Hoarding Symptoms Research Articles

Delivery of internet treatment for compulsive hoarding (D.I.T.C.H.)

This study tested the effectiveness of an existing private online CBT-based group intervention designed to help people with hoarding. Web-group participants were hypothesized to show more improvement in hoarding symptoms over time compared to those placed on a naturalistic waitlist. This web-based self-help group ( N = 106 members, N = 155 waitlisted) includes a formal application process and requires that participants post action steps and progress at least once monthly. Members have access to educational resources on hoarding, cognitive strategies, and a chat-group. Potential research participants were invited to complete an anonymous web-based survey about their hoarding behaviors and clinical improvement on five occasions (3 months apart). The sample was mainly middle-aged, female and White. Regression analyses show that Recent members reported greater improvement and less clutter at 6 months (than Waitlist). Long-term members reported milder hoarding symptoms than Recent ones, suggesting benefits from group participation over time. All members showed reductions in clutter and hoarding symptoms over 15 months. Less posting activity was associated with greater hoarding severity. Online CBT-based self-help for hoarding appears to be a promising intervention strategy that may extend access to treatment. Evaluating the benefits of internet self-help groups is critical given growing popularity of and demand for web-based interventions.

Distinct correlates of hoarding and cleaning symptom dimensions in relation to onset of obsessive–compulsive disorder at menarche or the perinatal period

Ninety female outpatients with obsessive-compulsive disorder (OCD) completed a semistructured interview to assess the relationship between different OCD symptom dimensions and the onset of OCD at menarche or during the perinatal period. Patients with hoarding symptoms had an earlier age at menarche than non-hoarders (12.1 +/- 1.3 vs 13.0 +/- 1.5 years, p = 0.019) and were more likely to report OCD onset at menarche (OR = 4.1, p = 0.034). Patients with symptoms of the contamination/cleaning dimension were more likely to report the onset of their disorder during pregnancy or postpartum (OR = 9.3, p = 0.048).

Artificial Neural Network Model for the Prediction of Obsessive-Compulsive Disorder Treatment Response

Several patients with obsessive-compulsive disorder (OCD) who are refractory to adequate treatment with first-line treatments are considered treatment-resistant. Further surveys were to be implemented to explore the outcome predictors of the antiobsessional response. Such study was aimed at building a model suitable to predict the final outcome of a mixed OCD pharmacologic and nonpharmacologic treatment approaches. We studied 130 subjects with OCD who underwent pharmacologic (with selective serotonin reuptake inhibitors alone or with selective serotonin reuptake inhibitors and risperidone at low dosage) and/or behavioral therapy (using exposure and response prevention techniques). The following variables were used as predictors: symptoms dimension, as resulting from the Yale-Brown Obsessive-Compulsive Scale items factor analysis; neuropsychologic performances; and epidemiologic variables. The treatment response arising from 3 to 6 months of therapy was used as dependent variable. A conventional logistic regression was used to define a previsional model of treatment response and multilayer perceptrons and to supervise an artificial neural network technique. The 46.9% of the sample resulted to be refractory to treatment. Results obtained with the logistic regression model showed that the only predictors of treatment outcome are hoarding symptoms, repeating rituals, and counting compulsions. Furthermore, using all the variables considered in the models, multilayer perceptrons showed highly better predictive performance as compared with the logistic regression models (93.3% vs 61.5%, respectively, of correct classification of cases). Complex interactions between different clinical and neuropsychologic variables are involved in defining OCD treatment response profile, and nonlinear and interactive modeling strategies, that is, supervised artificial neural networks, seem to be more suitable to investigate this complexity than linear techniques.

Group cognitive and behavioral treatment for compulsive hoarding: a preliminary trial

Time-limited group cognitive behavioral treatments (GCBT) for obsessive-compulsive disorder have demonstrated improvement in target symptoms. One small sample study of GCBT specifically for hoarding problems also showed benefit. This study examines the efficacy of a specialized GCBT for compulsive hoarding on a larger sample. Thirty-two clients diagnosed with hoarding participated in five groups. Four groups met once weekly for 2 hour over 16 weeks (n=27) and one group met for 20 weeks (n=5). All participants had two individual 90-min home sessions. Self-report assessments were completed at baseline, mid-treatment, and post-treatment about hoarding behavior and related symptoms (e.g., depression). The sample was predominantly female, White, highly educated, unemployed, and not partnered/married; mean age was 53. A majority was diagnosed with major depressive disorder and obsessive-compulsive personality disorder. Participants showed significant improvement from pre- to post-treatment on the Saving Inventory Revised, Saving Cognitions Inventory, Clutter Image Rating, and Clinical Global Severity. The most recent group (n=8) that used a more formalized treatment and research protocol improved significantly more than did earlier members. This study demonstrates the feasibility and modest success of GCBT methods in improving hoarding symptoms. Group treatment may be especially valuable because of its cost-effectiveness, greater client access to trained clinicians, and reduction in social isolation and stigma linked to this problem. Further research is needed to improve the efficacy of GCBT methods for hoarding and to examine durability of change, predictors of outcomes, and processes that influence change.

Age at onset and clinical features of late life compulsive hoarding

Compulsive hoarding is a debilitating, chronic disorder, yet we know little about its onset, clinical features, or course throughout the life span. Hoarding symptoms often come to clinical attention when patients are in late life, and case reports of elderly hoarders abound. Yet no prior study has examined whether elderly compulsive hoarders have early or late onset of hoarding symptoms, whether their hoarding symptoms are idiopathic or secondary to other conditions, or whether their symptoms are similar to compulsive hoarding symptoms seen in younger and middle-aged populations. The objectives of this study were to determine the onset and illustrate the course and clinical features of late life compulsive hoarding, including psychiatric and medical comorbidities. Participants were 18 older adults (> or =60) with clinically significant compulsive hoarding. They were assessed using structured interviews, including the Mini International Neuropsychiatric Interview (MINI), Structured Clinical Interview for DSM-IV (SCID I), Yale-Brown Obsessive Compulsive Scale (YBOCS), and UCLA Hoarding Severity Scale (UHSS). Self-report Measures Included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Sheehan Disability Scale (SDS), and Savings Inventory-Revised (SI-R). Psychosocial and medical histories were also obtained. To determine age at onset, participants were asked to rate their hoarding symptoms and describe major life events that occurred during each decade of their lives. Results show that (1) onset of compulsive hoarding symptoms was initially reported as being in mid-life but actually found to be in childhood or adolescence. No subjects reported late onset compulsive hoarding. (2) Compulsive hoarding severity increased with each decade of life. (3) Comorbid mood and anxiety disorders were common, but only 16% of patients met criteria for OCD if hoarding symptoms were not counted toward the diagnosis. (4) The vast majority of patients had never received treatment for hoarding. (5) Older adults with compulsive hoarding were usually socially impaired and living alone. Compulsive hoarding is a progressive and chronic condition that begins early in life. Left untreated, its severity increases with age. Compulsive hoarding should be considered a distinct clinical syndrome, separate from OCD. Unfortunately, compulsive hoarding is largely unrecognized and untreated in older adults.

A Long-Term Trial of the Effectiveness and Safety of Atypical Antipsychotic Agents in Augmenting SSRI-Refractory Obsessive-Compulsive Disorder

Although atypical antipsychotic agents have been found effective in the augmentation of serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in short-term trials, there are few data on the effectiveness and safety of these agents in clinical settings over the long term. Subjects (N = 46) who responded to selective SRIs (SSRIs) in an initial 12-week trial were continued on SSRI monotherapy plus cognitive-behavioral therapy (CBT) for 1 year. Subjects (N = 44) who failed to respond to SSRIs were randomly assigned to 1 of 3 atypical antipsychotics -- olanzapine, quetiapine, or risperidone -- and were consecutively treated using SSRI + atypical antipsychotics combined with CBT for 1 year. This study was conducted from January 2006 to November 2007 at Osaka City University Graduate School of Medicine Hospital, Japan. Augmentation with atypical antipsychotics reduced mean +/- SD Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores in SSRI-refractory OCD patients (at initial assessment = 29.3 +/- 9.9, after 1 year = 19.3 +/- 6.8). However, compared to SSRI responders (at initial assessment = 25.8 +/- 11.4, after 1 year = 13.7 +/- 4.6), total YBOCS scores in those who required atypical antipsychotic augmentation were initially higher, and they remained at higher levels than those of SRI responders after 1 year of the treatments. Our work does not sufficiently support the long-term effectiveness of the atypical antipsychotics in the augmentation of SSRIs for treatment-resistant OCD patients. Even though this approach seems useful for some types of OCD patients, such as those with symmetry/ordering and hoarding symptoms, these data emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD, and their chronic use raises a number of safety concerns. (ClinicalTrials.gov) Identifier NCT00854919.

Exploration of anxiety sensitivity and distress tolerance as vulnerability factors for hoarding behaviors

The phenomenon of compulsive hoarding, characterized by the acquisition of and failure to discard a large number of possessions, is increasingly recognized as a significant public health burden. Despite the magnitude of the impairment associated with this condition, empirical research is still in the nascent stages and many facets of the phenomenology, underlying vulnerability and risk factors for hoarding, are as of yet unknown. The overall aim of the current investigation was to examine the association between hoarding behaviors and two potential vulnerability factors-anxiety sensitivity (AS) and distress tolerance (DT). In addition, we investigated the robustness of these associations as well as the interaction between the two hypothesized risk factors. Three studies (total N=745) involving independent nonclinical samples assessed hoarding, AS, DT, and relevant covariates using a range of measures. Resutlts: Findings revealed that AS and hoarding are significantly and robustly associated with one another beyond general depressive, anxiety, and nonhoarding obsessive-compulsive symptoms. Hoarding was also found to be associated with low DT. Consistent with prediction, AS and DT interacted such that DT may play a less important role among individuals with low AS. By contrast, low DT appears to increase vulnerability to hoarding symptoms among individuals high in AS. Results are discussed with regard to future research and treatment implications. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc.

Formation of attachment to possessions in compulsive hoarding

Hypersentimentality to possessions has been proposed to play an important role in the development and maintenance of compulsive hoarding. The current study prospectively examined the formation of attachment to a newly acquired object in an OCD sample ( n = 62) to determine whether specific hoarding symptoms moderated the development of attachment to an object over time. Participants rated their level of attachment to a keychain immediately upon receipt (time 1) and one week later (time 2). We hypothesized that individuals with a tendency to hoard and strong beliefs about the value of possessions would exhibit greater attachment to the object over time. Hierarchical multiple regression analyses revealed that a person's initial attachment to the object was the best predictor of attachment one week later. Although emotional attachment increased similarly for all participants independent of their hoarding symptoms, specific hoarding-related beliefs and behaviors uniquely predicted initial attachment to the keychain.

Cardiac slowing and acute tryptophan depletion: a comment on the paper by van der Veen et al.

We note with interest the recent article Acute tryptophandepletion in healthy males attenuates phasic cardiac slow-ing but does not affect electro-cortical response to negativefeedback by van der Veen et al. (2008). In that study, acutetryptophan depletion (ATD, a dietary method to transientlylower central serotonin levels) attenuated cardiac decelera-tion, possibly reflecting a decreased impact of negativefeedback stimuli due to improved punishment prediction.This is congruent with preclinical data suggesting that ATDreduces cardiopulmonary reflex bradycardia and baroreflexgain (Kellett et al. 2004).The group of van der Veen et al. has previouslyemphasised the role of higher cortical centers in ATDaction (Evers et al. 2005, 2006); we wish to underline therole of brainstem systems here. There is evidence that 5-HT-containing pathways within the brainstem can haveprofound influences on the neurones involved in control ofthe heart (Lehnert et al. 1987) and these are mediated by avariety of 5-HT receptors that act at different brainstemsites (Jeggo et al. 2005; Kellett et al. 2005). Whilst theevidence suggests that these pathways are not tonicallyactive at rest, they are recruited during several differentreflexes which modify heart rate (Jordan 2005).We have now used the ATD procedure in clinical trialsof over 100 subjects and have found it to be safe, effectiveand well-tolerated. Our protocol (Hood et al. 2005) is basedon the standard described by Young et al. (1985) withwomen consuming 80% of the mixture because of lowerbody weight (Smith et al. 1997). On two occasions,however, we have observed adverse effects that werereported to local HRECs—both of these were cardiovascu-lar side effects involving significant episodes of bradycar-dia. Unblinding of patient data revealed that these incidentsboth occurred on the ATD occasion.Case #1 is a 64-year-old woman who presented withobsessive compulsive disorder (OCD, moderate checking,counting and mild hoarding symptoms), which respondedto escitalopram 15 mg/day. She participated in a ATD studyof patients who had selective serotonin reuptake inhibitor(SSRI)-remitted OCD. There was a past history of majordepression and mild hypertension, the latter well-controlledon amlodipine 5 mg/day. On the first testing day (ATDoccasion), the study progressed uneventfully until mid-afternoon when, shortly after having a venous blood sampleextracted from an in situ cannula present in her leftantecubital fossa, she experienced a vasovagal episodelasting less than 1 min. She was nauseated immediatelyprior to this episode and a transient drop in blood pressurewas noted (from 135/84 PR 72 to 104/56 PR 67). As aprecautionary measure, a 500-mL bag of IV saline/dextrosewas administered to maintain blood pressure, and thedecision was made to abort the study (despite the patient’srequest that she felt able to continue). Over the subsequent45 min we proceeded to prepare her for discharge home tothe care of her family, and this included feeding her a dietrich in tryptophan (the study depleted the body of this), andshe consumed some of the chocolate-flavoured milk thatshe had to hand. During the procedure of putting on hershoes (which may have involved some straining), she feltnauseated again, vomited and had a second vasovagal

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.

When Does Hoarding Cross Line Into Obsessive-Compulsive Disorder?

When Does Hoarding Cross Line Into Obsessive-Compulsive Disorder?

An exploratory study of the neural mechanisms of decision making in compulsive hoarding

Prior studies have suggested unique patterns of neural activity associated with compulsive hoarding. However, to date no studies have examined the process of making actual decisions about whether to keep or discard possessions in patients with hoarding symptoms. An increasing body of clinical data and experimental psychopathology research suggests that hoarding is associated with impaired decision making; therefore, it is important to understand the neural underpinnings of decision-making abnormalities in hoarding patients. Twelve adult patients diagnosed with compulsive hoarding, 17% of whom also met criteria for obsessive-compulsive disorder (OCD), and 12 matched healthy controls underwent functional magnetic resonance imaging (fMRI) while making decisions about whether or not to discard personal paper items (e.g. junk mail) brought to the laboratory as well as control items that did not belong to them. Items were either saved or destroyed following each decision. When deciding about whether to keep or discard personal possessions, compulsive hoarding participants displayed excessive hemodynamic activity in lateral orbitofrontal cortex and parahippocampal gyrus. Among hoarding participants, decisions to keep personal possessions were associated with greater activity in superior temporal gyrus, middle temporal gyrus, medial frontal gyrus, anterior cingulate cortex, precentral gyrus, and cerebellum than were decisions to discard personal possessions. These results provide partial support for an emerging model of compulsive hoarding based on complications of the decision-making process. They also suggest that compulsive hoarding may be characterized by focal deficits in the processing of reward and changes in reward contingencies, particularly when these are perceived to be punishing.

Brain structure and symptom dimension relationships in obsessive–compulsive disorder: A voxel-based morphometry study

Background Obsessive–compulsive disorder (OCD) is a clinically heterogenous disorder characterized by temporally stable symptom dimensions. Past inconsistent results from structural neuroimaging studies of OCD may have resulted from the effects of these specific symptom dimensions as well as other socio-demographic and clinical variables upon gray matter (GM) volume. Methods GM volume was measured in 25 adult OCD patients and 20 adult healthy controls using voxel-based morphometry (VBM), controlling for age and total brain GM volume. Univariate and multivariate regression analyses were carried out between regions of GM difference and age, age of onset, medication load, OCD severity, depression severity, and separate symptom dimension scores. Results Significant GM volumetric differences in OCD patients relative to controls were found in dorsal cortical regions, including bilateral BA6, BA46, BA9 and right BA8 (controls > patients), and bilateral midbrain (patients > controls). Stepwise regression analyses revealed highly significant relationships between greater total OCD symptom severity and smaller GM volumes in dorsal cortical regions and larger GM volumes in bilateral midbrain. Greater age was independently associated with smaller GM volumes in right BA6, left BA9, left BA46 and larger GM volumes in right midbrain. Greater washing symptom severity was independently associated with smaller GM volume in right BA6, while there was a trend association between greater hoarding symptom severity and lower GM volume in left BA6. Limitations The sample was relatively small to examine the relationship between symptom scores and GM volumes. Multiple patients were taking medication and had comorbid disorders. Conclusions These analyses suggest dorsal prefrontal cortical and bilateral midbrain GM abnormalities in OCD that appear to be primarily driven by the effects of total OCD symptom severity. The results regarding the relationship between GM volumes and symptom dimension scores require examination in larger samples.

To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder

Preliminary neuroimaging studies suggest that patients with the 'compulsive hoarding syndrome' may be a neurobiologically distinct variant of obsessive-compulsive disorder (OCD) but further research is needed. A total of 29 OCD patients (13 with and 16 without prominent hoarding symptoms) and 21 healthy controls of both sexes participated in two functional magnetic resonance imaging experiments consisting of the provocation of hoarding-related and symptom-unrelated (aversive control) anxiety. In response to the hoarding-related (but not symptom-unrelated) anxiety provocation, OCD patients with prominent hoarding symptoms showed greater activation in bilateral anterior ventromedial prefrontal cortex (VMPFC) than patients without hoarding symptoms and healthy controls. In the entire patient group (n=29), provoked anxiety was positively correlated with activation in a frontolimbic network that included the anterior VMPFC, medial temporal structures, thalamus and sensorimotor cortex. Negative correlations were observed in the left dorsal anterior cingulate gyrus, bilateral temporal cortex, bilateral dorsolateral/medial prefrontal regions, basal ganglia and parieto-occipital regions. These results were independent from the effects of age, sex, level of education, state anxiety, depression, comorbidity and use of medication. The findings are consistent with the animal and lesion literature and several landmark clinical features of compulsive hoarding, particularly decision-making difficulties. Whether the results are generalizable to hoarders who do not meet criteria for OCD remains to be investigated.

Hoarding behaviour in Xhosa patients with schizophrenia - prevalence and clinical presentation

<div style="left: 81.816px; top: 554.304px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.945404);" data-canvas-width="64.96499999999999"><strong>Objective:</strong></div><div style="left: 146.781px; top: 554.304px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.916953);" data-canvas-width="327.78">Hoarding is commonly defined as the acquisition of</div><div style="left: 81.816px; top: 577.634px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.925405);" data-canvas-width="392.8499999999999">and failure to discard possessions of little use or value, and is</div><div style="left: 81.816px; top: 600.963px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.925516);" data-canvas-width="392.82">included as a symptom in the diagnostic criteria for obsessive</div><div style="left: 81.816px; top: 624.293px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.921474);" data-canvas-width="392.63999999999976">compulsive personality disorder (OCPD) and obsessive</div><div style="left: 81.816px; top: 647.622px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.966516);" data-canvas-width="392.76">compulsive disorder (OCD). However, it has also been</div><div style="left: 81.816px; top: 670.952px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.927338);" data-canvas-width="392.80500000000006">observed in other clinical syndromes including schizophrenia.</div><div style="left: 81.816px; top: 694.281px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.877386);" data-canvas-width="392.8349999999999">This study was conducted to investigate the prevalence and</div><div style="left: 81.816px; top: 717.611px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.901411);" data-canvas-width="392.79">clinical presentation of hoarding behaviour in schizophrenia</div><div style="left: 81.816px; top: 740.94px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.896676);" data-canvas-width="145.65">among Xhosa patients.</div><div style="left: 81.816px; top: 778.453px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.945913);" data-canvas-width="52.845000000000006"><strong>Method:</strong></div><div style="left: 134.661px; top: 778.453px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.875209);" data-canvas-width="339.975">The sample consisted of 102 patients, recruited as</div><div style="left: 81.816px; top: 801.782px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.892501);" data-canvas-width="392.7749999999999">part of a larger genetic study in the Cape Town metropole</div><div style="left: 81.816px; top: 825.112px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.942281);" data-canvas-width="392.7900000000001">between November 2004 and January 2005, diagnosed with</div><div style="left: 81.816px; top: 848.441px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.911274);" data-canvas-width="392.82">schizophrenia or schizoaffective disorders according to the</div><div style="left: 81.816px; top: 871.771px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.906643);" data-canvas-width="335.72999999999996">Diagnostic and Statistical Manual of Mental Disorders</div><div style="left: 417.051px; top: 871.771px; font-size: 15.45px; font-family: sans-serif;">(</div><div style="left: 420.651px; top: 871.771px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.845623);" data-canvas-width="45.720000000000006">DSM-IV</div><div style="left: 466.371px; top: 871.771px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.873016);" data-canvas-width="8.25">)</div><div style="left: 81.816px; top: 895.1px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.933064);" data-canvas-width="392.82">criteria. They were screened for clinically significant hoarding</div><div style="left: 81.816px; top: 918.43px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.903346);" data-canvas-width="392.82000000000005">symptoms. If these were present, additional information on</div><div style="left: 81.816px; top: 941.759px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.883932);" data-canvas-width="392.7750000000001">the phenomenology was obtained by means of a structured</div><div style="left: 81.816px; top: 965.089px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.892874);" data-canvas-width="392.82000000000005">questionnaire. The Mini International Neuropsychiatric Interview</div><div style="left: 81.816px; top: 988.418px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.893517);" data-canvas-width="392.79000000000013">(MINI) (screen and full version), the Yale Brown Obsessive</div><div style="left: 81.816px; top: 1011.75px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.902758);" data-canvas-width="392.82000000000005">Compulsive Scale (Y-BOCS) Checklist, Y-BOCS, Clutter Image</div><div style="left: 81.816px; top: 1035.08px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.887528);" data-canvas-width="392.80499999999995">Rating Scale (CIRS) and a structured questionnaire on hoarding</div><div style="left: 81.816px; top: 1058.41px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.907236);" data-canvas-width="118.485">were administered.</div><div style="left: 81.816px; top: 1095.92px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.789549);" data-canvas-width="44.06999999999999"><strong>Results:</strong></div><div style="left: 125.886px; top: 1095.92px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.878424);" data-canvas-width="348.7050000000001">Only four patients with schizophrenia were classified</div><div style="left: 81.816px; top: 1119.25px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.890916);" data-canvas-width="392.7899999999999">as hoarders. Although their clinical presentation resembled that</div><div style="left: 81.816px; top: 1142.58px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.912332);" data-canvas-width="392.8349999999999">of hoarders described elsewhere in the literature, they had low</div><div style="left: 81.816px; top: 1165.91px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.908464);" data-canvas-width="392.835">Y-BOCS scores and did not report other obsessive-compulsive</div><div style="left: 81.816px; top: 1189.24px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.872842);" data-canvas-width="68.94">symptoms.</div><div style="left: 81.816px; top: 1226.75px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.906502);" data-canvas-width="73.2"><strong>Conclusion:</strong></div><div style="left: 155.016px; top: 1226.75px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.900338);" data-canvas-width="319.575">Our results suggest that hoarding behaviour is</div><div style="left: 81.816px; top: 1250.08px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.908745);" data-canvas-width="392.79000000000013">not common in Xhosa patients with schizophrenia. Further</div><div style="left: 81.816px; top: 1273.41px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.912192);" data-canvas-width="392.78999999999996">investigation of protective factors for hoarding behaviour in the</div><div style="left: 81.816px; top: 1296.74px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.907419);" data-canvas-width="192.63000000000002">Xhosa population is warranted.</div>

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.

Clinical features of children and adolescents with obsessive-compulsive disorder and hoarding symptoms

Objective This study was conducted to examine whether pediatric patients with obsessive-compulsive disorder (OCD) and hoarding symptoms differed in terms of clinical characteristics from pediatric OCD patients without hoarding symptoms. Method Eighty children and adolescents with OCD (range, 7-17 years) completed clinician-administered and parent- and child-report measures of OCD symptom severity, impairment, and emotional and behavioral symptoms. Results Twenty-one youth endorsed significant hoarding symptoms. Relative to nonhoarders, youth with hoarding symptoms had worse insight, more magical thinking obsessions, and ordering/arranging compulsions than nonhoarders, higher levels of anxiety, aggression, somatic complaints, and overall externalizing and internalizing symptoms. Higher rates of panic disorder were found in youth with hoarding symptoms although other comorbidity rates did not differ. Conclusions These findings in children are partially consistent with studies in adults, and suggest that pediatric patients with hoarding symptoms may exhibit a unique clinical presentation.

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Although standard diagnostic classifications consider obsessive-compulsive disorder (OCD) to be a single diagnostic entity, it has become clear that it is a heterogeneous disorder, with great variability in clinical presentation. This heterogeneity has complicated the interpretation of clinical, neurobiological, and genetic studies in OCD. Therefore, researchers have sought to identify clinically meaningful phenotypes that might be more homogeneous and heritable to facilitate our understanding of the etiology and pathophysiology of OCD and ultimately lead to improved treatments (1). Factor analytic studies have consistently identified four principal OCD symptom dimensions: 1) harm-related, aggressive, sexual, and religious obsessions with checking compulsions; 2) symmetry obsessions with arranging and repeating compulsions; 3) contamination obsessions with cleaning compulsions; and 4) hoarding and saving symptoms (1, 2). These symptom factors are relatively stable over time and show different patterns of genetic inheritance, age at onset, comorbidity, and treatment response (see 1 for review). Cluster analyses, which seek to identify mutually exclusive, categorical subgroups, indicate that some of these symptom factors, such as hoarding, may constitute discrete subtypes of OCD (3, 4). Hoarding is defined as the acquisition of and inability to discard items, even though they appear (to others) to have no value (5). Hoarding behavior has been observed in several neuropsychiatric disorders, including schizophrenia, dementia, eating disorders, autism, and mental retardation, as well as in non-clinical populations, but it is most commonly found in OCD (6). 30% to 40% of OCD patients report hoarding and saving symptoms (6–8), and about 10% to 15% have hoarding as their most prominent symptom factor (3, 6). Compulsive hoarding is most commonly driven by obsessional fears of losing important items that the patient believes will be needed later, distorted beliefs about the importance of possessions, excessive acquisition, and exaggerated emotional attachments to possessions (5). Compulsive hoarding and saving leads to clutter that can cover living and work spaces, rendering them unusable. Hoarding frequently causes significant impairment in social and occupational functioning. In severe cases, it can produce health risks from infestations, falls, fires, and inability to cook or eat in the home (6). In this issue of the Journal, Jack Samuels, Ph.D., et al. report results from the OCD Collaborative Genetics Study, finding “suggestive” linkage of compulsive hoarding to a marker on chromosome 14 in families with OCD. The linkage became stronger when only families with two or more family members with compulsive hoarding were tested. Compulsive hoarding is well known to run in families. Hoarding behaviors are significantly more prevalent in the relatives of hoarding OCD patients than nonhoarding OCD patients (9). In the OCD Collaborative Genetics Study, hoarding was the most strongly familial of the OCD symptom factors, with robust correlations among sibling pairs (10). Only two previous genetic studies have examined the hoarding phenotype. Lochner et al. (8) found that the met/met (L/L) genotype of the catechol O-methyltransferase val158met polymorphism on chromosome 22q11 was significantly more prevalent in Afrikaner OCD patients with

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Although standard diagnostic classifications consider obsessive-compulsive disorder (OCD) to be a single diagnostic entity, it has become clear that it is a heterogeneous disorder, with great variability in clinical presentation. This heterogeneity has complicated the interpretation of clinical, neurobiological, and genetic studies in OCD. Therefore, researchers have sought to identify clinically meaningful phenotypes that might be more homogeneous and heritable to facilitate our understanding of the etiology and pathophysiology of OCD and ultimately lead to improved treatments (1). Factor analytic studies have consistently identified four principal OCD symptom dimensions: 1) harm-related, aggressive, sexual, and religious obsessions with checking compulsions; 2) symmetry obsessions with arranging and repeating compulsions; 3) contamination obsessions with cleaning compulsions; and 4) hoarding and saving symptoms (1, 2). These symptom factors are relatively stable over time and show different patterns of genetic inheritance, age at onset, comorbidity, and treatment response (see 1 for review). Cluster analyses, which seek to identify mutually exclusive, categorical subgroups, indicate that some of these symptom factors, such as hoarding, may constitute discrete subtypes of OCD (3, 4). Hoarding is defined as the acquisition of and inability to discard items, even though they appear (to others) to have no value (5). Hoarding behavior has been observed in several neuropsychiatric disorders, including schizophrenia, dementia, eating disorders, autism, and mental retardation, as well as in non-clinical populations, but it is most commonly found in OCD (6). 30% to 40% of OCD patients report hoarding and saving symptoms (6–8), and about 10% to 15% have hoarding as their most prominent symptom factor (3, 6). Compulsive hoarding is most commonly driven by obsessional fears of losing important items that the patient believes will be needed later, distorted beliefs about the importance of possessions, excessive acquisition, and exaggerated emotional attachments to possessions (5). Compulsive hoarding and saving leads to clutter that can cover living and work spaces, rendering them unusable. Hoarding frequently causes significant impairment in social and occupational functioning. In severe cases, it can produce health risks from infestations, falls, fires, and inability to cook or eat in the home (6). In this issue of the Journal, Jack Samuels, Ph.D., et al. report results from the OCD Collaborative Genetics Study, finding “suggestive” linkage of compulsive hoarding to a marker on chromosome 14 in families with OCD. The linkage became stronger when only families with two or more family members with compulsive hoarding were tested. Compulsive hoarding is well known to run in families. Hoarding behaviors are significantly more prevalent in the relatives of hoarding OCD patients than nonhoarding OCD patients (9). In the OCD Collaborative Genetics Study, hoarding was the most strongly familial of the OCD symptom factors, with robust correlations among sibling pairs (10). Only two previous genetic studies have examined the hoarding phenotype. Lochner et al. (8) found that the met/met (L/L) genotype of the catechol O-methyltransferase val158met polymorphism on chromosome 22q11 was significantly more prevalent in Afrikaner OCD patients with