Understanding the human aspects of animal hoarding

An animal hoarder is defined as someone who has accumulated a large number of animals and who: 1) fails to provide minimal standards of nutrition, sanitation, and veterinary care; 2) fails to act on the deteriorating condition of the animals (including disease, starvation or death) and the environment (severe overcrowding, extremely unsanitary conditions); and often, 3) is unaware of the negative effects of the collection on their own health and well-being and on that of other family members (1). Animal hoarding has been gaining more attention from researchers in various areas of study, including sociological, psychological, and veterinary fields. Animal hoarding is considered a special manifestation of compulsive hoarding (2,3,4).

The Hoarding of Animals Research Consortium reviewed the case records of 71 incidents from across the United States and Canada to determine what characterizes a typical animal hoarding case (5). Of the cases reviewed, 83% involved women (71% involved individuals, who were widowed, divorced, or single); 53% of the animal hoarding residences were home to other individuals including children (5%), elderly dependents and disabled people (21%). Often essential utilities and major appliances such as showers, heaters, stoves, toilets, and sinks were not functional. Residential home interiors were usually unsanitary, 93%; 70% had fire hazards; and 16% of residences involved in animal hoarding were subsequently condemned as unfit for human habitation. In 25% of the cases, the hoarder was placed under permanent or temporary protective care (3).

Elderly individuals are at an increased risk for zoonotic diseases due to underlying medical conditions that weaken their immune systems (1,3). There is also a health risk from to ammonia, which at high concentrations causes ocular and respiratory irritation (1,3). The ammonia threshold limit values (TLVs) for a healthy individual should not exceed 25 ppm over an 8-hour period (4). The TLV is lower if the exposure has exceeded 8 h or if the individual is elderly or has respiratory problems (3). For short-term exposure (15 min), the recommended TLV is 35 ppm (3), while 20 ppm will cause an individual to feel uncomfortable, and 100 ppm will cause irritation of the upper respiratory tract, eyes, and nose (4). There is little information on ammonia levels in animal hoarding cases; however, 1 case reported levels of 152 ppm (5).

The key problem when dealing with these cases is that the animal hoarding is a symptom of a larger maladaptive situation and it is often too complicated to be adequately addressed, given the limited resources of animal protection officers and veterinarians (6–9). Simply removing the animals from the residence may not solve the problem; the person still has the ability and perhaps the need to find more animals as the rate of relapse is at least 50% (10,11). Some animal hoarders may also have combative attitudes towards government or animal welfare agencies, and as a result, violence must be considered an occupational hazard in animal welfare enforcement (11).

In order to aid the animals, it is important for hoarders to receive the necessary help to prevent further hoarding. Researchers have attempted to match the symptoms of animal hoarding to preexisting or concurrent mental psychopathologies in order to gain a better understanding of the phenomenon and to suggest treatment options. Frost (12) suggests that animal hoarders may suffer from a type of delusional disorder. This is supported by the recurrent belief of the hoarder that they have a special ability to understand and empathize with their animals. Most hoarders claim that the animals are being well cared for and are healthy, despite evidence to the contrary, suggesting that hoarders possess an unrealistic belief system (12).

A dementia model is supported by evidence that animal hoarders tend to show no insight or empathy in relation to the poor conditions under which the animals are held. Hoarding of inanimate possessions often occurs in cases of animal hoarding, and it has been reported that 20% of dementia patients also hoard objects (12).

Some researchers suggest that animal hoarding can be better understood using an addictions-based model, as these individuals share many characteristics with substance abusers, including: a preoccupation with animals, denial of a problem, excuses for their behavior, claims of persecution, and neglect of personal and environmental conditions (12,13). Hoarding animals can be compared to addictive behavior such as gambling and compulsive shopping, in which impulse control is impaired. The hoarders feel a need to get more animals even though they may recognize that it will cause financial, emotional, and physical stress; they are simply unable to control themselves (12).

Some animal hoarders have experienced traumatic childhoods leading to the inability to establish human relationships. Often this type of hoarder will cite the unconditional love of their animals as a reason why they need to be surrounded by them. Unfortunately, caring about animals is no substitute for caring for animals. This model is consistent with other models that have been suggested for the general compulsive hoarding of inanimate objects. The hoarders begin to identify themselves with the animals and fear taking a risk with human relationships (12). Often hoarders will describe their animals as “children” and it is clear from speaking to hoarders that their lives revolve around the unconditional love of the animals (3).

Another model attempts to compare animal hoarding with obsessive compulsive disorder (OCD), or a symptom of this condition. Animal hoarders often feel a strong responsibility to prevent any harm from coming to animals and will perform unrealistic procedures to protect them from harm; similar to the compulsive rituals an OCD patient engages in to prevent harm from befalling themselves. Similar to the dementia model, 20 to 30% of human OCD cases involve hoarding of inanimate objects or animals, or both (12). One study showed that 100% of 71 cases of animal hoarding also involved hoarding of inanimate objects (3). This OCD, as with animal hoarding, is more common in women and is often accompanied by personal and environmental neglect, both traits of animal hoarders (13). Sometimes the onset of OCD coincides with early or sudden loss of a loved one, which may indicate why animal hoarders abhor the thought of euthanasia for their animals and tend to deny the deteriorating conditions of the animals’ health and their environment (13).

Currently, animal hoarding has not been attached to any one specific psychiatric disorder and it is clear that one diagnosis may not exclude others (3). In order to prevent animal hoarders from relapsing, it is important that they receive the necessary care, counseling, or treatment for the underlying medical/psychiatric concern. It may be possible to determine an appropriate treatment plan based on a similar disorder, if the symptoms exhibited by the hoarder are known.

Mental health agencies, social services, and public authorities are often unable or unwilling to assist in animal hoarding cases because the animal hoarder’s behavior is excused as simply a lifestyle choice and, therefore, not a public health issue (7). In other cases, mental incompetence had not been established and the social agencies did not pursue a goal of developing a manageable companion animal colony, despite clear risks associated with animal neglect, human injury due to falls, fire, self-neglect, poor nutrition, and poor sanitation (3).

There is often significant evidence of self-neglect and neglect of dependents who live in the household where hoarding exists (3,11). Self-neglect is the most common form of abuse in the elderly and this may include poor nutrition, lack of medical care, poor personal care, no awareness of the consequences involved, social isolation, and extreme clutter. All of these manifestations are characteristic of animal hoarding cases; however, they are not sufficient to establish mental incompetence under most public health policies that give a high value to personal autonomy and the right to refuse treatment. This is a significant barrier to health agencies becoming involved in many animal hoarding cases (3,9,11).

Other barriers to cross-reporting of animal and human welfare situations evolve from administrative procedures, eligibility rules, and bureaucratic procedures that obstruct collaborative efforts as each agency may insist on following their own protocols or some may be bound by confidentiality requirements. Some individuals, who are trained in specific fields, may be uncomfortable dealing with issues outside their area of expertise or by working within a multidisciplinary framework. Such problems make it difficult to share information about the hoarder, which, in turn, makes it difficult to provide the individual with proper assistance (6,7).

In order to help animal hoarders and the animal victims, increased collaboration among various agencies including animal protection agencies, veterinarians, and social and health services, would allow earlier intervention and prevent escalation to more serious outcome (3,8). This may help decrease the overall financial and welfare costs associated with animal hoarding and increase the chances of having a successful intervention. Veterinarians are taking more of a leadership role in the concept of “One Medicine” in relation to zoonotic diseases, antimicrobial resistance, and food safety. The concept of One Medicine unites medical professionals and bridges the gap between human and animal health (14,15). The enforcement of societal values as described in animal welfare legislation has been a veterinary regulatory function in most European countries and is recognized as a veterinary activity by the OIE (Office international des épizooties) (16). As veterinarians called to support the health of animals in incidents of hoarding we should be aware of the human health issues associated with this phenomenon.