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What do I do with a parent who hoards and won't stop picking skin? My parent refuses to get help and is very defiant/gets angry when the issues are addressed, competent otherwise. Living in my home.

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There's a lot more than simple 'depression' going on for an elder to be hoarding and non-stop picking at her skin, refusing to get help, and acting defiant and angry when approached about the situation. You say she's 'competent' otherwise, which begs the question of what you consider 'competent'? She can be suffering from dementia or Alzheimer's, OCD disorder, and anxiety at the very least, which is what hoarding is a sign of: Mental illness. She is living in YOUR home, yet ruling the roost with all of this behavior she is 'refusing' to acknowledge or address. There is a problem here that YOU need to address, by getting her to the doctor for an accurate diagnosis, cognitive evaluation, and appropriate medication. Give her an ultimatum: either she complies with your request for that, or she moves OUT. You can find her an appropriate nursing home or Assisted Living Facility to reside at, and that's that. To give up your home and your life to her disorders is not acceptable, whether she's your mother or not.

Best of luck setting down the appropriate boundaries for mother to continue living in YOUR home.
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How old is she?

"Dermatillomania is a disorder characterized by the repetitive picking of one's own skin. It has been reported by individuals with attention deficit disorder, hyperactivity disorder, depression, Parkinson's disease, stress and anxiety and Alzheimer's disease and dementia."

source: https://www.theadvocate.com/baton_rouge/entertainment_life/health_fitness/article_d3c5034c-91d2-11e8-bfd4-0f91075018f9.html

Even if the skin-picking was gotten under control, the hoarding won't stop because it's a mental disorder and requires therapy.

It's your home, so you get to set the boundaries -- but even so, don't expect an untreated hoarder to respect them... They're not just "pack rats" or messy, they aren't rational. You can't reason with them about it.

Consulting with a therapist who specializes in hoarding disorder woud help you make decisions and create appropriate boundaries.
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Find her another place to live. She's not going to give up the hoarding voluntarily, and will eventually ruin your home. If her only health problem is depression (per your profile), there's no reason she should have to live with you. The majority of adults have depression to one degree or another.

Boot her out.
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