Hoarding in obsessive compulsive disorder: results from a case-control study

Hoarding occurs relatively frequently in obsessive-compulsive disorder (OCD), and there is evidence that patients with hoarding symptoms have more severe OCD and are less responsive to treatment. In the present study, we investigated hoarding symptoms in 126 subjects with OCD. Nearly 30% of the subjects had hoarding symptoms; hoarding was twice as prevalent in males than females. Compared to the 90 non-hoarding subjects, the 36 hoarding individuals had an earlier age at onset of, and more severe, obsessive-compulsive symptoms. Hoarders had greater prevalences of symmetry obsessions, counting compulsions, and ordering compulsions. Hoarders also had greater prevalences of social phobia, personality disorders, and pathological grooming behaviors (skin picking, nail biting, and trichotillomania). Hoarding and tics were more frequent in first-degree relatives of hoarding than non-hoarding probands. The findings suggest that the treatment of OCD patients with hoarding symptoms may be complicated by more severe OCD and the presence of co-occurring disorders. Hoarding appears to be transmitted in some OCD families and may differentiate a clinical subgroup of OCD.     

Hoarding behaviors in a large college sample

Hoarding behaviors occur in many clinical syndromes but are most commonly linked to obsessive compulsive disorder. Surprisingly little empirical work has examined the nature of hoarding behaviors despite their association with significant distress and impairment. The current study examined hoarding in 563 unselected college students. Using principal components analysis, we identified four domains of hoarding behaviors as measured by the 26-item Saving Inventory-Revised: Difficulty Discarding, Acquisition Problems, Clutter, and Interference/Distress. All four domains and total hoarding behaviors were strongly related to hoarding beliefs and to obsessive compulsive (OC) symptoms. Hoarding behaviors were most strongly correlated with subscales of an OC disorder (OCD) measure assessing hoarding and obsessions and least strongly correlated with the washing subscale. Hoarding behaviors also showed significant, but more modest, correlations with social anxiety, depressive symptoms, and worry. However, worry was not found to contribute unique variance to the prediction of hoarding behaviors. Of greatest note, hoarding behaviors showed a surprisingly strong relationship with anxiety sensitivity, similar in magnitude to the relationship between hoarding and OCD symptoms. Results are interpreted and lines of future research are proposed, with particular emphasis on further elucidating the relationship between hoarding behaviors and anxiety sensitivity.     

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.     

Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study

Hoarding behavior occurs frequently in obsessive-compulsive disorder (OCD). Results from previous studies suggest that individuals with OCD who have hoarding symptoms are clinically different than non-hoarders and may represent a distinct clinical group. In the present study, we compared 235 hoarding to 389 non-hoarding participants, all of whom had OCD, collected in the course of the OCD Collaborative Genetics Study. We found that, compared to non-hoarding individuals, hoarders were more likely to have symmetry obsessions and repeating, counting, and ordering compulsions; poorer insight; more severe illness; difficulty initiating or completing tasks; and indecision. Hoarders had a greater prevalence of social phobia and generalized anxiety disorder. Hoarders also had a greater prevalence of obsessive-compulsive and dependent personality disorders. Five personality traits were independently associated with hoarding: miserliness, preoccupation with details, difficulty making decisions, odd behavior or appearance, and magical thinking. Hoarding and indecision were more prevalent in the relatives of hoarding than of non-hoarding probands. Hoarding in relatives was associated with indecision in probands, independently of proband hoarding status. The findings suggest that hoarding behavior may help differentiate a distinct clinical subgroup of people with OCD and may aggregate in some OCD families. Indecision may be a risk factor for hoarding in these families.     

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.     

Consideration of the BDNF gene in relation to two phenotypes: hoarding and obesity

The gene coding for the brain derived neurotrophic factor (BDNF) has emerged as an interesting candidate for multiple brain and brain disorder-related phenomena. The primary aim of the present investigation was to consider the relationship between the BDNF Val66Met variant and two phenotypes: compulsive hoarding as a symptom dimension of obsessive-compulsive disorder (OCD), and body mass index (BMI). We examined the BDNF gene in a large (N=301) clinical sample of probands with OCD. Participants were classified as hoarding or nonhoarding using a strict, multimeasure grouping approach. Results revealed that the Val/Val genotype was linked with hoarding classification and more severe hoarding behaviors, as well as greater BMI levels. Hoarding status was also associated with greater BMI scores, with individuals in the hoarding group being far more likely to be classified as obese compared with the nonhoarding group. Our findings may provide a distinct avenue through which hoarding and BMI could be linked. These findings are suggestive of a complex gene, body weight, and psychopathology relationship wherein a primitive, survival "thrifty gene" strategy may be conserved and represented in a subgroup of humans manifesting severe hoarding symptoms.     

Worry and Rumination in Generalized Anxiety Disorder and Obsessive Compulsive Disorder

Ample work has already been conducted on worry and rumination as negative thought processes involved in the etiology of most of the anxiety and mood related disorders. However, minimal effort has been exerted to investigate whether one type of negative thought process can make way for another type of negative thought process, and if so, how it subsequently results in experiencing a host of symptoms reflective of one or the other type of psychological distress. Therefore, the present study was taken up to investigate whether rumination mediates the relationship between worry and generalized anxiety disorder (GAD), and between worry and obsessive compulsive disorder (OCD) in two clinical groups. Self-report questionnaires tapping worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) were administered to a clinical sample of 60 patients aged 30–40. Worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) correlated substantially with each other, however, rumination did not mediate the relationship between worry and generalized anxiety disorder (GAD) and between worry and obsessive compulsive disorder (OCD). We also analyzed differences of outcome variables within two clinical groups. These results showed that worry and rumination were significantly different between GAD and OCD groups.     

Neuropsychological impairment associated with compulsive hoarding

A group of patients with compulsive hoarding (n=30) was compared to a mixed clinical group (n=30) and a nonclinical community group (n=30) on laboratory tests of information-processing features hypothesized to be central to hoarding (memory, attention, and decision-making). Hoarding patients demonstrated slower and more variable reaction time, increased impulsivity, greater difficulty distinguishing targets and nontargets, and worse spatial attention relative to comparison groups. Multiple regression analyses demonstrated that slower reaction time and increased impulsivity were significantly related to hoarding symptoms over and above the effect of depression, schizotypy, and other obsessive-compulsive disorder (OCD) symptoms. There were no group differences on a test of emotion-based decision-making. Results are discussed in terms of previous findings and theoretical models of compulsive hoarding.     

A Norwegian version of the Obsessive‐Compulsive Inventory–Revised: Psychometric properties

Solem, S., Hjemdal, O., Vogel, P.A. & Stiles, T.C. (2010). A Norwegian version of the Obsessive‐Compulsive Inventory–Revised: Psychometric properties. Scandinavian Journal of Psychology 51, 509–516. The aims of this study were to test the psychometric properties of the Norwegian version of the Obsessive‐Compulsive Inventory–Revised (OCI‐R). The study included a student/community control sample (N = 1167) and a clinical sample (N = 72) with a diagnosis of obsessive‐compulsive disorder (OCD). The results indicated a good fit for the six‐factor structure of the OCI‐R. The mean scores and standard deviations were similar to that of studies from other countries as was the internal consistency. The OCI‐R scores were significantly higher in the OCD sample compared to the control sample. All the subscales, except hoarding, were significant predictors of obsessive‐compulsive severity, and the OCI‐R subscales seemed to be in agreement with the different subtypes of OCD according to DSM‐IV. The OCI‐R showed meaningful correlations with measures related to obsessive compulsive symptoms. As expected, it showed the strongest correlation with the Yale‐Brown Obsessive Compulsive Scale, followed by measures of worry, anxiety, and depression. In summary, the Norwegian OCI‐R showed adequate psychometric properties suggesting it could be a suitable measure of obsessive‐compulsive symptoms.     

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.     

The hoarding dimension of OCD: psychological comorbidity and the five-factor personality model

Although hoarding has been associated with several psychological disorders, it is most frequently linked to obsessive-compulsive disorder (OCD). The present study assessed hoarding obsessions and compulsions in 204 individuals with OCD, and evaluated how hoarding was related to obsessive-compulsive symptom severity, psychological comorbidity, and personality as measured by the five-factor model. Results indicated that hoarding in OCD is a dimensional variable that is positively associated with dysphoria, total number of lifetime Axis I disorders, and lifetime histories of bipolar I, PTSD, and body dysmorphic disorder. Hoarding was negatively correlated with the NEO-Personality Inventory-Revised (NEO-PI-R) factor of Conscientiousness and positively associated with the NEO-PI-R factor of Neuroticism. When all personality and psychopathology variables were entered into a regression equation, dysphoria, bipolar II disorder, Conscientiousness, age, and Extraversion emerged as significant predictors of hoarding severity. Recommendations are made for clinicians and for future research.     

Patterns of personality pathology in patients with generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia

The relationship between co-occurring personality disorders and anxiety disorders (panic disorder with or without agoraphobia, social phobia, and generalized anxiety disorder) was examined, taking into account the effect of major depression. This article describes findings for 622 participants in the Harvard/Brown Anxiety Research Project, a longitudinal follow-up study of DSM-III-R-defined anxiety disorders. A total of 24% of participants had at least one personality disorder, with avoidant, obsessive compulsive, dependent, and borderline most common. Generalized anxiety disorder, social phobia, and major depression were positively associated with the occurrence of one or more personality disorders, whereas panic disorder with agoraphobia was not associated. Major depression was associated in particular with dependent, borderline, histrionic, and obsessive compulsive personality disorders and social phobia was associated with avoidant personality disorder. Whereas some of our findings confirm results from earlier studies, others are somewhat inconsistent with previous results and indicate the need for further investigation.     

囤积症的行为心理特征及相关因素

囤积症是指过度获取和不能丢弃那些没有用处或失去价值的物品。这种行为通常会给患者本人及其家庭成员带来感情、躯体、财务、社会甚至法律方面的负面影响。对于囤积症的行为特征、心理特征及相关因素,学界已有大量的研究。近期,囤积症已被纳入DSM-5,这将有助于确定有持续性丢弃困难的个体,并对其予以帮助与干预。     

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.

Clarifying the convergence between obsessive compulsive personality disorder criteria and obsessive compulsive disorder

In this study we examined the convergence between obsessive-compulsive personality disorder (OCPD) criteria and obsessive-compulsive disorder (OCD). Baseline assessments of 629 participants of the Collaborative Longitudinal Personality Disorders Study were used to examine the associations between OCPD criteria and diagnoses of OCD. Three of the eight OCPD criteria--hoarding, perfectionism, and preoccupation with details--were significantly more frequent in subjects with OCD (n = 89) than in subjects without OCD (n = 540). Logistic regressions were used to predict the probability of each OCPD criterion as a function of Axis I diagnoses (OCD, additional anxiety disorders, and major depressive disorder). Associations between OCD and these three OCPD criteria remained significant in the logistic regressions, showing unique associations with OCD and odds ratios ranging from 2.71 to 2.99. In addition, other anxiety disorders and major depressive disorder showed few associations with specific OCPD criteria. This study suggests variability in the strength of the relationships between specific OCPD criteria and OCD. The findings also support a unique relationship between OCPD symptoms and OCD, compared to other anxiety disorders or major depression. Future efforts to explore the link between Axis I and Axis II disorders may be enriched by conducting analyses at the symptom level.     

Cognitive-behavioral therapy for geriatric compulsive hoarding

This investigation examined response to a manualized cognitive-behavioral therapy (CBT) protocol for compulsive hoarding (Steketee & Frost, 2007) in a sample of 12 adults over age 65. All participants were cognitively intact, not engaging in any other psychotherapy, and had compulsive hoarding as their primary problem. All received 26 sessions of individual CBT over the course of 17 weeks. The primary outcome measures were the Savings Inventory-Revised and UCLA Hoarding Severity Scale, which were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up. Other outcomes included Clinical Global Impression (CGI) scores, depression, anxiety, disability, and clutter image ratings. Results demonstrated statistically significant changes on hoarding severity and depression. However, only three of the twelve participants were classified as treatment responders at post-treatment, and their gains were not maintained at 6-month follow-up. CGI, anxiety, disability, and clutter ratings were unchanged at post-treatment and follow-up. No participants dropped out, but homework compliance was variable and correlated with decreases in hoarding severity. Findings suggest that older adults with compulsive hoarding may require an enhanced or alternative treatment.     

Hierarchical Model of Vulnerabilities for Anxiety: Replication and Extension with a Clinical Sample

This study served to replicate and extend our previously obtained hierarchical model of the relationships among general anxiety vulnerabilities, specific anxiety vulnerabilities and specific anxiety manifestations including panic symptoms, health anxiety, obsessive‐compulsive symptoms and worry. Questionnaires assessing these variables, as well as positive affectivity and depressiveness, were administered to 125 outpatients seeking treatment for panic disorder, social anxiety disorder, obsessive‐compulsive disorder, generalized anxiety disorder or major depressive disorder. The results, using a clinical sample, were highly consistent with the hierarchical model obtained in the previous study using a student sample. A more elaborate model, based on published theoretical and empirical evidence, was identified and tested, and similar results were obtained. Negative affectivity had expected direct positive effects on all of the specific anxiety and depression manifestations, with the exception of health anxiety, which showed a negative relationship, and OCD symptoms, which showed no relationship. Positive affectivity was found to be a specific risk factor for depression, while intolerance of uncertainty was found to be a specific risk factor for worry and depression. Finally, anxiety sensitivity appears to be a significant risk factor for panic and health anxiety.     

Rearing practices and impulsivity/hyperactivity symptoms in relation to inflated responsibility and obsessive‐compulsive symptoms

Smári, J., Rúrik Martinsson, D., & Einarsson, H. (2010). Rearing practices and impulsivity/hyperactivity symptoms in relation to inflated responsibility and obsessive‐compulsive symptoms. Scandinavian Journal of Psychology, 51, 392–397. The aim of the study was to investigate potential precursors of inflated responsibility (responsibility attitudes) and obsessive‐compulsive (OCD) symptoms. It was argued that both parental overprotection and impulsivity, separately and in interaction with each other, contribute to inflated responsibility and OCD symptoms. In a large sample of young adults (N = 570), self‐report measures of OCD symptoms (OCI‐R), responsibility attitudes (RAS), anxiety/depression (HADS), rearing practices (EMBU), present and past impulsivity/hyperactivity symptoms (IMP/HY) were administered. Overprotection as well as IMP/HY were found to predict OCD symptoms as well as inflated responsibility. Finally, a significant interaction was found between IMP/HY and overprotection with regard to both OCD symptoms and inflated responsibility. This effect reflected that IMP/HY was more strongly related to OCD symptoms and responsibility in people who had not been overprotected than in people who had been. Conversely overprotection was related to OCD symptoms and responsibility in people low but not in people high in IMP/HY. The results seem to indicate that the inadequacy between offer and need for parental control may play a role in the development of OCD symptoms.     

Comorbidity in compulsive hoarding: a case report

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.     

Body image in social anxiety disorder,obsessive–compulsive disorder,and panic disorder

Body dysmorphic disorder falls under the category of obsessive–compulsive and related disorders, yet research has suggested it may also be highly associated with social anxiety disorder. The current study examined body image variables among 68 outpatients with primary obsessive–compulsive disorder (OCD; n = 22), social anxiety disorder (SAD; n = 25), and panic disorder (PD; n = 21). Participants filled out self-report measures of body image disturbance, attitudes toward one's appearance, and anxiety. Body image disturbance and attitudes toward appearance did not significantly differ between the groups. However, SAD symptoms predicted body image disturbance, Appearance Evaluation and Body Areas Satisfaction, and OCD symptoms predicted Appearance Orientation. These findings suggest that SAD and OCD may be associated with different facets of body image. Implications for the treatment of anxiety disorders and for future research are discussed.