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.     

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.     

Erroneous choice and foregone gains in hoarding gray jays (Perisoreus canadensis)

Under the conventional assumption that natural selection favors choice behavior that maximizes some fitness-related currency, a forager making repeated binary choices should consistently choose the more valuable option. Under the alternative assumption that natural selection favors choice behavior that minimizes costly errors, erroneous choice is not only expected but is expected to be common when the cost of errors is low. This cost depends on the potential rate of return: the higher this rate, the smaller the cost of choosing the less valuable option. When this rate is very high, a forager may err frequently and yet forego no appreciable fitness gain. Errors should thus be more common when interruptions to foraging are shorter. Our experimental results supported this prediction: gray jays chose the less valuable option more frequently when subjected to shorter interruptions (experimentally imposed delays to access to food rewards). This tendency is consistent with the idea that an adaptive decision-making process may routinely produce errors, not because errors are in some way adaptive but because their fitness cost is minimal, particularly when delays are short. From a proximate perspective, this tendency to commit errors more frequently following shorter delays may be due to constraints on the jays’ information-processing capacity. In general, choice behavior should be viewed as the joint byproduct of adaptive decision making and cognitive constraints. Received: 8 June 2000 / Accepted after revision: 21 October 2000     

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.     

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.     

Hoarding and its relation to obsessive-compulsive disorder

Although hoarding is observed in some patients with obsessive-compulsive disorder (OCD), it has not been shown to share a specific relation with OCD. Across two studies, we found that (a) whereas the classic OCD symptoms of checking, rituals, and contamination intercorrelated consistently strongly with one another, hoarding related only moderately to both these OCD symptoms and to depression; (b) OCD patients were distinguished from both other patients and non-patients by classic OCD symptoms, but not by hoarding; and (c) whereas OCD symptoms showed consistent relations with Negative Affect, hoarding largely was uncorrelated with this dimension. These results do not support a specific OCD-hoarding relation but rather call into question the trend of considering it a specific symptom of OCD.