recommended treatment strategies for HD include medication (e.g., paroxetine and venlafaxine) and cognitive behavioral therapy (Saxena, 2008, 2011; Steketee and Frost, 2003). HD is associated with high levels of disability and impairment (Frost et al., 2000; Tolin et al., 2008). It causes public health problems when clutter attracts pest infestations or obstructs fire exits in apartment buildings, endangering both personal and neighbors’safety (Frost et al., 2000; Frost et al., 1999; Patronek, 1999). These conditions may lead neighbors and landlords to complain, resulting in legal proceedings and eviction (Frost et al., 1999). Two studies have examined the putative link between HD, eviction, and homelessness. An Internet study of the economic and social burden of HD surveyed 864 individuals with HD and found that 2% reported being evicted and 6% endorsed being threatened with eviction (Tolin et al., 2008). A study in the United Kingdom evaluated the prevalence of HD in 78 randomly selected homeless individuals newly admitted to Salvation Army shelters (Mataix-Cols D, Grayton L, Bonner A, Luscombe C, Taylor PJ, van den Bree M. A putative link between compulsive hoarding and homelessness: A pilot study [submitted for publication]): up to 21% of these individuals endorsed hoarding symptoms and 8% reported that hoarding problems directly contributed to their homeless state. Although these studies suggest that HD may contribute to eviction and homelessness, to our knowledge, no studies have examined the prevalence and correlates of HD in a population seeking housing assistance and at potential risk for eviction. To begin to address this gap, we evaluated the prevalence of HD in a sample of people seeking services from a not-for-profit community organization focused on helping individuals with housing problems including eviction. In further characterizing this sample, we also assessed sociodemographic correlates, threat of imminent eviction, history of eviction, and mental health treatment utilization.