Case Analysis
The Case of Lanie
I.
Case
Lainie was a 47-year-old single woman referred to a community mental health team for treatment of
depression and anxiety. She had never taken any psychiatric medication but had undergone CBT for
depression 5 years earlier.
Lainie had a college degree and worked as a part-time sales assistance in a charity thrift shop. She said
she had dated in college but had “some-how been too busy” in recent years. She was clearly in a down
mood. She complained about poor concentration and problems getting organized. She said she hadn’t
abused any substance.
The mental health care provider noticed that Lainie’s purse was filled with bills and other papers.
When asked, she first shrugged it off, saying that she “carried around my office.” But when asked again,
Lainie admitted she had a hard time throwing away business papers, newspapers, and magazines for as
long as she could remember. She felt that it all started when her mother got rid of her old toys when she
was 12 years old. Now, many years later, Lainie’s apartment had become filled with books, stationary,
crafts, plastic packages, cardboard boxes and all sorts of other things. She said she knew it was a little
crazy, but these items could be handy one day. She also stated that many of her possessions were
beautiful, unique, and irreplaceable, or had strong sentimental value,. The thought of throwing out any
of these items caused her great distress.
Over a series of interviews, the mental health care provider learned that rooms in Lainie’s apartment
had begun to fill when she was in her early 30s, and by the time of the interview, she had little room to
live. Here kitchen was almost entirely full, so she used a mini-fridge and a toaster oven that she had
wedged between piles of paper in the hallway. She ate her meals in the only open chair. At night, she
moved a pile of papers from the bed onto that chair so she could sleep. Lainie kept buying items from the
charity thrift store where she worked and also picked up daily free newspapers that she planned to read
in the future.
Ashamed by the state of her apartment, she had told no one about her behavior and invited no one
into her apartment for at least 15 years. She also avoided social functions and dating, because—despite
being friendly and very lonely—she knew she could not invite anyone to her home. She did not want the
mental health care provider to visit her home but showed some photographs from her phone’s camera.
The pictures showed furniture, papers, boxes and clothes piles from floor to ceiling.
II.
Clinical Diagnosis
Disorder: Hoarding Disorder
Diagnostic Criteria
Client
A. Persistent difficulty discarding or parting It is presented in the case that Lainie fits in the
with possessions, regardless of their Criteria A for Hoarding Disorder. She
actual value.
admitted that she is having a hard time
throwing away business papers, newspaper,
and magazines for as long as she could
remember. Which is really fit to Criteria A,
Since it said that the client with Hoarding
Disorder
has
the
persistent
difficulty
discarding or parting with possessions.
B. This difficulty is due to a perceived need For Criteria B, Lainie said she knew it was a
to save the items and to distress little crazy, but these items could be handy
associated with discarding them.
one day. She also stated that many of her
possessions were beautiful, unique and
irreplaceable, or had a strong sentimental
value in which the thought of throwing out
any of these items caused her great distress.
C. The difficulty discarding possessions In Criteria C, the mental health provider
results
in
the
accumulation
of learned that Lainie’s apartment begun to fill
possessions that congest and clutter when she was in her early 30’s, she had a little
active living areas and substantially
compromises their intended use. If living room to live. Her kitchen was almost entirely
areas are uncluttered, it is only because full, so she used a mini-fridge and a toaster
of the interventions of third parties (e.g., oven that she had wedge between piles of
family members, cleaners, authorities).
paper in the hallway. Lainie ate her meals in
the only open chair. At night, she will move a
pile of papers from the bed onto that chair so
she could sleep.
D. The
hoarding
clinically
Criterion D states that the hoarding causes
significant distress or impairment in
clinically significant distress or impairment in
social, occupational, or other important
social, occupational, or other important areas
areas
(including
of functioning. For Lainie’s case, she had told
maintaining a safe environment for self
no one about her behavior and invited no one
and others).
into her apartment for at least 15 years. She
of
causes
functioning
also avoided social functions and dating,
because—despite being friendly and very
lonely—she knew she could not invite anyone
to her home.
E. The hoarding is not attributable to
In Criteria E, Lainie case is not attributable to
another medical condition (e.g., brain
another medical condition, as the matter of
injury,
fact Lainie’s case doesn’t present any medical
cerebrovascular
disease,
Prader-Willi syndrome).
F.
condition.
The hoarding is not better explained by In Criteria F, Lainie’s case is not better
the symptoms of another mental explained by the symptoms of another
disorder (e.g., obsessions in obsessive- mental disorder for she has not taken any
compulsive disorder, decreased energy psychiatric medication before and did not
in major depressive disorder, delusions want the mental health care provider to visit
in schizophrenia or another psychotic and check her home.
disorder, cognitive deficits in major
neurocognitive
disorder,
restricted
interests in autism spectrum disorder).