Categorization in compulsive hoarding

Based on hypothesizing about the role of information processing, and in particular, underinclusive categorization in compulsive hoarding, this study examined categorization processes in people with clinically significant compulsive hoarding problems. Twenty-one participants with primary compulsive hoarding, 21 with OCD without hoarding, and 21 non-psychiatric controls completed three categorization tasks. Hoarding and OCD participants reported significantly more distress prior to each of the three tasks than did controls. On tasks sorting common household items, the groups did not differ on the number of piles created nor on the amount of time taken to sort. However, on a task sorting personally relevant items, hoarding participants took more time, created more piles, and reported more anxiety than non-psychiatric controls. Hoarders also took more time than the OCD group, and tended to create more piles. Hoarding severity was correlated with the number of piles created, but only when the objects were personally relevant. Results support under-inclusive categorizing for people with compulsive hoarding, but the effect was largely confined to objects of personal relevance.     

Categorization and cognitive deficits in compulsive hoarding

According to the cognitive-behavioural model of compulsive hoarding, information-processing deficits in the areas of attention, memory, decision-making, and categorization contribute to hoarding behaviour. The purpose of the current study was to examine whether individuals with compulsive hoarding exhibited impairment on executive functioning and categorization tasks. Three groups of participants were recruited (N = 60): individuals with compulsive hoarding syndrome, individuals with an Axis I mood or anxiety disorder, and non-clinical control participants. All participants completed self-report measures of cognitive difficulties, neuropsychological tests of executive functioning and decision-making, and four categorization tasks. Results suggested that hoarding participants reported more cognitive failures and more problems with attention and decision-making than non-clinical control participants. In addition, hoarding participants performed worse than both control groups on the Stockings of Cambridge (SOC), a neuropsychological test of planning ability, and were slower and more anxious during a categorization task. These findings suggest that specific deficits in executive functioning may be associated with the difficulties hoarding patients have organizing their possessions.     

The prevalence of compulsive hoarding and its association with compulsive buying in a German population-based sample

The aims of the study were to estimate the prevalence rate of compulsive hoarding, and to determine the association between compulsive hoarding and compulsive buying in a nationally representative sample of the German population (N = 2307). Compulsive hoarding was assessed with the German version of the Saving Inventory-Revised (SI-R; Frost, R.O., Steketee, G., & Grisham, J. (2004). Measurement of compulsive hoarding: saving inventory-revised. Behaviour Research and Therapy, 42, 1163-1182.). The point prevalence of compulsive hoarding was estimated to be 4.6%. Individuals with compulsive hoarding did not differ significantly from those without compulsive hoarding regarding age, gender, and other sociodemographic characteristics. Significant correlations were found between the compulsive hoarding and the compulsive buying measures. Participants with compulsive hoarding reported a higher propensity to compulsive buying than respondents without hoarding. About two thirds of participants classified as having compulsive hoarding were also defined as suffering from compulsive buying. In summary, these results suggest that compulsive hoarding may be relatively prevalent in Germany and they confirm the close association between compulsive hoarding and compulsive buying through the investigation of a large scale representative sample.     

Hoarding in a compulsive buying sample

Previous research has indicated that many compulsive buyers also suffer from compulsive hoarding. The present work specifically examined hoarding in a compulsive buying sample. Sixty-six treatment-seeking compulsive buyers were assessed prior to entering a group therapy for compulsive buying using the Compulsive Buying Scale (CBS), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)-Shopping Version, the Compulsive Acquisition Scale (CAS), the German-CBS, the Saving Inventory-Revised (SI-R), the Maudsley Obsessive Compulsive Inventory (MOCI), the Barratt Impulsiveness Scale (BIS-11), and the Structured Clinical Interview for DSM-IV Axis I (SCID). Inclusion criteria were current problems with compulsive buying according to the proposed diagnostic criteria for compulsive buying by McElroy, Keck, Pope, Smith, and Strakowski [(1994). Compulsive buying: A report of 20 cases. Journal of Clinical Psychiatry, 55, 242-248]. Our results support the assumption that many but not all compulsive buyers suffer from compulsive hoarding. A significant association between the SI-R and the compulsive buying measures CBS, Y-BOCS-SV, German-CBS, and the CAS-Buy subscale was found, which is mostly caused by the SI-R subscale acquisition. The SI-R subscales clutter and difficulty discarding were more closely associated with the CAS-Free subscale and with obsessive-compulsive symptoms. Hoarding compulsive buyers reported more severe buying symptoms and obsessive-compulsive symptoms and presented with a higher psychiatric co-morbidity, especially any current affective, anxiety and eating disorder. Specific therapeutic interventions for compulsive buyers who also report compulsive hoarding appear indicated.     

Family burden of compulsive hoarding: results of an internet survey

Compulsive hoarding, the acquisition of and failure to discard large numbers of possessions, is associated with substantial health risk, impairment in functioning, and economic burden. Despite clear indications that hoarding has a detrimental effect on people living with or near someone with a hoarding problem, no empirical research has examined these harmful effects. The aim of the present study was to examine the burden of hoarding on family members. Six hundred sixty-five family informants who reported having a family member or friend with hoarding behaviors completed an internet-based survey. Living with an individual who hoards during childhood was associated with elevated reports of childhood distress and family strain. Family members reported high levels of patient rejection attitudes, suggesting high levels of family frustration and hostility. Rejecting attitudes were predicted by severity of hoarding symptoms, the individual's perceived lack of insight into the behavior, and having lived in a cluttered environment during childhood. These results suggest that compulsive hoarding adversely impacts not only the hoarding individual, but also those living with them.     

An open trial of cognitive-behavioral therapy for compulsive hoarding

The aim of the present study was to provide preliminary data on the efficacy of a new cognitive-behavioral treatment (CBT) for compulsive hoarding. Fourteen adults with compulsive hoarding (10 treatment completers) were seen in two specialty CBT clinics. Participants were included if they met research criteria for compulsive hoarding according to a semistructured interview, were age 18 or above, considered hoarding their main psychiatric problem, and were not receiving mental health treatment. Patients received 26 individual sessions of CBT, including frequent home visits, over a 7-12 month period between December 2003-February 2005. Primary outcome measures were the Saving Inventory-Revised (SI-R), Clutter Image Rating (CIR), and Clinician's Global Impression (CGI). Significant decreases from pre- to post-treatment were noted on the SI-R and CIR, but not the CGI-severity rating. CGI-Improvement ratings indicated that at mid-treatment, 40% (n=4) of treatment completers were rated "much improved" or "very much improved;" at post-treatment, 50% (n=5) received this rating. Adherence to homework assignments was strongly related to symptom improvement. CBT with specialized components to address problems with motivation, organizing, acquiring and removing clutter appears to be a promising intervention for compulsive hoarding, a condition traditionally thought to be resistant to treatment.     

Measurement of compulsive hoarding: saving inventory-revised

Four studies examined a new measure of compulsive hoarding (Saving Inventory-Revised; SI-R). Factor analysis using 139 hoarding participants identified 3 factors: difficulty discarding, excessive clutter, and excessive acquisition. Additional studies were conducted with hoarding participants, OCD participants without hoarding, community controls and an elderly sample exhibiting a range of hoarding behavior. Internal consistencies and test-retest reliabilities were good. The SI-R distinguished hoarding participants from all other non-hoarding comparison groups. The SI-R showed strong correlations with other indices and methods of measuring hoarding (beliefs, activity dysfunction from clutter, observer ratings of clutter in the home) and relatively weaker correlations with non-hoarding measures (positive and negative affect and OCD symptoms). The SI-R appears to be an appropriate instrument for assessing symptoms of compulsive hoarding in clinical and non-clinical samples.     

Executive and Attention Functioning Among Children in the PANDAS Subgroup

Evidence from past studies indicates that adults and children with Obsessive-Compulsive Disorder (OCD) and Tourette syndrome (TS) experience subtle neuropsychological deficits. Less is known about neuropsychological functioning of children and adolescents with a symptom course consistent with the PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection) subgroup of OCD and tics. To provide such information, we administered three tests of attention control and two of executive function to 67 children and adolescents (ages 5–16) diagnosed with OCD and/or tics and a symptom course consistent with the PANDAS subgroup and 98 healthy volunteers (HV) matched by age, sex, and IQ. In a paired comparison of the two groups, the PANDAS subjects were less accurate than HV in a test of response suppression. Further, in a two-step linear regression analysis of the PANDAS group in which clinical variables were added stepwise into the model and in the second step matching variables (age, sex, and IQ) were added, IQ emerged as a predictor of performance on this task. In the same analysis, ADHD diagnosis and age emerged as predictors of response time in a continuous performance task. Subdividing the PANDAS group by primary psychiatric diagnosis revealed that subjects with TS or OCD with tics exhibited a longer response time compared to controls than subjects with OCD only, replicating previous findings within TS and OCD. This study demonstrates that children with PANDAS exhibit neuropsychological profiles similar to those of their primary psychiatric diagnosis.     

Do traumatic events influence the clinical expression of compulsive hoarding?

Traumatic experiences have been posited as one potential catalyst for the abrupt onset of obsessive-compulsive symptoms including compulsive hoarding. To determine whether traumatic life events (TLEs) might influence the expression of compulsive hoarding in obsessive-compulsive disorder (OCD), interview responses to the Posttraumatic Stress Disorder module of the Structured Clinical Interview for DSM-IV (SCID) were examined in 180 individuals with OCD. Compared to individuals with OCD who did not meet criteria for hoarding, participants classified as hoarders (24% of the sample) were significantly more likely to have reported at least one TLE in their lifetime. Patients who met criteria for hoarding and who had also experienced TLEs had significantly greater hoarding symptom severity than those hoarders not exposed to trauma. This association was found to be robust. That is, the relationship between TLEs and hoarding symptom severity was not better accounted for by age, age of OCD onset, depressive symptoms, general OCD symptomatology, or mood and anxiety comorbidity. Closer examination revealed that the clutter factor of compulsive hoarding (and not difficulty discarding or acquisitioning) was most strongly associated with having experienced a traumatic event.     

No evidence for object alternation impairment in obsessive-compulsive disorder (OCD)

Recent neuroimaging studies have consistently ascribed the orbito-frontal cortex (OFC) a pivotal role in the pathogenesis of obsessive-compulsive disorder (OCD). Cognitive tests presumed sensitive to this region, such as the Object Alternation Task (OAT), are considered important tools to verify this assumption and to investigate the impact of cortical dysfunction on behavior. The aim of the present study was to assess if patients with OCD show enhanced perseveration errors on the OAT relative to healthy controls taking into account several potential moderators, especially comorbid depression and OCD subtype. Thirty-five OCD patients and 18 healthy controls underwent the OAT as well as the Trail-Making Tests (TMT) A and B. In line with prior studies, OCD patients were slowed on both TMT tasks. In contrast, samples performed similarly on the OAT. While the latter finding does not invalidate the assumption that the OFC is affected in OCD, dysfunctions involving this region may be more subtle than often claimed and likely encompass only a small subset of functional domains hosted in the OFC.     

My possessions need me: Anthropomorphism and hoarding

Hoarding disorder (HD ), a new DSM ‐5 classification, is characterized by difficulty discarding and the excessive acquisition of possessions to the extent that living spaces are compromised by clutter. Individuals with hoarding difficulties have a variety of motivations for object ownership, including emotional attachment towards their possessions which sometimes manifests through imbuing possessions with human‐like terms. Limited extant evidence suggests that anthropomorphism, attributing human qualities to non‐human objects, is related to hoarding, possibly because of difficulties with interpersonal attachment and social isolation. The current study investigated the relationship between hoarding behaviors (i.e., difficulty discarding, excessive acquisition, and clutter), hoarding beliefs (i.e., motivations for ownership including responsibility, emotional attachment, memory, control), anthropomorphism (i.e., generally in childhood, generally in adulthood, and towards three different personally‐owned objects), and loneliness. Moderation analyses examined whether hoarding beliefs or loneliness impacted how anthropomorphism related to hoarding symptoms. Results suggested that all dimensions of anthropomorphism were related to hoarding behaviors. Regression analyses indicated that anthropomorphism in adulthood and of personally owned‐objects were the best predictors of hoarding behavior. Mixed evidence was found for hoarding beliefs and loneliness moderating these associations. Findings successfully replicated and extended previous literature and provide a novel measure of anthropomorphism specifically incorporating personal ownership.     

Differences in cognitive control in children and adolescents with combined and inattentive subtypes of ADHD

The aim of the present study was to investigate the ability of children with attention deficit/hyperactivity disorder-combined subtype (ADHD-C) and predominantly inattentive subtype (ADHD-PI) to direct their attention and to exert cognitive control in a forced attention dichotic listening (DL) task. Twenty-nine, medication-naive participants with ADHD-C, 42 with ADHD-PI, and 40 matched healthy controls (HC) between 9 and 16 years were assessed. In the DL task, two different auditory stimuli (syllables) are presented simultaneously, one in each ear. The participants are asked to report the syllable they hear on each trial with no instruction on focus of attention or to explicitly focus attention and to report either the right- or left-ear syllable. The DL procedure is presumed to reflect different cognitive processes: perception (nonforced condition/NF), attention (forced-right condition/FR), and cognitive control (forced-left condition/FL). As expected, all three groups had normal perception and attention. The children and adolescents with ADHD-PI showed a significant right-ear advantage also during the FL condition, while the children and adolescents in the ADHD-C group showed a no-ear advantage and the HC showed a significant left-ear advantage in the FL condition. This suggests that the ADHD subtypes differ in degree of cognitive control impairment. Our results may have implications for further conceptualization, diagnostics, and treatment of ADHD subtypes.     

Cognitive aspects of nonclinical obsessive-compulsive hoarding

Research on the cognitive variables associated with obsessive-compulsive hoarding is scarce. In this study, we investigated cognitive variables that may contribute to the maintenance and possibly etiology of hoarding. College students who characterized themselves as either "packrats" (nonclinical hoarders; n=21) or not (control participants; n=20) completed questionnaires assessing hoarding behavior and beliefs about hoarding, and completed a task requiring them to categorize diverse objects and trinkets of minimal value into groups. The results revealed that nonclinical hoarders, relative to control participants, rated the categorization task as significantly more stressful and difficult. Relative to control participants, hoarders took longer to complete the task and sorted objects into more categories. These findings suggest that underinclusiveness and indecisiveness, characteristic of clinical hoarders, are evident in nonclinical hoarders as well.     

Neuropsychological Functioning in Children with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) has been associated with deficits in the areas of verbal memory and learning, executive functioning, working memory, and attention in adults. Findings have been less consistent in the few studies examining neuropsychological functioning in childhood PTSD, which are often limited by comparing children with PTSD to children without trauma histories, making it unclear whether observed neuropsychological deficits are related to trauma exposure or to PTSD symptomatology. In an ethnically diverse sample of 62 children who witnessed intimate partner violence (n = 27 PTSD+ and 35 PTSD?), children with PTSD exhibited slower and less effective learning, heightened sensitivity to interference, and impaired effect of rehearsal on memory acquisition on the California Verbal Learning Test – Children's Version, a word list learning task. Both groups performed in the below average range on measures of executive functioning, attention, and intellectual ability.     

When hoarding is a symptom of OCD: A case series and implications for DSM-V

Hoarding, the excessive collection and failure to discard objects of apparently little value, can represent a serious psychiatric problem and pose a threat to public health. Hoarding has traditionally been considered a symptom (or symptom dimension) of Obsessive-Compulsive Disorder (OCD), but its nosological status has recently been debated. Mounting evidence suggests that, once other primary causes are ruled out, hoarding may be a discrete diagnostic entity, recently named Hoarding Disorder. However, hoarding can sometimes be a genuine OCD symptom. This can be confusing and clinicians may sometimes struggle making the differential diagnosis. To illustrate this, we describe 10 OCD patients with severe hoarding behavior that is better conceptualized as a symptom of OCD. We focus on the motivations for hoarding and the overlapping of hoarding with other obsessive-compulsive symptom dimensions. We estimate that this clinical presentation is relatively rare and accounts for a minority of severe hoarding cases. We discuss the unique characteristics of hoarding as a symptom of OCD and the implications for DSM-V.     

Deteriorating memory confidence, responsibility perceptions and repeated checking: comparisons in OCD and control samples

Repeated checking has been repeatedly associated with memory distrust. We sought to extend previous research using a computer-based checking task by incorporating a group of 15 individuals with OCD, and examining the effect of increased perceived responsibility. Participants were asked to repeatedly check a virtual stovetop, with half the participants also placed under a condition of high-perceived responsibility. Our observations replicated previous research showing that the act of repeatedly checking leads to reductions in memory vividness, detail and confidence, without accompanying reductions in memory accuracy. Furthermore, while a sense of increased personal responsibility had little effect on a student control sample, it led to a significant further deterioration in memory confidence in individuals with OCD. These results suggest that in people with OCD, normal reductions in memory confidence over repeated trials are exacerbated and intensified by inflated responsibility perceptions.     

Elucidating the Relation of Hoarding to Obsessive Compulsive Disorder and Impulse Control Disorders

Hoarding has historically been conceptualized as a symptom of Obsessive Compulsive Disorder (OCD); however, data demonstrate important differences between hoarding and OC symptoms (for discussion, see Grisham et al. Anxiety Disorders, 19, 767‑779. 2005). Hoarding has also been observed in disorders besides OCD, including specific Impulse Control Disorders (ICDs; e.g., kleptomania, trichotillomania, pathological gambling, compulsive buying). Therefore, the current study tested the hypothesis that hoarding would be as strongly related to symptoms of ICDs as it is to OCD and that these relationships would be medium to strong in magnitude. Results from an undergraduate sample showed hoarding behaviors were strongly related to symptoms of OCD, moderately related to symptoms of compulsive buying, and more modestly related to symptoms of pathological gambling, trichotillomania, and kleptomania. Finally, findings suggest indecisiveness may be a particularly important underlying feature in hoarding behaviors. These results support the consideration of hoarding outside the confines of OCD.

Relationships among compulsive hoarding, trauma, and attention-deficit/hyperactivity disorder

The current study investigated aspects of post-traumatic stress disorder and attention deficit/ hyperactivity disorder (ADHD) among hoarders. Compared to a sample of 36 controls, hoarders (n=26) reported a significantly greater number of different types of trauma, more frequent traumatic experiences, more symptoms of inattention, hyperactivity, and greater comfort derived from possessions. These findings are consistent with previous reports of extensive comorbidity associated with hoarding behaviors, and may reflect the potential usefulness of assessing PTSD and ADHD symptoms at the outset of hoarding treatments, as well as considering alternative pharmacological interventions.     

The status of hoarding as a symptom of obsessive-compulsive disorder

Hoarding is considered by many to be a symptom of obsessive-compulsive disorder (OCD). Yet although it is observed in people with OCD, hoarding symptoms also appear in a number of other psychological and psychiatric conditions. The present studies were conducted using samples of OCD patients, patients with other anxiety disorders, and a non-clinical sample to further elucidate the relationship between hoarding and OCD. Across two investigations, we found that (a) whereas OCD patients had higher scores than the other groups on non-hoarding symptoms, this was not the case for hoarding symptoms; (b) hoarding tended to correlate more weakly with other OCD symptoms (e.g., washing, checking) than these other symptoms intercorrelated; (c) items measuring hoarding had the weakest factor loadings when a measure of OCD symptoms was submitted to factor analysis; (d) hoarding symptoms were not correlated with global OCD or anxiety severity, whereas other OCD symptoms were; and (e) hoarding did not show consistent relationships with OCD-related cognitive variables. These results do not support a specific relationship between hoarding and OCD; and they call into question hoarding's status as a specific symptom of OCD. Results are also discussed in terms of the importance of functional assessment of hoarding and OCD symptoms.     

Spontaneous decay of compulsive urges: the case of covert compulsions

It is well established that many patients with obsessive-compulsive disorder have covert, or internal, compulsions. Empirical studies of this phenomenon, however, are limited. The present study followed the paradigm developed by Rachman and his colleagues for the study of overt compulsions. Patients with urges to carry out covert compulsions underwent an experimental procedure in which their compulsive urges were provoked, followed by a period of response prevention. The strength of the compulsive urges and associated discomfort were monitored. There was marked, and relatively rapid, spontaneous decay of both the compulsive urges and the discomfort. Implications of these results are discussed.