A qualitative analysis of emotion and emotion regulation in hoarding disorder

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

BACKGROUND

Symptoms 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.

METHODS

The study employed a cross-sectional survey on a purposive sample of 300 older adults.

TOOLS

Saving Inventory-Revised and Functional Idiographic Assessment Template-Questionnaire-Short Form were used.

RESULTS

The 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).

CONCLUSION

The 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.

Do they really care? Specificity of social support issues in hoarding disorder and obsessive-compulsive disorder

OBJECTIVES

Unmet interpersonal needs may play a role in excessive emotional attachments to objects for people with hoarding disorder (HD). Previous research indicates that social support (but not attachment difficulties) may be specific to HD. The study aimed to evaluate social networks and support in HD relative to clinical controls with obsessive-compulsive disorder (OCD) and healthy controls (HC). The secondary aim was to explore the extent of loneliness and thwarted belongingness. Potential mechanisms for deficits in social support were also considered.

DESIGN

A cross-sectional between-groups design was used to compare scores on measures in those with HD (n = 37); OCD (n = 31); and HCs (n = 45).

METHODS

Participants completed a structured clinical interview by telephone (to assign diagnostic categories) followed by online questionnaires.

RESULTS

Whilst individuals with HD and OCD both report smaller social networks than HC, lower levels of perceived social support appear to be specific to HD. The HD group also showed higher levels of loneliness and thwarted belonging compared to OCD and HC. No differences were found between groups for perceived criticism or trauma.

CONCLUSIONS

The results support previous findings of lower levels of self-reported social support within HD. Loneliness and thwarted belongingness also appear significantly elevated within HD compared with OCD and HC. Further research is required to explore the nature of felt support and belonging, direction of effect and to identify potential mechanisms. Clinical implications include advocating and promoting support systems (both personal supporters and professionals) for individuals with HD.

Association between attachment and hoarding behavior: Mediation of anthropomorphism and moderation of hoarding beliefs among Chinese adolescents

The impact of insecure attachment on hoarding behavior (HB) has been supported by empirical evidence. However, scant literature has focused on how anthropomorphism (attributing human-like traits, characteristics, or emotions to nonhuman objects) and hoarding beliefs (motivations for ownership) affect the relationship between insecure attachment and HB, especially among Chinese adolescents. Using a cross-sectional study, we reserved 903 participants (561 males, 342 females, M = 20.20, SD = 1.85, age range = 18-24 years) to complete self-report questionnaires about close relationships, anthropomorphism, saving beliefs, and saving inventory to investigate the mediating role of anthropomorphism and the moderating role of hoarding beliefs in the relationship between insecure attachment and HB. Attachment anxiety and avoidance had a positive relationship with HB, and anthropomorphism is a mediating factor in the association between attachment anxiety and HB. In addition, hoarding beliefs moderated the relationship between attachment anxiety and HB. This study further elaborated on the relationships between insecure attachment, anthropomorphism, hoarding beliefs, and HB, which might shed some light on adolescent clinical interventions.

The impact of coronavirus on individuals with problematic hoarding behaviours

We aimed at investigating the impact of the coronavirus pandemic on individuals with problematic hoarding behaviors. One hundred seventeen subjects with hoarding problems responded to the Coronavirus Stressful and Traumatic Rating Scale (COROTRAS), an instrument that quantified the number of coronavirus-related events, whether they were experienced as stressful, and the range of emotions resulting from them. The research subjects also answered self-report tools to evaluate the severity of hoarding, hoarding beliefs/motivations, social support, self-efficacy, internalized stigma, and other psychopathological symptoms. The number of stressful coronavirus-related events was predicted by lower age at onset of hoarding, decreased social support, greater severity of obsessive-compulsive symptoms, and lower intensity of concerns over memory as drivers of hoarding. Two emotional states experienced in the aftermath of trauma, namely greater helplessness and lower sadness, and higher depression, anxiety and distress, predicted greater severity of hoarding. In conclusion, we were able to find significant associations between hoarding disorder phenotypes and covid-19 related stressful events.

The Relationship Between Affective and Obsessive-Compulsive Symptoms in Internet Use Disorder

We investigated the relationships and diagnostic power of symptoms associated with affective disorders, obsessive-compulsive disorder, and drug addictions on Internet use disorder. Moreover, we tested whether Internet use disorder is characterized by a specific network of symptoms. One-hundred-and-four young adults (78 women) were assessed in laboratory using self-report measures of Internet addiction, alcohol use disorder, cannabis abuse, depression, anxiety, and stress symptoms, impulsiveness, and obsessive-compulsive symptoms. Only hoarding, obsessing, and depression symptoms were positively linked to Internet use disorder severity, with hoarding having greater power and accuracy than other obsessive-compulsive and affective symptoms. Only individuals with mild-moderate Internet use disorder were characterized by a network of strong and positive associations of affective and obsessive-compulsive symptoms. These findings may encourage future longitudinal studies aimed at identifying potential clinical criteria for the diagnosis of Internet use disorder and treatment targets.

A critical review of cognitive behavioural therapy for hoarding disorder: How can we improve outcomes?

Psychological treatment for hoarding problems has historically been associated with poor outcomes. When treated as a subgroup of obsessive-compulsive disorder, individuals with hoarding beliefs were less likely to respond to treatment than individuals exhibiting other obsessive-compulsive beliefs and behaviours. When treated as its own disorder using cognitive behavioural therapy, individuals report approximately 25% improvement in symptoms on average. However, less than a third of people experience clinically meaningful change. Further, changes in functioning and quality of life are not routinely assessed. In this paper, we review the current conceptualization and treatment of hoarding problems to shed light on how treatment for hoarding disorder may be improved. Utilizing a harm reduction approach before administering treatment may be important to ensure the safety of individuals. Research should test whether treatment outcomes improve by including strategies that enhance a client's interpersonal functioning and ability to regulate emotions (i.e., based on dialectal behaviour therapy and mentalization-based treatments), especially while discarding and organizing belongings. We should also use modern learning theory to improve the delivery of exposure activities.

Coping associated with compulsive buying tendency

Research on general coping is limited within compulsive buying (CB) literature. Nevertheless, other behavioural addictions and hoarding might provide insights into coping in CB. One-hundred and ninety-nine participants (M age = 52.72, SD = 16.06; 50.3% female, 1% unknown sex) completed online questionnaires. Mental and behavioural disengagements were hypothesized to predict greater self-reported CB tendency. Whilst these relationships were found in the correlations, a regression analysis indicated that only mental disengagement significantly predicted CB tendency. Additionally, the exploration of denial and substance use identified that denial was an important predictor of CB tendency coping. The relationship between CB tendency and substance use could not be explored given the large degree of participants reporting minimal scores. CB tendency is associated with maladaptive mental disengagement, denial and lack of acceptance coping strategies, which could be useful to consider in therapy.

Object attachment and emotions in hoarding disorder

BACKGROUND AND AIMS

Object attachment is a core feature of hoarding disorder (HD), but it also occurs in people without HD. It is therefore critical to clarify differences between normal and abnormal object attachment. Although previous studies show that HD is associated with high emotional reactivity, no study to date has examined the nature and intensity of discrete emotions in people with and without HD in relation to object attachment.

METHOD

Individuals with HD (n = 93) and matched controls (n = 93) were recruited via MTurk. They identified and described a possession of low monetary value that they were emotionally attached to and found difficult to discard. Participants rated their object attachment and the intensity of emotions when imagining being with the object (Scenario A) and irretrievably losing the same object (Scenario B).

RESULTS

Unexpectedly, there were no significant between-group differences on object attachment; however, the HD group experienced more incongruent emotions about their possessions; they reported significantly higher disgust, anxiety and anger than controls when they imagined being with their chosen object (Scenario A) and were more relaxed compared to controls when the object was lost (Scenario B). There were no significant differences between groups on congruent emotions (i.e., positive emotions in Scenario A or negative emotions in Scenario B).

CONCLUSION

People with and without HD experience similar emotional attachment for sentimental items but people with HD experience more mixed emotions, consistent with an insecure object attachment.

Exploring emotions and cognitions in hoarding: a Q-methodology analysis

BACKGROUND

The cognitions and emotions of people prone to hoarding are key components of the dominant cognitive behavioural model of hoarding disorder.

AIMS

This study sought to use Q-methodology to explore the thoughts and feelings of people that are prone to hoarding, to identify whether distinct clusters of participants could be found.

METHOD

A 49-statement Q-set was generated following thematic analysis of initial interviews (n = 2) and a review of relevant measures and literature. Forty-one participants with problematic hoarding met various study inclusion criteria and completed the Q-sort (either online or offline). A by-person factor analysis was conducted and subsequent participant clusters compared on psychometric measures of mood, anxiety, hoarding and time taken on the online task as proxy for impulsivity.

RESULTS

Four distinct participant clusters were found constituting 34/41 (82.92%) of the participants, as the Q-sorts of n = 7 participants failed to cluster. The four clusters found were 'overwhelmed' (n = 11 participants); 'aware of consequences' (n = 13 participants); 'object complexity' (n = 6 participants) and 'object-affect fusion' (n = 4 participants). The clusters did not markedly differ with regard to hoarding severity, anxiety, depression or impulsivity.

CONCLUSIONS

Whilst the participant clusters reflect extant research evidence, they also reveal significant heterogeneity and so prompt the need for further research investigating emotional and cognitive differences between people prone to hoarding.

An exploratory study on the lived experiences of hoarding in Singapore

Research studies have revealed that people with hoarding typically collect and keep items due to their aesthetic appeal, utility and strong emotional attachment to the items resulting in clutter and limiting living spaces. This study aims to explore the experiences of individuals with hoarding disorder to understand and describe-the patterns and reasons for hoarding, experiences with decluttering and the impact of hoarding disorder on significant others and society in the context of a multi-ethnic urban Asian country. A total of 12 participants with hoarding disorder were recruited and interviewed using a simple semi-structured interview guide designed for the study. The resulting transcribed interviews were analysed using thematic analysis. The mean age of the participants was 56.7 years (SD = 14.5). Nine super-ordinate and discrete but interconnecting themes emerged from the qualitative interviews: types of hoarded items, sources of hoarded items, ways of storing/arranging hoarded items, help-seeking/treatment contact, reasons for hoarding, experiences with decluttering, impact upon family, community and self, restricting hoarding behaviours and insight. Key themes identified in the study are consistent with the literature on studies on hoarding which have been done in other populations. Hoarding in the community has serious consequences for individuals with hoarding disorder and others living in the community, which is compounded by the lack of insight among these individuals. There is a pressing need to increase public awareness and recognition of hoarding behaviours to aid efforts in bringing timely and appropriate services to the affected individuals.

Recent Advances in Research on Hoarding

PURPOSE OF REVIEW

The purpose of the following paper is to review recent literature trends and findings in hoarding disorder (HD). Our goal is to highlight recent research on etiology, associated features, and empirically based treatments.

RECENT FINDINGS

Recent literature has added support for cognitive differences as a risk factor for HD; however, there is evidence that individuals with HD may overestimate their level of cognitive impairment. Several associated features have been highlighted in recent studies, including emotion regulation, intolerance of uncertainty and distress intolerance, and attachment. Finally, several psychotherapeutic treatments for hoarding have been recently validated, including group-based therapy and treatments using the cognitive-behavioral model. Although recent research demonstrates that hoarding can be effectively treated with available psychotherapeutic modalities, the effectiveness of current treatments is not as robust as that for other psychiatric disorders and more work is needed in treatment precision.

Exploring aspects of the cognitive behavioural model of physical hoarding in relation to digital hoarding behaviours

While the hoarding of physical objects has been extensively explored, there is little research relating to the hoarding of digital materials. The research that has been conducted suggests that digital hoarding (DH) behaviours appear to have some similarities with physical hoarding (PH) behaviours, and can be just as psychologically distressing. This study uses the framework of the cognitive behavioural model of PH to explore DH behaviours, including possible similarities regarding emotional attachment to digital possessions, and possible links with Obsessive Compulsive Disorder (OCD) and indecisiveness. For the study, 282 participants completed an online survey which measured levels of digital and physical hoarding, compulsive acquisition, OCD, indecisiveness and mood. Strong emotional attachments to particular types of digital possessions were evident: this was especially true for photographs and videos. Significant positive relationships were found between all the variables measured. However, a regression analysis revealed that only OCD and PH scores were significant predictors of DH. DH thus appears to share some of the features of PH. Implications, limitations and future research possibilities are discussed.

Predictors of treatment outcome and attrition in adults with hoarding disorder

While a number of hoarding disorder-specific therapeutic interventions have been developed over recent years, hoarding disorder (HD) remains difficult to treat. The purpose of this investigation is to inform HD treatment efforts by examining factors that influence treatment attrition and treatment response. Secondary data analysis of baseline and post-treatment data from two previously published psychotherapy treatment studies for hoarding were performed to identify predictors of hoarding symptom improvement and treatment attrition in 106 adults with HD. No demographic variables were associated with symptom improvement or treatment attrition. However, higher levels of avoidant coping (i.e., self-distraction combined with behavioral disengagement) significantly predicted symptom improvement. The maintenance stage of change along with high readiness for change also significantly predicted symptom improvement. Participants who dropped from treatment had significantly higher baseline levels of denial and clutter, both of which independently predicted treatment attrition. The findings from this study suggest that emotion-related constructs, such as managing stress and motivation for change, may play an important role in patients' response to and participation in HD treatment.