Too Many Pets: The Dangers of "Noah Syndrome"

This post was written by Dr. Katherine Compitus and Kathryne Gerol, MSW.

What is "Noah Syndrome"?

It's another way to describe a serious mental illness known as animal hoarding disorder. It is called Noah Syndrome after the Biblical figure, Noah, who built a giant ship and collected a large number of animals.

Few people know much about animal hoarding, but it is a serious public health issue that affects entire communities. Animal hoarding may be defined as the accumulation of a large number of animals along with a failure to provide at least the very minimum standards of nutrition, sanitation, and veterinary care. Hoarders live in complete squalor; urine and feces may stain the walls and floors, and the house itself may be deteriorating due to unsanitary conditions. Often, the people and animals in the house suffer from serious medical illnesses and, sadly, usually do not receive adequate medical treatment.

There are approximately 2,000 new hoarding cases identified in the USA each year, although there likely are many more that occur behind closed doors. The cost of remediating an animal hoarding case may be around $100,000 per case, usually paid by the local taxpayers. In the majority of cases, sanitation, law enforcement, and animal rescue organizations must all be involved. Mental health treatment is rarely provided to animal hoarders, which explains the near 100 percent rate of recidivism—as soon as the animals are removed from the hoarding house, the person will likely seek out more animals to "rescue," and the cycle will start again.

The American Psychiatric Association indicates that hoarding may affect 2-5 percent of the adult population in the United States. The most common species of animals hoarded are cats and dogs, although it is possible to hoard any type of animal, including large farm animals. In one study of 71 animal hoarders, approximately 82 percent of cases involved cats, 55 percent dogs, 17 percent birds, 6 percent reptiles, 11 percent small mammals, 6 percent horses, and 6 percent cattle, sheep, or goats.

According to the DSM-V, approximately 75 percent of people with hoarding disorder have comorbid mood or anxiety disorders. Some clinicians postulate that hoarding behavior may be a symptom of obsessive-compulsive and related disorders, such as delusional disorders, major depressive disorder, social anxiety disorder, and generalized anxiety disorder. Others believe that hoarding may emerge as a maladaptive coping response to a traumatic event, such as the sudden death of a loved one. The typical (not exclusive) profile of an animal hoarder is a woman who is 60+ years old, has more than 40 animals in her care, and has collected animals for more than 20 years.

Three Types of Animal Hoarders

Animal hoarding is more complex than object hoarding because of the underlying motivation. Lockwood suggested three overarching types: the Overwhelmed Caregiver, the Rescue Hoarder, and the Exploiter Hoarder. The first two types (Caregiver and Rescue) may suffer from a delusional disorder that includes a "Savior Complex." They genuinely believe that they are helping animals, despite the illness and deteriorating conditions that surround them.

The Overwhelmed Caregiver (OC) is likely to minimize, rather than deny, an animal care problem. Usually, these result from a significant change in the person's health, economic, social, medical, or career status. The OC often has strong attachments to the animals in their care; however, they are unable to care for them as they used to, and this leads to a deterioration of care. The overwhelmed caregiver tends to be socially isolated and is more cooperative with authorities than most hoarders. In these cases, law enforcement usually limits their involvement to citation violation of housing sanitation or public nuisance ordinances.

The Rescue Hoarder (RH) is the largest and most common subtype of animal hoarding. In cases involving Rescue Hoarders, the individual feels emotionally driven to "save" all animals, and they may reject any prospect of euthanasia, even when an animal is terminally ill and suffering. The rescue hoarder poses a challenge to interventionists because of the lack of insight into the harm they are causing, often leading them to be uncooperative when authorities attempt to intervene. In addition, they may view animal control agencies as the enemy since they are attempting to remove the animals from their care. Researchers believe that these psychological conditions almost guarantee recidivism regardless of any legal or financial consequences they may face.

Of the three types of hoarders, the Exploiter Hoarder is the most difficult to manage since it is likely that they may have a comorbid Antisocial Personality Disorder. This type of hoarder may have insight into their condition, but they have a lack of empathy for people or animals and may be motivated by financial gain. Due to their lack of emotional attachment to their animals, they may not fit the diagnostic criteria for hoarding disorder. The Exploiter may benefit from treatment for their antisocial tendencies rather than the traditional treatments for animal hoarding.

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Help for Animal Hoarders

Courts may mandate counseling for animal hoarding disorder; however, there are no validated therapy treatments for animal hoarding. There is an increase in research on hoarding disorder treatments; however, there is a high dropout rate and poor treatment outcomes in hoarding disorder treatments compared to non-hoarding OCD patients. Most individuals who are involved in animal hoarding cases are reluctant to participate in therapy and resistant to change, making court-mandated therapy difficult to enforce.

Approaches that are commonly used include cognitive-behavioral therapy (CBT), relapse prevention, and harm reduction. By using the cognitive-behavioral approach of relapse prevention, the goal is to identify and prevent high-risk situations. Exposure and response prevention (ERP) is the gold-standard treatment for obsessive-compulsive disorder (OCD) and may be beneficial when working with someone with an animal hoarding disorder.

A harm reduction technique would include monitoring and wrap-around services such as frequent check-ins with clients, spay or neuter services, veterinary care, environmental clean-up, and connection to social services. The best response to animal hoarding so far is early detection and coordination of multiple agencies and services. The American Society for the Prevention of Cruelty to Animals (ASPCA) has a program that combines professionals such as social workers, veterinarians, animal behaviorists, humane law enforcement agencies, and a range of additional human and animal service agencies.

As there is limited information available on this isolated population, it is imperative that there be more research conducted on effective treatment approaches in working with people with animal hoarding disorder. Additionally, there needs to be a further push to separate animal hoarding from item hoarding in the DSM.

Our society has villainized people with Noah Syndrome, especially when we see images of complete squalor and sickly animals in a hoarding house, but we must recognize that this is a severe mental illness that requires treatment, not a lifestyle choice. If we are to be effective in reducing the number of animal hoarding cases, we must increase awareness of this illness and actively pursue more treatment research.

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