Hoarding Symptoms Research Articles

Randomized waitlist-controlled trial of buried in treasures facilitated support groups and in-home uncluttering (BIT+) for hoarding disorder

ObjectiveThe Buried in Treasures (BIT) workshop is a promising treatment for hoarding disorder (HD), though many participants struggle with home uncluttering. This randomized waitlist-controlled trial investigated the efficacy of a version of BIT, augmented with in-home uncluttering practice (BIT+). MethodAdults (N = 41) with hoarding disorder were recruited from the community and randomly assigned to BIT+ or waitlist. BIT+ consisted of 16 sessions of the BIT workshop and 10 uncluttering home visits over 18 weeks. Outcome measures included the Saving Inventory-Revised (self-report) and the Clutter Image Rating Scale (self and independent evaluator rated). Between group repeated measures analyses using general linear modeling examined the effect of BIT+ vs waitlist control on hoarding symptoms after 18 weeks. Within group analyses examined pre-post effects for all BIT+ participants combined after 18 weeks. ResultsAfter 18 weeks, BIT+ participants benefited significantly more than waitlist controls on hoarding severity with large effect size (Cohen's d = 1.5, p < .001). BIT+ was also associated with improvement reductions in hoarding symptoms, clutter, and functional impairment. ConclusionsThe BIT+ intervention offers promise as a treatment option for hoarding. Adding in-home uncluttering practice may incrementally improve discarding practices. Future controlled trials are warranted.

Filling the void: boredom’s associations with hoarding symptom severity

In hoarding disorder, features including attentional difficulties and emotion dysregulation can contribute to the core symptoms of clutter, difficulties discarding, and excessive acquisition. Boredom is a negative feeling state that shares a high level of overlap with associated features of hoarding, including inattention, depressive symptoms, and impulsivity, and has been implicated in compulsive buying behaviors. Boredom may be a particularly relevant factor in compulsive hoarding; however, this relationship remains significantly under-researched. The present studies aimed to thoroughly investigate associations between boredom and hoarding severity using diverse methodologies. Study 1 (N = 253) replicated, in an online community sample, previously reported positive associations between hoarding severity and recent state boredom while statistically controlling for potentially confounding variables (e.g., depression, indecisiveness), and extended these findings to include boredom proneness. In Study 2, individuals with elevated hoarding symptoms (n = 56) and a history of hoarding problems (n = 43) reported higher levels of recent state and trait boredom than controls (n = 61). Additionally, boredom was associated with performance on simulated acquiring and discarding tasks. Finally, Studies 3a (N = 144) and 3b (N = 146) attempted the first experimental tests of induced boredom on acquiring and discarding behaviors. Although results were mixed and preclude causal conclusions, exploratory analyses revealed that individuals reporting higher in-the-moment boredom took more (p = .008) and discarded fewer (p = .021) items on the simulated tasks. Overall, results suggest that boredom may have crucial implications in hoarding symptom severity.

An online experimental test of the compensatory process in hoarding disorder: reducing loneliness and its effects on object attachment

Attachment theory suggests that strong object attachment in hoarding disorder (HD) may be due to an attempt at compensating for unmet relatedness needs. We tested this compensatory process with an online experiment and hypothesized that reducing loneliness among participants with high hoarding symptoms would result in lower object attachment, and that change in loneliness would mediate the impact of an online loneliness intervention on object attachment. A pretest-posttest control group design was used. Participants were 298 MTurk workers pre-screened for high hoarding symptoms recruited via cloudresearch.com. At Time 1, participants completed measures of hoarding severity, loneliness, and four aspects of object attachment: overall object attachment to possessions, insecure object attachment, attachment to an old cherished item, and attachment to a novel item. We randomly assigned participants to either a loneliness intervention (n = 142) or an active control (a health education program; n = 156). All participants completed follow-up questionnaires after two weeks. We conducted ANCOVAs to assess for group differences at Time 2 whilst controlling for Time 1 variables. Results showed small but significant improvements in loneliness, thwarted belongingness, and object attachment for the novel item for participants who received the loneliness intervention relative to control participants. Mediational analyses revealed that the change in loneliness mediated the effect of the intervention on insecure object attachment. Consistent with attachment theory, these results indicate that reducing loneliness might lead to lower object attachment in hoarding disorder. Trials with clinical participants using more intensive loneliness interventions are warranted.

Cluttered spaces, strained bonds: Examining the correlation between hoarding symptoms and social functioning among long-term care facilities older adult residents

BackgroundSymptoms of hoarding, such as the inability to part with possessions, leading to significant clutter, are commonly observed among residents in long-term care facilities in Egypt. This behavior significantly impacts their social interactions and functioning. Therefore, this study examined the relationship between hoarding symptoms and social functioning among older adult residents in long-term care facilities. MethodsThe study employed a cross-sectional survey on a purposive sample of 300 older adults. ToolsSaving Inventory-Revised and Functional Idiographic Assessment Template-Questionnaire-Short Form were used. ResultsThe findings revealed a significant positive correlation between hoarding symptoms and social functioning (r = 0.682, p < 0.000). A linear regression analysis supported this correlation, establishing hoarding symptoms as a significant predictor of social functioning (adjusted R2 = 0.32). ConclusionThe current study highlighted that a significant proportion of long-term care older adult residents displayed moderate hoarding symptoms and compromised social functioning. A noticeable positive association was observed between hoarding symptoms and social functioning. These results underscore the potential impact of hoarding symptoms on various aspects of social functioning. Given these findings, long-term care nurses should comprehend the various facets of compulsive hoarding behavior and devise effective strategies for assessment and intervention. Establishing support groups within these facilities could provide a platform for these residents to share their experiences and coping strategies. This could reduce interpersonal conflicts and argumentativeness and foster emotional expression and intimacy.

Preliminary investigation of objective and subjective experiences of relatives of individuals with hoarding behaviors.

Families of individuals with hoarding symptoms report substantial burden; however, there has been no investigation of potential positive experiences. The objective of this study was to examine the experiences reported by individuals with a relative with elevated hoarding symptoms using a cross-sectional design. The current investigation expands on the literature in this area by incorporating a detailed interview of experiences in conjunction with validated measures of hoarding symptomology. Twenty-nine adults with relatives with elevated hoarding symptoms completed self-report measures of hoarding severity for themselves and their relative and a clinician-administered assessment of their experiences with their family member with hoarding symptoms. Participants endorsed significant burden across a range of areas, including permanent changes in their daily routine. The majority (93%) of participants reported at least one positive experience, with 69% endorsing companionship as a benefit of the relationship. Greater symptom severity of the relative with hoarding symptoms was associated with greater subjective burden and decreased positive experiences. Our results add further evidence to the potential for interpersonal psychotherapy to lead to a reduction in hoarding symptomology.

Prevalence of Obsessive Compulsive Symptoms in Medical and Dental Practitioners with Respect to Gender

Obsessive compulsive disorder (OCD) comprises of mental images that provoke anxiety and fear and are recurrent. Objective: To find the prevalence of OCD symptoms in medical doctors and dentists with respect to gender. Methods: The study design was cross sectional comparative. It was conducted in College of Dentistry, Sharif Medical and Dental College Lahore. All practitioners irrespective of their age and gender were included in the study. Individuals practiced in a clinic or hospital for less than 6 months were excluded from the study. Obsessive compulsive inventory scale was used for data collection. Results: Gender of medical doctors and dentists and the symptom of washing (p=0.335, p=0.760 respectively), obsessing (p=0.131, p=0.476 respectively), checking (p=0.620, p=1.000 respectively) and neutralizing (p=0.294, p=1.000 respectively) was not significantly associated. The association between the symptom of ordering and gender of medical practitioners (p=0.05) was statistically significant. The association between gender of dental practitioners with hoarding (p=0.188), ordering (p=0.713) and doubting (p=1.000) was non-significant. Conclusions: Among the medical practitioners the symptoms of washing, obsessing, checking and neutralizing were higher in males as compared to the females. Among the dental practitioners the symptom of washing, obsessing and neutralizing were more prevalent in males while the symptom of checking was more prevalent in females. The symptoms of hoarding, ordering and doubting were more prevalent in males in comparison to female medical practitioners. Among the dental practitioners where the prevalence of hoarding was higher in the males while that of ordering and doubting was higher in the females.

55 Hoarding Behaviors in Late Life Depression are Associated with Increased Burden of Executive Dysfunction, Disability, and Poorer Response to Depression Treatment

Objective:Late Life Major Depressive Disorder (LLD) and Hoarding Disorder (HD) are common in older adults with prevalence estimates up to 29% and 7%, respectively. Both LLD and HD are characterized by executive dysfunction and disability. There is evidence of overlapping neurobiological dysfunction in LLD and HD suggesting potential for compounded executive dysfunction and disability in the context of comorbid HD and LLD. Yet, prevalence of HD in primary presenting LLD has not been examined and potential compounded impact on executive functioning, disability, and treatment response remains unknown. Thus, the present study aimed to determine the prevalence of co-occurring HD in primary presenting LLD and examine hoarding symptom severity as a contributor to executive dysfunction, disability, and response to treatment for LLD.Participants and Methods:Eighty-three adults ages 65-90 participating in a psychotherapy study for LLD completed measures of hoarding symptom severity (Savings Inventory-Revised: SI-R), executive functioning (WAIS-IV Digit Span, Letter-Number Sequencing, Coding; Stroop Interference; Trail Making Test-Part B; Letter Fluency), functional ability (World Health Organization Disability Assessment Schedule-II-Short), and depression severity (Hamilton Depression Rating Scale) at post-treatment. Pearson's Chi-squared tests evaluated group differences in cognitive and functional impairment rates and depression treatment response between participants with (HD+LLD) and without (LLD-only) clinically significant hoarding symptoms. Linear regressions were used to examine the association between hoarding symptom severity and executive function performance and functional ability and included as covariates participant age, years of education, gender, and concurrent depression severity.Results:At post-treatment, 24.1% (20/83) of participants with LLD met criteria for clinically significant hoarding symptoms (SI-R.41). Relative to LLD-only, the LLD+HD group demonstrated greater impairment rates in Letter-Number Sequencing (χ2(1)=4.0, p=.045) and Stroop Interference (χ2(1)=4.8, p=.028). Greater hoarding symptom severity was associated with poorer executive functioning performance on Digit Span (t(71)=-2.4, β=-0.07, p=.019), Letter-Number Sequencing (t(70)=-2.1, β=-0.05, p=.044), and Letter Fluency (t(71)=-2.8, β=-0.24, p=.006). Rates of functional impairment were significantly higher in the LLD+HD (88.0%) group compared to the LLD-only (62.3%) group, (χ2(1)=5.41, p=.020). Additionally, higher hoarding symptom severity was related to greater disability (t(72)=2.97, β=0.13, p=.004). Furthermore, depression treatment response rates were significantly lower in the LLD+HD group at 24.0% (6/25) compared to 48.3% (28/58) in the LLD-only group, χ2(1)=4.26, p=.039.Conclusions:The present study is among the first to report prevalence of clinically significant hoarding symptoms in primary presenting LLD. The findings of 24.1% co-occurrence of HD in primary presenting LLD and increased burden on executive functioning, disability, and depression treatment outcomes have important implications for intervention and prevention efforts. Hoarding symptoms are likely under-evaluated, and thus may be overlooked, in clinical settings where LLD is identified as the primary diagnosis. Taken together with results indicating poorer depression treatment response in LLD+HD, these findings underscore the need for increased screening of hoarding behaviors in LLD and tailored interventions for this LLD+HD group. Future work examining the course of hoarding symptomatology in LLD (e.g., onset age of hoarding behaviors) may provide insights into the mechanisms associated with greater executive dysfunction and disability.

53 Hoarding Behaviors are Associated with Greater Perceived Cognitive Dysfunction and Disability in Individuals with Late Life Depression

Objective:Perceived cognitive dysfunction is a common feature of late-life depression (LLD) that is associated with diminished quality of life and greater disability. Similar associations have been demonstrated in individuals with Hoarding Disorder. The degree to which hoarding behaviors (HB) are associated with greater perceived cognitive dysfunction and disability in individuals with concurrent LLD is not known.Participants and Methods:Participants with LLD (N=83) completed measures of hoarding symptom severity (Savings Inventory-Revised; SI-R) and were classified into two groups based on HB severity: LLD+HB who exhibited significant HB (SI-R . 41, n = 25) and LLD with low HB (SI-R &lt; 41, n = 58). Additional measures assessed depression severity (Hamilton Depression Rating Scale; HDRS), perceived cognitive difficulties (Everyday Cognition Scale; ECOG), and disability (World Health Organization Disability Assessment Scale [WHODAS]-II-Short). Given a non-normal distribution of ECOG and WHODAS-II scores, non-parametric Wilcoxon-Mann-Whitney tests were used to assess group differences in perceived cognitive dysfunction and disability. A regression model assessed the extent to which perceived cognitive dysfunction was associated with hoarding symptom severity measured continuously, covarying for age, education, gender, and depression severity. A separate regression model assessed the extent to which disability scores were associated with perceived cognitive dysfunction and HB severity covarying for demographics and depression severity.Results:LLD+HB endorsed significantly greater perceived cognitive dysfunction (W = 1023, p = 0.003) and greater disability (W = 1006, p = &lt; 0.001) compared to LLD. Regression models accounting for demographic characteristics and depression severity revealed that greater HB severity was associated with greater perceived cognitive dysfunction (β = 0.009, t = 2.765, p = 0.007). Increased disability was associated with greater perceived cognitive dysfunction (β = 4.792, t(71) = 3.551, p = 0.0007) and HB severity (β = 0.080, t(71) = 1.944, p = 0.056) approached significance after accounting for variance explained by depression severity and demographic covariates.Conclusions:Our results suggest that hoarding behaviors are associated with increased perceived cognitive dysfunction and greater disability in individuals with LLD. Screening for HB in individuals with LLD may help identify those at greater risk for poor cognitive and functional outcomes. Interventions that target HB and perceived cognitive difficulties may decrease risk for disability in LLD. However, longitudinal studies would be required to further evaluate these relationships.

The potential relationship between loot box spending, problem gambling, and obsessive-compulsive gamers.

Loot boxes are digital containers of randomised rewards available in many video games. Individuals with problem gambling symptomatology spend more on loot boxes than individuals without such symptoms. This study investigated whether other psychopathological symptomatology, specifically symptoms of obsessive-compulsive behaviour and hoarding may also be associated with increased loot box spending. In a large cross-sectional, cross-national survey (N = 1,049 after exclusions), participants recruited from Prolific, living in Aotearoa New Zealand, Australia, and the United States, provided self-reported loot box spending, obsessive-compulsive and hoarding symptomatology, problem gambling symptomatology, and consumer regret levels. There was a moderate positive relationship between loot box spending and obsessive-compulsive symptoms and hoarding. Additionally, greater purchasing of loot boxes was associated with increased consumer regret. Results identified that those with OCD and hoarding symptomatology may spend more on loot boxes than individuals without OCD and hoarding symptomatology. This information helps identify disproportionate spending to more groups of vulnerable players and may assist in helping consumers make informed choices and also aid policy discussions around the potentialities of harm.

Attention, response inhibition, and hoarding: A neuropsychological examination.

The prominent cognitive-behavioral model of hoarding posits that information processing deficits contribute to hoarding disorder. Although individuals with hoarding symptoms consistently self-report attentional and impulsivity difficulties, neuropsychological tests have inconsistently identified impairments. These mixed findings may be the result of using different neuropsychological tests, tests with poor psychometric properties, and/or testing individuals in a context thatdrastically differs from their own homes. One hundred twenty-three participants (hoarding = 63; control = 60) completed neuropsychological tests of sustained attention, focused attention, and response inhibition in cluttered and tidy environments in a counterbalanced order. Hoarding participants demonstrated poorer sustained attention and response inhibition than the control group (CPT-3 Omission and VST scores) and poorer response inhibition in the cluttered environment than when in the tidy environment (VST scores). CPT-3 Detectability and Commission scores also indicated that hoarding participants had greater difficulty sustaining attention and inhibiting responses than the control group; however, these effect sizes were just below the lowest practically meaningful magnitude. Posthoc exploratory analyses demonstrated that fewer than one-third of hoarding participants demonstrated sustained attention and response inhibition difficulties and thatthese participants reported greater hoarding severity and greater distress in the cluttered room. Given these findings and other studies showing that attentional difficulties may be a transdiagnostic factor for psychopathology, future studies will want to explore whether greater sustained attention and response inhibition difficulties in real life contexts contribute to comorbidity and functional impairment in hoarding disorder.

Making space: A randomized waitlist-controlled trial of an acceptance and commitment therapy website for hoarding

BackgroundHoarding disorder causes significant impairment, but existing treatments have notable barriers to access and do not target several psychological processes that may contribute to hoarding. Therefore, this study evaluated an acceptance and commitment therapy (ACT) self-help website for hoarding with minimal coaching in a randomized waitlist-controlled trial to evaluate initial feasibility and efficacy. MethodsParticipants were 73 U.S.-based adults with clinically significant hoarding symptoms. The website comprised 16 self-help sessions to be completed over 8 weeks. Measures were taken at baseline, posttreatment, and 1-month follow-up. ResultsMultilevel models indicated that the ACT condition improved significantly more than waitlist on hoarding symptom severity (the primary outcome; β = 0.74, Holm-corrected p = .01) as well as secondary outcomes (e.g., functional impairment, well-being, and progress toward personal values, Holm-corrected ps < .05). Rates of reliable (34.61%) and clinically significant (11.54%) change at posttreatment were limited, with no significant differences between groups. Responses indicated that this intervention was acceptable, credible, and easy to use, although adherence could be further improved. ConclusionsOverall, results suggest that an ACT self-help program for hoarding can be acceptable and efficacious. Limitations include a predominantly White and female sample and the lack of an active control condition.

Translating and validating the hoarding rating scale-self report into Arabic

BackgroundHoarding disorder is characterized by a persistent inability to part with possessions due to a perceived need to keep them, regardless of their actual value. Arabic-speaking populations currently lack a validated tool specifically designed to assess hoarding symptoms.ObjectiveThis study aimed to translate, adapt, and validate the Hoarding Rating Scale-Self Report (HRS-SR) into the Arabic-language.MethodsThe study employed the gold standard approach to translation, involving forward translation by independent translators and back translation review. We conducted a cross-sectional study using an online survey completed by 500 participants from four Arabic-speaking countries. Psychometric analyses included internal consistency, test-retest reliability, convergent validity against generalized anxiety disorder (GAD-7), and confirmatory factor analysis.ResultsWith a McDonald’s omega and Cronbach’s alpha of approximately 0.80, the Arabic translation of the HRS-SR showed acceptable test-retest reliability as well as good internal consistency. The survey also showed strong convergent validity with the 7-item survey for GAD-7. Confirmatory factor analysis supported a one-factor structure, confirming that each item measured the same construct.ConclusionThe HRS-SR is a trustworthy and valid tool for evaluating hoarding symptoms in Arabic-speaking people. This survey could be helpful for both clinical and academic research. Future research should examine cultural variations in hoarding behavior in Arabic-speaking populations and validate the questionnaire in clinical populations.

Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults

Hoarding disorder is common and debilitating, especially in older adults, and novel treatment approaches are needed. Many current treatments emphasize skills related to discarding and decision-making about possessions, which can be practiced in the patient's home. However in many cases, in-home visits are unfeasible, or real-life discarding is too difficult. Virtual reality (VR) offers the ability to create a virtual “home” including 3D scans of the patient's actual possessions that can be moved or discarded. VR discarding is an alternative to in-home visits and an approach that provides a stepping stone to real-life discarding. VR has been successfully utilized to treat many disorders but tested minimally in hoarding disorder. In nine older adults with hoarding disorder, we tested an 8-week VR intervention administered to augment a 16-week Buried in Treasures group treatment. Individualized VR rooms were uniquely modeled after each patient's home. During clinician-administered VR sessions, patients practiced sorting and discarding their virtual possessions. The intervention was feasible to administer. Open-ended participant responses, examined by two independent evaluators, indicated that VR sessions were well-tolerated and that participants found them useful, with nearly all participants noting that VR helped them increase real-life discarding. Self-reported hoarding symptoms decreased from baseline to close, with seven of the nine participants showing reliable improvement in this timeframe and none showing deterioration. Results from this exploratory pilot study suggest that VR is a feasible way to simulate an at-home sorting and discarding experience in a manner that may augment skills acquisition. It remains an open question whether VR discarding practice yields greater improvement than existing treatments. VR for this population merits further clinical investigation.

High levels of loneliness in people with hoarding disorder

Attachment theory suggests that hoarding is an attempt at compensating for unmet relatedness needs. We therefore expect high loneliness levels in hoarding disorder (HD). While previous studies have shown a positive association between hoarding and loneliness in non-clinical samples, few studies have examined loneliness levels in clinical HD samples. In Study 1, we examined loneliness in a treatment-seeking HD sample (n = 39). Results showed that 87.2% of HD sufferers reported high loneliness levels, which was significantly higher than loneliness rates in community samples. Loneliness was positively associated with hoarding severity even after controlling for depression. In Study 2, we examined loneliness in MTurk workers with clinical levels of hoarding (high hoarding [HH] group; n = 305) compared to MTurk workers with low hoarding symptoms (LH group; n = 775). Results showed high loneliness levels in 77.7% of participants in the HH group compared to 36.8% in the LH group. Differences remained significant for HH vs LH groups matched on depression. The positive association between loneliness and hoarding was also significant even after controlling for age, gender, marital status, and depression. Our results underscore the importance of assessing and addressing loneliness in the HD treatment.

Using item response theory to investigate potential gender bias in hoarding symptoms

Gender and/or sex differences in the prevalence of hoarding disorder have been well documented, yet there remains a striking lack of understanding as to potential reasons. Critically no study to date has examined whether gender differences may stem from underlying biases in hoarding assessment instruments. The current study used item response theory to evaluate the Saving Inventory-Revised (SI-R; Frost et al., 1994), to determine if there might be differential item functioning (DIF) between men and women across the three core features of hoarding. We first examined responses in a sample of individuals with clinically significant hoarding symptoms (N = 255), and then replicated our findings in a non-selected community sample (N = 719). There was evidence of modest DIF, which affected only a handful of items in each SI-R subscale. In the clinical sample, women scored significantly higher on the clutter and acquisition latent continuum, whereas there was no gender difference for difficulties discarding. In contrast, there were no gender differences in any of the subscales for the community sample. Findings indicate that while there are likely gender differences in the manifestation and associated features of hoarding, those gender differences are not the result of measurement artifacts in the SI-R.

Using Motivational Interviewing to Treat Hoarding Symptoms in a Rural-Dwelling Older Adult: A Case Study

IntroductionHoarding disorder is one of the few psychological disorders that increases in severity and prevalence in older adulthood. It is marked by maladaptive cognitions (e.g., distress parting with items others would discard) and behavioral patterns (e.g., avoidance of sorting/discarding items) that result in the problematic accumulation of items, typically referred to as clutter. Due to its various consequences for both the individual and society, hoarding disorder is a critical area of research for treatment development and refinement. MethodsThis is a case report of an older adult living in rural Mississippi who participated in a pilot study of a brief in-home intervention for hoarding disorder. Ms. T is a 61-year-old White woman with a psychiatric history of hoarding disorder and several psychiatric and medical comorbidities, including high blood pressure, diabetes, asthma, arthritis, obesity, and sleep apnea. She also reported an extensive history of head trauma, both in childhood and as an adult. At baseline, she reported high levels of distress during a sorting task and discarded 23% of items sorted. She also completed the NIH Toolbox Cognition Battery. She performed in the mildly to moderately impaired range on measures of working memory, processing speed, memory, and overall fluid intelligence. However, she performed in the average to above average range on measures of vocabulary, cognitive flexibility, oral reading, and overall crystallized intelligence. Ms. T received six one-hour long sessions of treatment using motivational interviewing (MI), a treatment approach that facilitates behavioral change through a focus on the patient's values and exploring discrepancy between their current behaviors and their desired goals (Miller & Rollnick, 2013). Session one involved an assessment of strengths, values, and goals. Ms. T then engaged in sorting practice, which involved sorting items from her home into keep and discard piles. Sessions 2-6 involved checking in on progress and engaging in sorting practice while using MI skills to facilitate motivation for behavioral change. Each week, she recorded number of days and average time spent sorting. ResultsFollowing treatment, Ms. T reported increased frequency and duration of sorting/discarding clutter independently between sessions. She also demonstrated decreases in reported sadness and somatic arousal associated with fear. Despite the brief nature of the intervention, Ms. T also indicated a slight decrease in overall negative affect and a slight increase in social satisfaction. Expanding on her self-identified strength of surviving and being resilient, Ms. T was able to overcome her feeling of being overwhelmed at initiating sorting and avoidance behaviors to consistently engage in sorting practice for the majority of each session. At post-assessment, she reported low to medium levels of distress during the sorting task and was able to discard 48% of items sorted, an increase of 25% from baseline. Ms. T consistently reported increased motivation driven by her desire to gain a fresh start after her traumatic past and provided her treatment progress with unique momentum that protected against attrition and encouraged continued compliance. ConclusionsMs. T presented externally as a typical hoarding disorder case; however, the psychosocial factors of the case created a unique set of barriers and protective factors. This case report discusses the interplay between the effectiveness of MI and the impact of external psychosocial factors (i.e., resilience within negative lifetime experiences, relational stress, and physical limitations) as they relate to Ms. T's treatment for her hoarding symptoms. Here, we illustrate the need for a more comprehensive approach to case conceptualization for older adults diagnosed with hoarding disorder.

Follow the Money (Deeper)—A Clinical Diagnosis of Opportunity Hoarding

In his argument for a rereading of opportunity hoarding and related policy prescriptions, David Imbroscio provides evidence for the misdiagnosis of elements of the problem vis-à-vis the entry and exit hypotheses consequentially resulting in limited effectiveness of common “prescribed treatments” for this behavior. His way forward focuses on a fundamental rebalancing of the instruments through which wealth is distributed to create more parity—a breaking up of the hoard. Thinking about his argument, I offer three additional premises that ask us to look more closely at how we treat the symptoms of opportunity hoarding, in a way that reflects the power of the mechanisms that sustain it.

PERSONALITY PROFILE OF RURAL-DWELLING OLDER ADULTS IN AN ONGOING HOARDING TREATMENT STUDY

Abstract Symptoms of hoarding disorder, such as significant household clutter, difficulty discarding, and excessive acquisition tend to increase in later life. With many challenges involved in aging in place, older adults may be particularly vulnerable to adverse events occurring while living with excessive clutter (e.g., fall risk, sanitation issues). Therefore, understanding what factors predict hoarding symptom severity is an essential step towards increasing older adults’ ability to age in place while experiencing hoarding symptoms. Personality traits have been demonstrated to predict hoarding symptoms in a wide range of ages. However, a sample of older adults in this clinical population has not been evaluated. The IPIP-NEO-60 is a shortened version of a widely used open-source personality measure that utilizes the five-factor model of personality (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness). We used this measure to evaluate the personality profiles of rural-dwelling older adults (age 50 and up, M = 63) enrolled in an ongoing treatment study for hoarding disorder (n = 14). Compared to normative data from 910 adults aged 50 and up and matched for gender, most participants scored in the average range for Neuroticism, Extraversion, and Openness, with a nearly even split between high, low, and average scores for Agreeableness. Half of participants scored in the low range for Conscientiousness. Given the considerable proportion of participants demonstrating low Conscientiousness in this sample, screening a larger sample for beyond-average facet scores within this factor (e.g., self-efficacy, cautiousness) may assist clinicians in selecting impactful treatment targets for hoarding disorder in older adults.

A latent factor approach to the Saving Inventory – Revised: Congeneric evaluation of construct and content validity

BackgroundInconsistencies have been identified in the three-factor structure and item loadings of the most commonly used self-report hoarding screening tool, the Saving Inventory – Revised (SI-R), which assesses difficulty discarding, clutter and acquisition. The current study aimed to confirm the factor structure of the SI-R using congeneric modelling, and evaluate the construct and content validity of this measure. Methods139 participants with self-identified hoarding completed the SI-R. Congeneric structural equation modelling was then performed to validate the SI-R factor structure. ResultsThe three-factor structure of the SI-R was confirmed as a valid, reliable and good fitting model. However, the difficulty discarding and clutter subscales were required to covary. ConclusionsThe SI-R was confirmed as an appropriate screening tool for hoarding severity; however, revision of item wording may improve content validity. Future research could consider exploring the relationships between a range of hoarding-related constructs and the differential endorsement of SI-R subscales. LimitationsAs data were collected during the 2020 COVID-19 pandemic, panic buying and hoarding-related acquiring behaviours may have been exacerbated. In addition, the diagnostic status of participants was not verified, despite the inclusion of individuals endorsing clinically significant hoarding symptoms.

The generational impact of household clutter.

Hoarding disorder can create long-term problems for adult children of individuals with hoarding symptoms; however, the extent of the psychosocial consequences of growing up in a cluttered household are not yet fully understood. This study investigated the extent to which generational clutter (i.e., parent/caregiver and grandparent) influenced individuals' self-reported hoarding severity and psychiatric and psychosocial functioning. A total of 1306 adults completed an online survey that included measures of hoarding, anxiety, depression, companionship and emotional support. A subsample (n=198) reported on parent and grandparent household clutter, as well as family impact from hoarding. We used correlations, t-tests, linear and hierarchical regressions and mediation analyses to investigate whether hoarding symptoms were predicted by parent or grandparent hoarding. Parent clutter level significantly predicted participant hoarding symptoms. For participants who reported having caregivers with elevated clutter, self-reported psychosocial functioning was lower overall. Self-reported behaviour modification due to family hoarding symptoms (accommodation) was a significant predictor of participant hoarding symptoms. Parent clutter and family accommodation behaviours may be a risk factor for future clutter in adult children. Further comparisons between parents and children are needed to determine whether this association increases children's risk for future hoarding symptoms.