Research in other spheres may play a crucial role in the developing science of animal hoarding. For example, complex feedback mechanisms involving the oxytocinergic system have been linked not only to a history of childhood adversity but also to human-animal interactions.36,37 Oxytocin may promote a tendency to “tend and befriend” animals and increase defensive behavior against perceived threats from outsiders. Tending and befriending is a more typical response to stress among women than men, which would be consistent with the sex disparity seen in animal hoarding.38 While it is speculative, this account suggests avenues for neurobiolog-ical research into animal-hoarding disorder.
Animal hoarding poses some unique legal issues, above and beyond those typically encountered in extreme object hoarding, because the conditions observed in these cases often violate state criminal statutes prohibiting cruelty to animals. Unlike civil child protection laws, however, animal cruelty statutes do not provide an avenue for intervention until a crime can be proved. Thus, in the absence of voluntary cooperation or the presence of children or dependent adults whose welfare may be compromised, intervention may be delayed until environmental conditions deteriorate substantially. Ultimately, despite potential mental illness that contributes to the behavior, a person with animal-hoarding disorder may be prosecuted and subjected to criminal penalties, including fines, jail, and/or forcible removal of animals and/or prohibitions or limitations on future ownership or caregiving, with no provision for mental health treatment.
The animals are often in legal limbo for months to years during protracted legal proceedings because, under the law, they are treated primarily as evidence rather than as victims of a crime.39 There is also no legal mandate that the interests of the animals must be considered during case disposition. To avoid this, some agencies may not prosecute but, instead, may attempt to negotiate, even if the proposed solutions are suboptimal for animals and people.20
Clinical evaluation of a person with animal-hoarding disorder can take 2 primary forms: psychiatric evaluation for purposes of therapy and forensic evaluation for the courts. For the former, we recommend that the clinician be skilled in evaluating a broad spectrum of behavioral disorders and familiar with published guidelines for assessing and treating object hoarding.22 Given the potential for deep attachment to animate beings who often provide reciprocal interaction, there may be limits to how far we can extrapolate from object hoarding. Thus, it is important for the therapist to be knowledgeable about the human-animal bond and to explore those issues with the individual.40 The potential for self-neglect should also be explored.
With respect to forensic evaluation, several dozen states have legislated mandatory or discretionary evaluation of persons convicted of animal maltreatment, including animal hoarding. However, legislatures provide little guidance on what the goals of such an evaluation might be (eg, detection of danger to public safety, detection of mental illness, identification of being dangerous to self and others, identification of competency/capacity to care for animals). Limited forensic instruments are available for these purposes, and none has yet been validated. (One such instrument has been used for several years at the University of Denver and will be described in an upcoming book by Levitt, Grisso, and Patronek.41)
Many studies of animal hoarding report recidivism rates from 60% to 100%.12 Recidivism in this context refers to the frequency with which people reacquire multiple animals after having animals legally removed. This differs from the concept of relapse, which refers to the return of symptoms after someone has been successfully treated for a disorder. Nothing is known about relapse in animal hoarding, since no studies of treatment outcomes have been done. However, there are some case examples of individuals who have stopped hoarding animals and have been able to keep from reacquiring them.23
As noted earlier, although courts may mandate counseling, no validated therapy for animal-hoarding disorder is available. In addition, most individuals who have been adjudicated for animal hoarding are reluctant to participate in therapy, making this strategy difficult to enforce. Similar to nonvoluntary clients who are prosecuted in housing courts for object hoarding, the most appropriate method for initial engagement of persons with animal-hoarding disorder may be through community task forces composed of a mix of service professionals (housing, police, fire, public health, mental health, legal). Members of such multidisciplinary task forces can work together to engage offenders in identifying goals that matter to them while requiring compliance with nonhoarding behaviors. Of critical importance is determining whether to limit the number of animals or require abstinence (eg, because of overt cruelty rather than neglect).
Essential to this process is determining how to provide basic social support that meets the need for bonding that was previously filled by animals. According to Fonagy and colleagues,42 it is important that therapists avoid demanding a level of mentalizing from patients that is beyond their ability. A relatively high level of metacognition (ie, the ability to reflect on one’s own thought process or that of others) is required before a patient’s own distorted thinking can be challenged and distinguished from reality. Our clinical experience strongly suggests that animal hoarders often show profound deficits in this area.
Quick fixes for these cases are unlikely; court-mandated therapy must be applied carefully to avoid extending the period of legal limbo for animals or putting animals at future risk. Given the long-standing nature of the hypothesized psychopathology underlying animal hoarding, even in an ideal situation with a cooperative and receptive patient, a longer-term therapeutic undertaking with periodic checks on compliance would be expected.
Dr Frost is Harold and Elsa Siipola Israel Professor or Psychology at Smith College, Northampton, Mass. Dr Patronek is Adjunct Assistant Professor at the Cummings School of Veterinary Medicine, Tufts University, North Grafton, Mass. Dr Arluke is Professor of Sociology at Northeastern University, Boston. Dr Steketee is Professor in the School of Social Work at Boston University. The authors report no conflicts of interest concerning the subject matter of this article.
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