Hoarding, compulsive buying and reasons for saving

A Hierarchical Personality Approach Toward a Fuller Understanding of Onychophagia and Compulsive Buying

PURPOSE

Employing a hierarchical model of personality, prior research suggests that cardinal traits such as conscientiousness and agreeability predict central traits such as materialism and need for arousal that in turn impact surface traits such as onychophagia and compulsive buying. More research is needed to explore additional central traits and their effect on onychophagia and compulsive buying. Thus, the goal of the current research is to examine how another central trait-negative perfectionism-impacts onychophagia and compulsive buying.

DESIGN/METHODOLOGY/APPROACH

A survey was administered both online and face-to-face resulting in a sample of 634 subjects of which 391 were individuals with onychophagia. Through a multi-group analysis, a causal model was tested to identify personality traits and their relationship with compulsive buying.

RESULTS

Results showed that onychophagia was affected by other obsessive-compulsive disorders-particularly trichotillomania, and excoriation disorder, which significantly increased the likelihood that the participant was a compulsive buyer.

The Relationship Between Compulsive Buying and Hoarding in China: A Multicenter Study

There is no previous research that has explored the correlation between compulsive buying and hoarding in the Chinese population. This study aims to determine the relationship between compulsive buying and hoarding in a sample of the Chinese population comprising participants from mainland China (emerging economy) and Hong Kong (developed economy). Self-reported measures consisting of demographic questions, the Chinese version of the Hoarding Rating Scale (CHRS), and Richmond Compulsive Buying Scale-Traditional Chinese (RCBS-TC) were administered to participants. After data collection, common method biases were precluded. The RCBS-TC and CHRS were validated by confirmatory factor analysis and found correlated by Pearson correlation coefficient. The RCBS-TC and CHRS demonstrated satisfactory levels of internal consistency (Cronbach’s α = 0.872 and 0.828, respectively). A three-factor model, including hoarding, obsessive-compulsive, and impulse control disorders, was obtained through Confirmatory Factor Analysis (CFA) with the satisfactory fit for the total sample from Hong Kong and mainland China. A significant correlation was found between RCBS-TC and CHRS (r = 0.473). Findings also showed that 14% of the participants exhibited compulsive buying behavior. This study provides sufficient proof of the reliability and validity of RCBS-TC and CHRS. Their relationship was explored based on two sets of samples from different regions in Asia, which contributes more applicability in a cross-cultural context.

The developmental origins of hoarding disorder in adolescence: a longitudinal clinical interview study following an epidemiological survey

Hoarding disorder (HD) is hypothesized to originate in childhood/adolescence but little is known about the presentation of hoarding symptoms in youth and their natural history. In this longitudinal study, we tracked and conducted in-depth psychiatric interviews with twins who participated in an epidemiological survey and screened positive on a measure of hoarding symptoms at age 15. Twins screening positive for clinically significant hoarding symptoms at age 15 (n = 42), their co-twins (n = 33), a group of screen negative twins (n = 49), and their parents underwent a clinical assessment a median of 3 years after the initial screening. The assessment included psychiatric screening, hoarding symptoms and cognitions, in-home or photographic assessment of clutter levels, parental accommodation and familial burden. None of the participants had significant levels of clutter at follow-up and thus did not meet strict criteria for HD. However, twins meeting partial criteria (i.e., DSM-5 criteria A and B) for HD (n = 28) had more psychiatric disorders and scored significantly higher on all measures of hoarding symptoms including researcher-rated levels of clutter in their homes, compared to twins who did not meet partial criteria for HD (n = 46). As currently defined in DSM-5, HD may be rare in young people. A non-negligible proportion of young people who were screen positive on hoarding symptoms at age 15 had substantial hoarding symptoms and other psychopathology at follow-up. Whether and how many of these individuals will develop full-blown HD is unknown but the results offer unique insights about the probable origins of HD in adolescence.

Treatment of compulsive buying disorder: comparing the effectiveness of cognitive behavioural therapy with person-centred experiential counselling

Background:

Outcome studies of the treatment of compulsive buying disorder (CBD) have rarely compared the effectiveness of differing active treatments.

Aims:

This study sought to compare the effectiveness of cognitive behavioural therapy (CBT) and person-centred experiential therapy (PCE) in a cross-over design.

Method:

This was an ABC single case experimental design with extended follow-up with a female patient meeting diagnostic criteria for CBD. Ideographic CBD outcomes were intensively measured over a continuous 350-day time series. Following a 1-month baseline assessment phase (A; 28 days; three sessions), CBT was delivered via 13 out-patient sessions (B: 160 days) and then PCE was delivered via six out-patient sessions (C: 63 days). There was a 99-day follow-up period.

Results:

Frequency and duration of compulsive buying episodes decreased during active treatment. CBT and PCE were both highly effective compared with baseline for reducing shopping obsessions, excitement about shopping, compulsion to shop and improving self-esteem. When the PCE and CBT treatment phases were compared against each other, few differences were apparent in terms of outcome. There was no evidence of any relapse over the follow-up period. A reliable and clinically significant change on the primary nomothetic measure (i.e. Compulsive Buying Scale) was retained over time.

Conclusions:

The study suggests that both CBT and PCE can be effective for CBD. Methodological limitations and suggestions for future CBD outcome research are discussed.

The Role of Intrusive Imagery in Hoarding Disorder

Despite the incidence of trauma in the histories of people with Hoarding Disorder (HD), reexperiencing symptoms, namely intrusive images, have not been investigated in the condition. To address this, 27 individuals who met DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about (a) their everyday experiences of intrusive imagery, and (b) the unexpected images they experience when discarding high- and low-value possessions. Compared to CCs, everyday images described by the HD group were more frequent, had a greater negative valence, and were associated with greater interference in everyday life and attempts to avoid the imagery. With regard to discard-related imagery, a MANOVA followed up with mixed ANOVAs showed that HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD and CC participants both experienced positive imagery when discarding high-value objects. CC participants reported greater avoidance of imagery in the high-value object condition, but imagery-avoidance did not change between conditions for HD participants. The findings are discussed, particularly in relation to the potential of imagery-based interventions for HD.

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.

Animal hoarding: The challenge for mental health, law enforcement, and animal welfare professionals

Animal hoarding has been considered a significant problem by animal welfare and law enforcement professionals for over a century. However, it has only been recognized as an indication of a mental disorder in the last decade. I review the different forms that animal hoarding can take and the current understanding of the prevalence, demographics and possible etiology of this disorder. Conventional animal cruelty laws have often been inadequate to respond to animal hoarding cases until they reach levels that may involve serious harm to animals and people. I document how prosecution of such cases can be difficult and often does not adequately consider the mental health issues underlying the problem or the high likelihood of recidivism. Attempts to solve these problems by enacting new laws specifically addressing animal hoarding have been controversial and ineffective. I explore new approaches that coordinate a variety of community resources in response to hoarding cases that offer the best opportunity to respond to both the human and animal problems associated with animal hoarding.

The need to consume: Hoarding as a shared psychological feature of compulsive buying and binge eating

INTRODUCTION

Compulsive buying and binge eating are two frequently co-occurring psychiatric conditions. Hoarding, which is the psychological need to excessively gather and store items, is frequently associated with both compulsive buying severity and binge eating severity. In the present study, we explored whether different dimensions of hoarding are a shared feature of compulsive buying and binge eating.

METHOD

Participants consisted of 434 people seeking treatment for compulsive buying disorder. Registered psychiatrists confirmed the diagnosis of compulsive buying through semi-structured clinical interviews. Participants also completed measures to assess compulsive buying severity, binge eating severity, and dimensions of hoarding (acquisition, difficulty discarding, and clutter). Two-hundred and seven participants completed all three measures.

RESULTS

Significant correlations were found between compulsive buying severity and the acquisition dimension of hoarding. Binge eating severity was significantly correlated with all three dimensions of hoarding. Hierarchical regression analysis found that compulsive buying severity was a significant predictor of binge eating severity. However, compulsive buying severity no longer predicted binge eating severity when the dimensions of hoarding were included simultaneously in the model. Clutter was the only subscale of hoarding to predict binge eating severity in step two of the regression analysis.

CONCLUSION

Our results suggest that the psychological need to excessively gather and store items may constitute a shared process that is important in understanding behaviors characterized by excessive consumption such as compulsive buying and binge eating.

Treatments for compulsive buying: A systematic review of the quality, effectiveness and progression of the outcome evidence

Background and aims This review appraises the progression and status of the evidence base for the treatment of compulsive buying disorder (CBD), in order to highlight what currently works and to prompt useful future research. Methods Online databases ISI Web of Knowledge, PsycINFO, and PubMed via Ovid were searched at two time points. Two quality checklists and an established model of therapy evaluation (hourglass model) evaluated the quality and progression of both psychotherapy and pharmacotherapy treatments for CBD. Uncontrolled effect sizes were calculated and meta-regression analyses were performed regarding treatment duration. Results A total of 29 articles met the inclusion criteria, which were divided into psychotherapy (n = 17) and pharmacotherapy treatments (n = 12). Of the 29 studies, only 5 studies have been tested under conditions of high methodological quality. Both forms of treatment had been evaluated in a haphazard manner across the stages of the hourglass model. Although large effects were demonstrated for group psychotherapy and pharmacotherapy, such evidence of effectiveness was undermined by poor study quality and risk of publication bias. Long-term CBD treatment was associated with improved outcome with pharmacotherapy, but not when delivering psychotherapy. Discussion Group psychotherapy currently appears the most promising treatment option for CBD. Poor methodological control and sporadic evaluation of specific treatments have slowed the generation of a convincing evidence base for CBD treatment. Defining the active ingredients of effective CBD treatment is a key research goal.

Behavioral and emotional consequences of thought listing versus cognitive restructuring during discarding decisions in hoarding disorder

An essential criterion for hoarding disorder (HD) is difficulty discarding or parting with possessions, yet few studies have examined reactions to actual discarding behaviors. The present study examined whether individuals with HD differed from non-hoarding community controls (CC) in discarding behavior and emotional reactions to discarding. A second purpose was to examine the course of experienced distress following discarding. A third purpose was to determine whether HD participants responded differently to a simple thought listing (TL) instruction or to a cognitive restructuring (CR) protocol. Participants were asked to decide whether to keep or discard (a) a personal possession and (b) a newly acquired object (magazine). HD participants anticipated more and longer distress and reported stronger attachment motives than community controls, but they did not differ significantly from community controls in actual discarding behavior. TL was somewhat more effective than CR in improving discarding behavior and reducing negative emotions and attachments to discarded objects among HD participants. Reductions in distress were observed for both HD-TL and HD-CR groups. Thought listing may have reduced avoidance of decision-making about discarding or perhaps CR, but not TL, provoked therapeutic reactance. Discarding was not related to reductions in distress or hoarding-related beliefs.

Spanish Version of the Savings Inventory–Revised

The factor structure, psychometric properties, and relationship with personality variables of a Spanish version of the Savings Inventory-Revised (SI-R) are investigated in a sample of 381 undergraduate students. A maximum likelihood factor analysis suggests a three-factor structure, which is similar but not identical to that of the original English version. The three factors mirror the three hypothesized domains of compulsive hoarding: acquisition, difficulty discarding, and clutter. The Spanish SI-R demonstrates acceptable high internal consistency and test-retest reliability, but its divergent validity is weaker than expected because of a significant overlap with depressive symptoms. Different SI-R factors are associated with different personality traits: Whereas the difficulty discarding dimension is predominantly associated with susceptibility to punishment, the acquisition dimension is predominantly associated with susceptibility to reward. The authors conclude that the Spanish SI-R is a promising instrument to measure hoarding symptoms.

Clinical Correlates of Hoarding With and Without Comorbid Obsessive-Compulsive Symptoms in a Community Pediatric Sample

OBJECTIVE

We assessed the prevalence and clinical correlates of hoarding, with and without obsessive-compulsive (OC) symptoms, in a community-based pediatric sample.

METHOD

We measured hoarding and OC symptoms using the Toronto Obsessive-Compulsive Scale (TOCS) in 16,718 youth aged 6 to 17 years in the community. We classified participants with high and low symptom counts for hoarding and OC into 4 groups: hoarding+OC; hoarding-only; OC-only; and control (no OC or hoarding symptoms). We compared these 4 groups on parent- or self-reported medical and psychiatric conditions, anxiety symptoms measured with the Child Behavior Checklist (CBCL), and attention-deficit/hyperactivity disorder (ADHD) symptoms measured with the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior Scale (SWAN).

RESULTS

Almost 10% of participants were in the high hoarding group. Of these participants, 40% did not fall into the high OC group. The prevalence of reported psychiatric disorders (e.g., ADHD, autism spectrum disorder, obsessive-compulsive disorder) was greater in the hoarding (hoarding+OC and hoarding-only) and OC groups (hoarding+OC and OC-only) than in the nonhoarding (OC-only and control) and non-OC groups (hoarding-only and control), respectively. ADHD, specifically inattentive, symptoms were more common in the hoarding-only than in the OC-only group while anxiety symptoms were more common in the OC-only than in the hoarding-only group.

CONCLUSION

In a community pediatric sample, hoarding symptoms occurred in both the presence and absence of obsessive-compulsive symptoms. Hoarding symptoms alone had some unique clinical correlates, in particular, more inattentive ADHD symptoms and fewer anxiety symptoms. These findings suggest that hoarding is distinct from OC traits in youth.

Motives for Acquiring and Saving in Hoarding Disorder, OCD, and Community Controls

Hoarding Disorder (HD) was classified as a separate disorder in DSM-5 (APA, 2013). However, only recently has research on hoarding begun in earnest, and as of yet, very little research exists on the motivation to acquire and save the excessive volume of possessions seen in patients with this disorder. This investigation examined the frequency of four motives for acquiring and saving possessions that are often reported anecdotally by people with HD (information, emotional reasons, avoid waste, and aesthetic reasons). Comparisons in a sample of 443 participants indicated that those with HD reported higher frequencies of each of these four motives for acquiring and saving compared to OCD participants and community controls. The intention to avoid waste emerged as the most prominent motive in people with HD. Understanding waste avoidance may be key to better understanding and treating HD.

Experimental evidence for the influence of cognitions on compulsive buying

BACKGROUND AND OBJECTIVES

Compulsive buying is a disabling condition, where individuals are unable to resist or control their buying behavior, leading to substantial social and financial problems. Cognitive models implicate the role of beliefs as one factor in buying behavior, for example, "this item is unique and will help me improve my life".

METHODS

This study experimentally examined the contribution of such beliefs to the disorder, in individuals who compulsively buy (N = 18) and in non-clinical controls (N = 17). Participants were presented with photographs of idiosyncratically appealing and unappealing items, in the context of imagined scenarios that either minimized or maximized aspects relevant to hypothesized "compulsive buying beliefs" (i.e., beliefs that acquisition can compensate for negative feelings, beliefs regarding uniqueness and lost opportunities, and emotional reasons for buying).

RESULTS

It was found that individuals who compulsively buy demonstrated stronger urges to purchase than control participants, regardless of context, but the overall strength of these urges was responsive to manipulations of beliefs about consumer items said to be associated with compulsive buying.

LIMITATIONS

The main limitation of the study was a small sample size, potentially reducing power.

CONCLUSIONS

Nonetheless, these findings provide insights into the processes underlying compulsive phenomena, in particular supporting the role of cognitions in compulsive buying.

Relationships that compulsive buying has with addiction, obsessive-compulsiveness, hoarding, and depression

BACKGROUND AND OBJECTIVES

Compulsive buying has been associated with addiction, depression, and obsessive-compulsive disorder, as well as hoarding. The present study investigated the relationship that compulsive buying (CB) has with 'addictive' (i.e., sensitivity to reward), obsessive-compulsive, and depressive phenomena, after controlling for hoarding, substance dependence, manic, and Borderline Personality Disorder symptoms.

METHODS

87 participants from a community population completed the online questionnaires for the study, however 70 participants (M=29.19, SD=10.45; 70% were female) were used in the analyses because of exclusion criteria.

RESULTS

As expected, CB measures correlated with hoarding, depression, sensitivity to reward, and, but less so, obsessive-compulsive measures. Sensitivity to reward was the most important predictor of CB severity, compared to obsessive-compulsive and depression symptoms. Hoarding was also an important predictor of CB severity.

LIMITATIONS

Small sample size meant gender comparisons could not be made, and the use of a novel, communicated questionnaire meant that interpretation should be considered conservatively.

CONCLUSIONS

Overall, findings suggest that CB may be most closely related to the phenomena associated with addiction (an increased sensitivity to reward), rather than obsessive-compulsive or depression symptoms. Hoarding and reward sensitivity perhaps might separate compulsive buying from ordinary and recreational shopping.

An initial investigation of the relationships between hoarding and smoking

Cigarette smokers have increased rates of mood and anxiety-related conditions. Hoarding is another anxiety-related condition that has yet to be examined in relation to smoking behavior. The current investigation sought to examine smoking rates among a sample of individuals with hoarding disorder and individuals with non-hoarding obsessive-compulsive disorder (OCD). Additionally, we examined the relationship between hoarding symptoms and reasons for smoking. Participants in Study 1 consisted of 57 individuals with non-hoarding OCD or hoarding disorder. Participants in Study 2 consisted of 661 adult daily smokers. Results revealed that a significantly greater proportion of individuals diagnosed with hoarding were current smokers compared to the non-hoarding OCD group. Additionally, hoarding severity was associated with negative affect reduction expectancies. These results provide important information regarding smoking behaviors within hoarding disorder. Given the poor treatment outcomes and negative health risks associated with hoarding, this information could inform future research and treatment programs.

Cognitive processes associated with compulsive buying behaviours and related EEG coherence

The behavioural and cognitive phenomena associated with Compulsive Buying (CB) have been investigated previously but the underlying neurophysiological cognitive process has received less attention. This study specifically investigated the electrophysiology of CB associated with executive processing and cue-reactivity in order to reveal differences in neural connectivity (EEG Coherence) and distinguish it from characteristics of addiction or mood disorder. Participants (N=24, M=25.38 yrs, S.D.=7.02 yrs) completed the Sensitivity to Punishment Sensitivity to Reward Questionnaire and a visual memory task associated with shopping items. Sensitivities to reward and punishment were examined with EEG coherence measures for preferred and non-preferred items and compared to CB psychometrics. Widespread EEG coherence differences were found in numerous regions, with an apparent left shifted lateralisation for preferred and right shifted lateralisation for non-preferred items. Different neurophysiological networks presented with CB phenomena, reflecting cue reactivity and episodic memory, from increased arousal and attachment to items.

An intensive time-series evaluation of the effectiveness of cognitive behaviour therapy for hoarding disorder: a 2-year prospective study

OBJECTIVE

To intensively evaluate the effectiveness of cognitive-behavioural therapy (CBT) for Hoarding Disorder.

METHOD

An ABC with extended follow-up N=1 single-case experimental design (SCED) measured discard incidence/frequency/volume and associated cognitions, behaviours and emotions in a 644-day time series. Following a 4-week baseline (A), CBT was initially delivered via out-patient sessions (B) and then out-patient sessions plus domiciliary visits (C). Total treatment duration was 45 sessions (65 weeks) and follow-up was 4 sessions over 23 weeks.

RESULTS

There was a significant increase in frequency and volume of discard, with a reliable and clinically significant reduction in hoarding. The addition of domiciliary visits did not significantly improve discard ability.

DISCUSSION

The clinical utility of domiciliary visits whilst treating of hoarding is discussed and study limitations noted.

"Do they think I am a pack rat?"

This case study presents details of the life of one older man who lived in seclusion and squalor, surrounded by hoarded possessions. This man was one participant of a focused ethnography of eight older adults who received home care. All participants in the original ethnography were identified by their community care coordinators as exhibiting hoarding behaviors. The case study presented here provides rich narrative and photographic detail in order to add strength to what has already been presented in previous research articles about compulsive acquisition. The narratives reveal examples of debilitating dysfunction, distress associated with decision making, broad acquisition of free things, compulsive buying, and ritualistic discarding. Quotes included in the case study stem from the original ethnography.

Experimental analysis of the relationship between depressed mood and compulsive buying

BACKGROUND AND OBJECTIVES

Compulsive buying is a serious but understudied problem, where individuals are unable to resist or control their buying behaviour, leading to substantial social and financial problems. To date there has been a lack of experimental research into the disorder.

METHODS

The relationship between mood and compulsive buying was examined in compulsive buyers (N = 18) and non-clinical controls (N = 17), using experimental information-processing paradigms. In study 1, it was expected that, if buying behaviours function as a coping strategy for depressed mood, then an induction of depressed mood would lead to an enhanced memory for appealing consumer-objects in compulsive buyers, but not controls. In study 2, we examined the association between emotional and functional constructs and consumer items. It was expected that compulsive buyers would show stronger semantic relationships and thus better episodic memory for object-emotion pairs, relative to object-function pairs, for appealing items.

RESULTS

Unexpectedly, in study 1 the memory-facilitating effect of depressed mood was evident among control participants and absent among compulsive buyers. In study 2, compulsive buyers showed a lesser association of undesirable objects with positive emotional concepts than did non-clinical controls, and compulsive buyers were found to more strongly associate all consumer items with emotional concepts than with concepts of function.

LIMITATIONS

Key limitations were low power and possible floor effects due to error frequency data.

CONCLUSION

These findings provide insights into the processes underlying CB phenomena, in particular supporting the role of mood in compulsive buying.

Beliefs and experiences in hoarding

Recent research suggests that hoarding problems may be relatively heterogeneous, with the suggestion that three belief dimensions may underpin hoarding experiences, namely harm avoidance, fear of material deprivation, and heightened "sentimentality" in relation to possessions. The role of these hypothesised belief dimensions in hoarding was evaluated in this study, together with the association between compulsive hoarding and OCD on several clinically relevant variables. As hypothesised, individuals with hoarding and co-existing OCD reported greater harm avoidance beliefs in relation to possessions compared with a group of hoarders without OCD. Contrary to expectation, however, the hoarding group without OCD did not report significantly stronger beliefs associated with material deprivation and attachment disturbance relative to the hoarding with OCD group. The comparison of the clinical presentation of participants across groups lends further support to the notion that hoarding should be considered a distinct clinical syndrome from OCD.

Hoarding behaviour in an Italian non-clinical sample

BACKGROUND

Hoarding is associated with significant impairment. Although traditionally considered as a symptom of obsessive-compulsive disorder (OCD), some authors have proposed that pathological hoarding could be considered as a stand alone condition. The prevalence of pathological hoarding behaviour has been shown to be high in some countries, but little is known about the prevalence and correlates of hoarding in the non-clinical population in Italy.

METHOD

We studied the prevalence of self-reported hoarding behaviour using the Italian version of the Saving Inventory-Revised, as well as the association between hoarding and various clinical correlates, including obsessive-compulsive symptoms, compulsive buying, anxiety, and depression.

RESULTS

The prevalence of pathological hoarding behaviour in two studies was between 3.7 and 6.0%. No differences were found between hoarding and non-hoarding participants with regard to gender, age, marital status, level of education, and employment status. Significant correlations were found between compulsive hoarding and obsessive-compulsive symptoms and also between hoarding and a measure of compulsive buying, even after controlling for anxiety and depressive symptoms.

CONCLUSIONS

These results indicate that pathological hoarding may also be prevalent in Italy and highlight the need for further epidemiological studies using validated instruments to assess hoarding disorder.

Quality of life and psychiatric work impairment in compulsive buying: increased symptom severity as a function of acquisition behaviors

The aims of the current study were to determine if compulsive acquisition behaviors are meaningfully related to quality of life and psychiatric work impairment and to determine if compulsive buyers who engage in 2 forms of acquisition (buying and excessive acquisition of free items) are more impaired than individuals who only engage in 1 form of acquisition. In a community-recruited sample, analysis of covariance conducted between groups identified as noncompulsive buyers (NCB) (n = 30), compulsive buyers who did not acquire free items (CBB) (n = 30), and compulsive buyers who also acquired free items (CBF) (n = 35) revealed that both acquisition groups reported higher levels of depression and stress and lower quality of psychological well-being than the NCB group, despite a comparable number of individuals self-reporting a current mental health disorder in each group. The CBF group reported higher levels of anxiety and general distress as well as greater work inefficiency days compared with the NCB and CBB groups. Furthermore, regression analyses supported the unique contribution of acquisition of free items to the prediction of psychiatric work impairment. Taken together, the findings highlight the serious impact of compulsive buying on work functioning, general quality of life, and psychological well-being and provide avenues for future research to investigate the role of acquisition of free items in symptom severity. Limitations and future directions are discussed.

Older adults with hoarding behaviour aging in place: looking to a collaborative community-based planning approach for solutions

This paper reports on and synthesizes new research that examines how a collaborative community response can promote successful aging in place for older adults with hoarding behaviour. Through interviews with older adults with hoarding behaviour, who used a particular community support and a focus group interview with members of the community collaborative that directed supports for this population, our findings suggest that there were valuable outcomes for both groups. These older adults with hoarding behaviour were able to remain in their own homes, their safety was enhanced, their sense of isolation was minimized, empowerment was fostered, and they gained valuable insight into their behaviour. The members of the community collaborative were able to access the expertise of other professionals, maximize their own expertise, and they generated an enhanced understanding of the experience of older adults living with hoarding behaviour in Edmonton. This study is a significant addition to the much too sparse literature about the community planning needs of older adults with hoarding behaviour. It offers knowledge that is integral to theories and principles of better aging in place but attempts to translate this into practice.

Characteristics and Antecedents of People who Hoard Animals: An Exploratory Comparative Interview Study

Currently, case studies and media reports provide the only descriptive information available to understand what distinguishes hoarding of animals from nonhoarding animal ownership. This poorly understood problem appears to be associated with substantial mental health difficulties. The present study investigated characteristics and antecedents that might explain hoarding behaviors. Sixteen people who fit criteria for hoarding of animals and 11 nonhoarding controls who owned large numbers of animals participated in semistructured interviews that were analyzed using somewhat atypical qualitative and quantitative methods. The interviews focused on demographic information, history of animal contact, social history, insight into physical and mental health issues, collecting behaviors, and beliefs and emotions associated with animals. Descriptive statistics and qualitative analyses were used to examine differences between hoarding and nonhoarding groups and to capture distinguishing themes and patterns. Both groups were well matched in demographic variables and were mainly White women of middle age; the average number of animals owned was 31. Thematic content common to both groups was stressful life events (both childhood and adult), strong emotional reactions to animal death, strong caretaking roles and attitudes toward animals, a tendency to rescue animals, and intense feelings of closeness or attachment to animals. Themes found significantly more often among animal hoarding participants than controls included problems with early attachment, chaotic childhood environments, significant mental health concerns, attribution of human characteristics to animals, and the presence of more dysfunctional current relationships. These themes are elaborated and discussed with regard to potential models for understanding hoarding of animals.

Challenges and advances in treating hoarding

This article introduces an issue of the Journal of Clinical Psychology: In Session devoted to understanding, assessing, and treating hoarding disorder (HD). After a case example is presented, the proposed the Diagnostic and Statistical Manual, 5th Edition criteria for HD are discussed, and the problems associated with hoarding are discussed from a psychotherapeutic and public health perspective. The articles in this issue are then outlined and summarized.

Inattention, but not OCD, predicts the core features of hoarding disorder

Hoarding Disorder (HD), defined as the acquisition of and failure to discard large volumes of possessions, resulting in clutter that precludes normal use of living spaces, is a common and debilitating condition. Although hoarding has historically been conceptualized as a variant of obsessive-compulsive disorder (OCD), increasing evidence suggests that hoarding might be more closely associated with the symptoms of attention deficit-hyperactivity disorder (ADHD). The aim of the present study was to clarify the relationship between the core features of hoarding (clutter, difficulty discarding, acquiring), OCD symptoms, and ADHD symptoms. HD (N = 39), non-hoarding OCD (N = 26), and healthy control (N = 36) participants underwent careful diagnostic interviewing and completed standardized self-report measures of the core features of hoarding (clutter, difficulty discarding, acquiring), OCD symptoms, negative affect, and the inattentive and hyperactive/impulsive symptoms of ADHD. Multiple linear regressions demonstrated that after controlling for global negative affect, OCD symptoms did not significantly predict any of the core features of HD. Conversely, the inattentive (but not hyperactive/impulsive) symptoms of ADHD significantly predicted severity of clutter, difficulty discarding, and acquiring. These results challenge current conceptualizations of hoarding as a subtype of OCD, and suggest an association with neurocognitive impairment.

Compulsive hoarding

Compulsive hoarding is a chronic and debilitating condition that represents a significant public health concern. Hoarding is characterized by four key elements: difficulty discarding, excessive acquiring, clutter, and distress and impairment due to hoarding. This article reviews the current literature on compulsive hoarding, including its course and features, comorbidity, nosology, clinical presentation, and treatment response. The authors describe the cognitive-behavioral therapy model and treatment of hoarding, including a case presentation of a cognitive behavioral group treatment of compulsive hoarding.

The Brazilian Portuguese version of the Saving Inventory-Revised: internal consistency, test-retest reliability, and validity of a questionnaire to assess hoarding

Pathological hoarding results in clutter that precludes normal activities and creates distress or dysfunction. It may lead to an inability to complete household functions, health problems, social withdrawal, and even death. The aim of this study was to describe the validation of the Brazilian version of the hoarding assessment instrument, the Saving Inventory-Revised. Sixty-five patients with obsessive-compulsive disorder (OCD) and 70 individuals from the community were assessed using the Structured Clinical Interview for the Diagnosis of DSM-IV (clinical sample), the Saving Inventory-Revised, the Obsessive-Compulsive Inventory-Revised, the Beck Depression Inventory, and the Beck Anxiety Inventory. The Brazilian version of the Saving Inventory-Revised exhibited high internal consistency (Cronbach's alpha = .94 for OCD and .84 for controls), high to moderate test-retest reliability and, using the hoarding dimension of the Obsessive-Compulsive Inventory-Revised as a reference point, high to moderate convergent validity. The Saving Inventory-Revised total scores also correlated significantly with comorbid anxiety and depressive symptoms.

Compulsive Hoarding: An Interpretative Phenomenological Analysis

Background: This project aimed to explore the experiences of people who compulsively hoard and how they make sense of their own hoarding behaviours. Method: A total of 11 compulsive hoarders were recruited and interviewed using a simple semi-structured interview format, designed for the purposes of the study. The resulting transcribed interviews were analyzed using interpretive-phenomenological analysis. Results: Four super-ordinate discrete, but interacting, themes were found: (1) childhood factors; (2) the participants' relationship to their hoarded items; (3) cognitive and behavioural avoidance of discard; and (4) the impact of hoarding on self, others and the home environment. The themes as a whole described people entrapped in massively cluttered physical environments of their own making. Efforts at discard appeared consistently sabotaged by cognitive/behavioural avoidance, thereby creating maintaining factors of associated personal distress and environmental decline. Conclusions: The results are discussed in the context of the extant evidence concerning hoarding, the distinct contribution made by the current results and the identified methodological shortcomings of the research approach.

Investigating the mechanisms of hoarding from an experimental perspective

BACKGROUND

Acquiring and discarding objects are routine decision processes for most people. Despite the ubiquitous need to make such decisions, little is known about how they are made and what goes wrong when individuals acquire and fail to discard so many items that many areas of their home become unlivable (i.e., clinical hoarding). We hypothesize that clinical hoarding reflects a normal variation in the tendency to acquire and retain objects, only just at a more extreme level.

METHODS

To test this hypothesis, we examined 89 nonclinical, undergraduate students' performance on a novel experimental paradigm that measures decisions about acquiring and discarding everyday objects. To test our hypothesis, and validate our task as a possible research tool for studying hoarding, we related decisions on the task to a variety of measures known to correlate with clinical hoarding. The paradigm was sensitive to individual differences, as subjects varied widely in the quantity of objects they chose to acquire and retain under an increasing pressure to discard. In addition, we replicated expected relationships from the clinical hoarding literature between acquisition and retention tendencies and self-report measures of hoarding, indecisiveness, and obsessive-compulsive behavior.

RESULTS

Our data suggest that decisions about objects, even in a nonclinical undergraduate population, vary widely and are influenced by the same variables that influence clinical hoarding, but to a less extreme degree.

CONCLUSIONS

Future research with this experimental task can separately investigate the role of acquisition, retention, impulsivity, and sensitivity to constraints in clinical hoarding to inform our understanding of this disorder.

Excessive acquisition in hoarding

Compulsive hoarding (the acquisition of and failure to discard large numbers of possessions) is associated with substantial health risk, impairment, and economic burden. However, little research has examined separate components of this definition, particularly excessive acquisition. The present study examined acquisition in hoarding. Participants, 878 self-identified with hoarding and 665 family informants (not matched to hoarding participants), completed an Internet survey. Among hoarding participants who met criteria for clinically significant hoarding, 61% met criteria for a diagnosis of compulsive buying and approximately 85% reported excessive acquisition. Family informants indicated that nearly 95% exhibited excessive acquisition. Those who acquired excessively had more severe hoarding; their hoarding had an earlier onset and resulted in more psychiatric work impairment days; and they experienced more symptoms of obsessive-compulsive disorder, depression, and anxiety. Two forms of excessive acquisition (buying and free things) each contributed independent variance in the prediction of hoarding severity and related symptoms.

The prevalence of compulsive hoarding and its association with compulsive buying in a German population-based sample

The aims of the study were to estimate the prevalence rate of compulsive hoarding, and to determine the association between compulsive hoarding and compulsive buying in a nationally representative sample of the German population (N = 2307). Compulsive hoarding was assessed with the German version of the Saving Inventory-Revised (SI-R; Frost, R.O., Steketee, G., & Grisham, J. (2004). Measurement of compulsive hoarding: saving inventory-revised. Behaviour Research and Therapy, 42, 1163-1182.). The point prevalence of compulsive hoarding was estimated to be 4.6%. Individuals with compulsive hoarding did not differ significantly from those without compulsive hoarding regarding age, gender, and other sociodemographic characteristics. Significant correlations were found between the compulsive hoarding and the compulsive buying measures. Participants with compulsive hoarding reported a higher propensity to compulsive buying than respondents without hoarding. About two thirds of participants classified as having compulsive hoarding were also defined as suffering from compulsive buying. In summary, these results suggest that compulsive hoarding may be relatively prevalent in Germany and they confirm the close association between compulsive hoarding and compulsive buying through the investigation of a large scale representative sample.

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.

Reasons to accumulate excess: older adults who hoard possessions

This article is directed towards a deeper understanding of emotional issues that underpin hoarding behaviors by older people. A focused ethnographic research design was used as the method of exploration. The sample consisted of eight older adults who received home care and who were identified as exhibiting compulsive hoarding behaviors. The act of acquiring excess was found to be reassuring for older hoarders because stockpiled possessions relieved their anxieties and helped them to feel proud and productive, needed by others, connected, socially engaged, and in control. The hoarded possessions had value that was embedded but undeclared. Older hoarders were likely to have a positive view of themselves and their hoarding habits. For those who were not in imminent danger, hoarding constituted a certain quality of life.

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

BACKGROUND

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.

METHOD

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.

RESULTS

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.

CONCLUSIONS

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.