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Zakrzewski JJ, Doran N, Mayes TL, Twamley EW, Ayers CR. Rates of diagnosis and service utilization in veterans with hoarding disorder. Psychiatry Res 2024; 336:115888. [PMID: 38608540 DOI: 10.1016/j.psychres.2024.115888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
Hoarding Disorder (HD) is a prominent and disabling neuropsychiatric condition defined by the inability to discard objects resulting in impairing levels of clutter. The prevalence rate is 2-6 % and increases with age. The aging Veteran population is a high risk group for impairment associated with HD. Medical and psychiatric comorbidities as well as associated rates of disability and poor quality of life are very common in both HD and the related disorder of OCD. We examined rates of HD and OCD diagnoses at the VA San Diego Healthcare System. Data were obtained from medical records for all Veterans with these diagnoses over 8-years and included information on medical and psychiatric care, homelessness services, and Care Assessment Needs (CAN) scores. Rates of diagnosis for both HD and OCD were well below epidemiological estimates. Veterans with HD were older, had higher rates of medical hospital admissions with longer stays; had more cardiac, neurological, and acquired medical conditions; had more psychiatric comorbidities; had more interactions with the suicide prevent team and homelessness services; and had higher CAN scores than Veterans with OCD. The low rate of diagnosis and high services utilization of Veterans with HD demonstrates an area of unmet need.
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Affiliation(s)
- Jessica J Zakrzewski
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States.
| | - Neal Doran
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States
| | - Tina L Mayes
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, United States
| | - Catherine R Ayers
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States.
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Worden BL, Tolin DF, Stevens MC. An exploration of neural predictors of treatment compliance in cognitive-behavioral group therapy for hoarding disorder. J Affect Disord 2024; 345:410-418. [PMID: 38706461 PMCID: PMC11068362 DOI: 10.1016/j.jad.2023.10.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
A persistent and influential barrier to effective cognitive-behavioral therapy (CBT) for patients with hoarding disorder (HD) is treatment retention and compliance. Recent research has suggested that HD patients have abnormal brain activity identified by functional magnetic resonance (fMRI) in regions often engaged for executive functioning (e.g., right superior frontal gyrus, anterior insula, and anterior cingulate), which raises questions about whether these abnormalities could relate to patients' ability to attend, understand, and engage in HD treatment. We examined data from 74 HD-diagnosed adults who completed fMRI-measured brain activity during a discarding task designed to elicit symptom-related brain dysfunction, exploring which regions' activity might predict treatment compliance variables, including treatment engagement (within-session compliance), homework completion (between-session compliance), and treatment attendance. Brain activity that was significantly related to within- and between-session compliance was found largely in insula, parietal, and premotor areas. No brain regions were associated with treatment attendance. The results add to findings from prior research that have found prefrontal, cingulate, and insula activity abnormalities in HD by suggesting that some aspects of HD brain dysfunction might play a role in preventing the engagement needed for therapeutic benefit.
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Affiliation(s)
| | - David F Tolin
- Institute of Living/ Hartford Hospital, Hartford, CT
- Yale University School of Medicine, New Haven, CT
| | - Michael C Stevens
- Institute of Living/ Hartford Hospital, Hartford, CT
- Yale University School of Medicine, New Haven, CT
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Grassi G, Moradei C, Cecchelli C, van Ameringen M. Who really hoards? Hoarding symptoms in adults with attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and healthy controls. J Psychiatr Res 2023; 166:74-79. [PMID: 37741062 DOI: 10.1016/j.jpsychires.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/16/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
Although hoarding disorder (HD) is included in the DSM-5 in the obsessive-compulsive and related disorders chapter, in the last few years, HD has been consistently associated with attention-deficit hyperactivity disorder (ADHD). Some studies on HD patients show higher comorbidity with ADHD than with OCD and some studies on ADHD patients found significant higher rates of HD symptoms compared to the general population. However, the aim of the present study was to be the first direct comparison of the prevalence of HD and HD symptoms across adults with a primary diagnosis of ADHD, OCD and a sample of matched healthy controls (HCs). METHODS 57 adult patients with a primary diagnosis of ADHD and 50 adult patients with a primary diagnosis of OCD were enrolled and matched with 50 HCs. The presence of hoarding disorder and symptoms were assessed though the Saving Inventory Revised (SI-R). RESULTS ADHD patients showed significantly higher prevalence of HD comorbidity (32.1%) with respect to both OCD patients (8%) and HCs (4%). The prevalence of HD symptoms was also significantly higher in ADHD patients than in both OCD and HCs. Although OCD patients showed a higher prevalence of HD and HD symptoms with respect to HCs, these differences did not reach statistical significance. CONCLUSION HD is significantly more comorbid in ADHD patients than in OCD and HCs. A better understanding and definition of the boundaries between HD and the OCD and ADHD spectrum could lead to the development of a more precise treatment approach for hoarding disorder.
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Affiliation(s)
| | | | | | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, MacAnxiety Research Centre, Canada
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Wong SF, Dewar E, Baldwin PA, Grisham JR. Evaluating the effects of a brief motivational interviewing protocol on excessive acquisition. J Behav Ther Exp Psychiatry 2023; 80:101790. [PMID: 37247973 DOI: 10.1016/j.jbtep.2022.101790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Individuals with hoarding disorder, especially those with problems around acquiring, typically demonstrate a lack of motivation and awareness of their problematic behaviours. Since acquiring behaviours are important targets in interventions for hoarding, effective strategies for increasing motivation in this population are required to enhance the acceptability and efficacy of these interventions. METHODS The aim of the current study was to evaluate the ability of a brief online motivational intervention to reduce acquiring in a community sample of high acquirers (N = 159). Participants were randomly assigned to either a motivational interviewing protocol (n = 73) or progressive muscle relaxation control condition (n = 86). Readiness to change and motivation to acquire was measured via self-report, and acquiring behaviour was measured using a modified version of the Preston Acquisition Decision Making Task (to increase ecological validity). RESULTS In both conditions, participants' readiness and motivation to change increased over time. Contrary to hypotheses, the magnitude of this improvement did not significantly differ between conditions. Furthermore, conditions did not perform differently on the behavioural measure of acquiring. LIMITATIONS Insufficient dose of the intervention may have precluded any differences being observed between conditions. CONCLUSIONS Results underscore the need to better address the problem of lowered motivation in this population.
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Affiliation(s)
- Shiu F Wong
- Department of Psychology, Counselling, and Therapy, La Trobe University, Australia.
| | - Emily Dewar
- School of Psychology, University of New South Wales, Australia
| | - Peter A Baldwin
- Black Dog Institute, University of New South Wales, Australia
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Hussain NM, AlMansouri DH, AlGhareeb M, Almutawa YM, Bucheeri OK, Helmy M, Trabelsi K, Saif Z, Jahrami H. Translating and validating the hoarding rating scale-self report into Arabic. BMC Psychol 2023; 11:233. [PMID: 37587535 PMCID: PMC10433611 DOI: 10.1186/s40359-023-01277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Hoarding disorder is characterized by a persistent inability to part with possessions due to a perceived need to keep them, regardless of their actual value. Arabic-speaking populations currently lack a validated tool specifically designed to assess hoarding symptoms. OBJECTIVE This study aimed to translate, adapt, and validate the Hoarding Rating Scale-Self Report (HRS-SR) into the Arabic-language. METHODS The study employed the gold standard approach to translation, involving forward translation by independent translators and back translation review. We conducted a cross-sectional study using an online survey completed by 500 participants from four Arabic-speaking countries. Psychometric analyses included internal consistency, test-retest reliability, convergent validity against generalized anxiety disorder (GAD-7), and confirmatory factor analysis. RESULTS With a McDonald's omega and Cronbach's alpha of approximately 0.80, the Arabic translation of the HRS-SR showed acceptable test-retest reliability as well as good internal consistency. The survey also showed strong convergent validity with the 7-item survey for GAD-7. Confirmatory factor analysis supported a one-factor structure, confirming that each item measured the same construct. CONCLUSION The HRS-SR is a trustworthy and valid tool for evaluating hoarding symptoms in Arabic-speaking people. This survey could be helpful for both clinical and academic research. Future research should examine cultural variations in hoarding behavior in Arabic-speaking populations and validate the questionnaire in clinical populations.
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Affiliation(s)
| | | | - Muneera AlGhareeb
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | | | - Mai Helmy
- Psychology Department, College of Education, Sultan Qaboos University, Muscat, Oman
- Psychology Department, Faculty of Arts, Menoufia University, Shibin Al Kawm, Egypt
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3000, Tunisia
- Research Laboratory Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, 3000, Tunisia
| | | | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
- Government Hospitals, Manama, Bahrain.
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Jägholm S, Lindstedt S, Andersson E, Mataix-Cols D, Fernández de la Cruz L, Rück C, Ivanov VZ. Study protocol for a randomized controlled trial of in-home decluttering augmentation of group cognitive-behavioral therapy for hoarding disorder: the Joining Forces Trial. Trials 2023; 24:483. [PMID: 37507772 PMCID: PMC10386309 DOI: 10.1186/s13063-023-07509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is a moderately efficacious treatment for hoarding disorder (HD), with most individuals remaining symptomatic after treatment. The Joining Forces Trial will evaluate whether 10 weeks of in-home decluttering can significantly augment the outcomes of group CBT. METHODS A randomized controlled trial of in-home decluttering augmentation of group CBT for HD. Adult participants with HD (N = 90) will receive 12 weeks of protocol-based group CBT for HD. After group CBT, participants will be randomized to either 10 weeks of in-home decluttering led by a social services team or a waitlist. The primary endpoint is 10 weeks post-randomization. The primary outcome measures are the self-reported Saving Inventory-Revised and the blind assessor-rated Clutter Image Rating. Participants on the waitlist will cross over to receive the in-home decluttering intervention after the primary endpoint. Data will be analyzed according to intention-to-treat principles. We will also evaluate the cost-effectiveness of this intervention from both healthcare and societal perspectives. DISCUSSION HD is challenging to treat with conventional psychological treatments. We hypothesize that in-home decluttering sessions carried out by personnel in social services will be an efficacious and cost-effective augmentation strategy of group CBT for HD. Recruitment started in January 2021, and the final participant is expected to reach the primary endpoint in December 2024. TRAIL REGISTRATION ClinicalTrials.gov NCT04712474. Registered on 15 January 2021.
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Affiliation(s)
- Sofia Jägholm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, M48, Karolinska Universitetssjukhuset Huddinge, 14186, Stockholm, Sweden.
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Sara Lindstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, M48, Karolinska Universitetssjukhuset Huddinge, 14186, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Karolinska Institutet, Nobelsväg 9, 17195, Solna, Sweden
| | - David Mataix-Cols
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, M48, Karolinska Universitetssjukhuset Huddinge, 14186, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, M48, Karolinska Universitetssjukhuset Huddinge, 14186, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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7
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Stanton CH, Worden B. Two Case Examples of Cognitive Behavioral Treatment for Hoarding Disorder. J Cogn Psychother 2023:JCP-2022-0009.R1. [PMID: 37369540 DOI: 10.1891/jcp-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
The application of cognitive behavioral therapy (CBT) for hoarding disorder (HD) is described. We describe the components of CBT for HD and provide examples of how this treatment was implemented with two individuals at our clinic, one in group treatment and the other in individual therapy. These case examples are used to highlight a process of troubleshooting common barriers to treatment, enhancing motivation, creating structure, and assessing treatment progress. We compare the group and individual treatment for HD and discuss the pros and cons of each approach. Furthermore, we emphasize the importance of in-session practice, accountability and clear expectations, and realistic goal-setting across individual and group treatment. Finally, based on the cases included here, we highlight the need for additional research to extend CBT for HD (e.g., additional modules to help family members support a loved one in treatment for HD).
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Affiliation(s)
| | - Blaise Worden
- Institute of Living/Hartford Hospital, Hartford CT, USA
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Crowley JJ. Genomics of Obsessive-Compulsive Disorder and Related Disorders: What the Clinician Needs to Know. Psychiatr Clin North Am 2023; 46:39-51. [PMID: 36740354 DOI: 10.1016/j.psc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A wealth of evidence has shown that genetics plays a major role in susceptibility to obsessive-compulsive disorder (OCD) and all of its related disorders. Several large-scale, collaborative efforts using modern genomic methods are beginning to reveal the genetic architecture of these traits and identify long-sought risk genes. In this article, we summarize current OCD and related disorder genomic knowledge and explain how to communicate this information to patients and their families. The article concludes with a discussion of how genomic discovery in OCD and related disorders can inform our understanding of disease etiology and provide novel targets for therapeutic development.
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Affiliation(s)
- James J Crowley
- Department of Genetics, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC 27599, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC 27599, USA.
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Lin N, Bacala L, Martin S, Bratiotis C, Muroff J. Hoarding Disorder: The Current Evidence in Conceptualization, Intervention, and Evaluation. Psychiatr Clin North Am 2023; 46:181-196. [PMID: 36740352 DOI: 10.1016/j.psc.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions due to strong urges to save the items, leading to the excessive accumulation of items. High clutter levels result in varied personal, social, and legal consequences. Specialized treatments, including individual, virtual, and group cognitive and behavioral therapies, community-based interventions, and peer support approaches have shown preliminary effectiveness. Animal, attachment, and neurobiological models are expanding our understanding of the etiological bases of the disorder. Specialized populations such as children, older adults, and involuntary patients are highlighted as requiring special consideration for intervention and risk mitigation. Directions for future research are identified.
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Affiliation(s)
- Nancy Lin
- University of British Columbia, School of Social Work, Jack Bell Building, 2080 West Mall, Vancouver, British Columbia V6T 1Z2, Canada
| | - Lindsay Bacala
- University of Manitoba, Faculty of Social Work, 521 Tier Building, 173 Dafoe Road West, Winnipeg, Manitoba R3J 2N2, Canada
| | - Spenser Martin
- Canadian Mental Health Association, 930 Portage Avenue, Winnipeg, Manitoba R3G 0P8, Canada
| | - Christiana Bratiotis
- University of British Columbia, School of Social Work, Jack Bell Building, 2080 West Mall, Vancouver, British Columbia V6T 1Z2, Canada
| | - Jordana Muroff
- Boston University, School of Social Work, 264 Bay State Road, Boston, MA 02215, USA.
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Wilson LA, Scarfo J, Suleyman E, Rehm IC, Baldwin PA. A latent factor approach to the Saving Inventory - Revised: Congeneric evaluation of construct and content validity. J Affect Disord 2023; 323:689-697. [PMID: 36526114 DOI: 10.1016/j.jad.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/24/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inconsistencies have been identified in the three-factor structure and item loadings of the most commonly used self-report hoarding screening tool, the Saving Inventory - Revised (SI-R), which assesses difficulty discarding, clutter and acquisition. The current study aimed to confirm the factor structure of the SI-R using congeneric modelling, and evaluate the construct and content validity of this measure. METHODS 139 participants with self-identified hoarding completed the SI-R. Congeneric structural equation modelling was then performed to validate the SI-R factor structure. RESULTS The three-factor structure of the SI-R was confirmed as a valid, reliable and good fitting model. However, the difficulty discarding and clutter subscales were required to covary. CONCLUSIONS The SI-R was confirmed as an appropriate screening tool for hoarding severity; however, revision of item wording may improve content validity. Future research could consider exploring the relationships between a range of hoarding-related constructs and the differential endorsement of SI-R subscales. LIMITATIONS As data were collected during the 2020 COVID-19 pandemic, panic buying and hoarding-related acquiring behaviours may have been exacerbated. In addition, the diagnostic status of participants was not verified, despite the inclusion of individuals endorsing clinically significant hoarding symptoms.
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Affiliation(s)
- Lizzie A Wilson
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia
| | - Jessica Scarfo
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia.
| | - Emra Suleyman
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia
| | - Imogen C Rehm
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia
| | - Peter A Baldwin
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia; School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
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Hossain R, Sinyor M, Nestor S, Richter MA, Lipsman N, Hamani C, Giacobbe P. Mapping the future of interventional psychiatry for the obsessive-compulsive related disorders: A scoping review. Psychiatry Res 2023; 319:115007. [PMID: 36525901 DOI: 10.1016/j.psychres.2022.115007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Body dysmorphic disorder (BDD), hoarding disorder (HD), skin-picking disorder (SPD), and hair-pulling disorder (HPD) are characterized by compulsive behaviours leading to distress and impairment. Current treatments attain only partial or non-response. Interventional psychiatric approaches may target specific regions of the brain for treatment. This scoping review maps the current literature and synthesizes key findings. Databases were searched up to June 27, 2022 for studies examining interventional psychiatric treatments for BDD, HD, SPD, and HPD, producing 910 results. Twenty were included; 16 were case reports, two were case series, and two were randomized controlled trials. Studies reported on electroconvulsive therapy (ECT) (n=7), deep brain stimulation (DBS) (n=1), and intermittent theta-burst stimulation repetitive transcranial magnetic stimulation (rTMS) (n=1) for BDD; rTMS (n=1) and transcranial direct current stimulation (n=1) for HD; gamma knife capsulotomy (n=1) and rTMS (n=1) for SPD; and rTMS (n=2) and ECT (n=1) for HPD. Four studies reported on DBS for other indications complicated by SPD or HPD. The current literature consists mainly of case reports. Future studies should be randomized, controlled, adequately powered and blinded, examining rTMS localized to the anatomical targets for each disorder. Presently, the mainstay of treatment remains disorder-specific psychotherapy with limited evidence for medications.
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Akıncı MA, Turan B, Esin İS, Dursun OB. Prevalence and correlates of hoarding behavior and hoarding disorder in children and adolescents. Eur Child Adolesc Psychiatry 2022; 31:1623-1634. [PMID: 34283287 DOI: 10.1007/s00787-021-01847-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
Although hoarding symptoms are reported to begin in childhood and adolescence, the true prevalence of the disorder in this age group is unknown. This study aims to estimate the prevalence of hoarding disorder (HD) in children and adolescents. The present study was planned as a two-stage epidemiological research. In the first stage, the Children's Saving Inventory (CSI) and informed consent forms were delivered to a group of students' parents. In the second stage, one-on-one psychiatric interviews with a physician were planned with the families and children who had hoarding behavior (HB), as described by their parents. The DSM-5-based HD interview and the Development and Well-Being Assessment (DAWBA) diagnostic tool were used to detect prevalence of HD and comorbid psychiatric disorders. A total of 3249 children were included in the study, and 318 children and their parents were evaluated in the second stage. As a result of the second assessment, 32 out of 318 children met the HD diagnostic criteria. The estimated prevalence of HD was 0.98% (95% CI 0.7-1.4). Hoarding disorder was found more frequently in females (F/M = 3/1). After a logistic regression analysis, variables such as female sex and the presence of any psychopathology were identified as independent correlates of HD. More than half (56.2%) of the children diagnosed as having HD also had a comorbid psychiatric disorder. In the present study, the two-stage evaluation method was used in a large pediatric sample to determine the estimated prevalence of HD, as well as the factors associated with the disorder and comorbid psychiatric disorders.
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Affiliation(s)
- Mehmet Akif Akıncı
- Department of Child and Adolescent Psychiatry, Dr. Ali Kemal Belviranlı Maternity and Children Hospital, Konya, Turkey.
| | - Bahadır Turan
- Autism, Mental Special Needs and Rare Diseases Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
| | - İbrahim Selçuk Esin
- Department of Child and Adolescent Psychiatry, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Onur Burak Dursun
- Autism, Mental Special Needs and Rare Diseases Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
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Nutley SK, Read M, Eichenbaum J, Nosheny RL, Weiner M, Mackin RS, Mathews CA. Health-related quality of life in hoarding: A comparison to chronic conditions with high disease burden. J Psychiatr Res 2022; 149:68-75. [PMID: 35255385 DOI: 10.1016/j.jpsychires.2022.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/28/2022] [Accepted: 02/28/2022] [Indexed: 12/21/2022]
Abstract
Hoarding disorder often results in debilitating functional impairment and may also compromise health-related quality of life (QoL). This study investigated the association between hoarding behavior and QoL relative to six highly impairing medical and psychiatric disorders in a sample of 20,722 participants enrolled in the internet-based Brain Health Registry. Nearly 1 in 8 participants (12.2%) endorsed clinically relevant hoarding symptoms (CHS). In separate multivariable linear regression models, hoarding was more strongly associated with mental QoL than diabetes (Standardizedβ = -0.21, 95% CI: [-0.22, -0.20] vs. -0.01 [-0.02, 0.0]), heart disease (-0.22 [-0.23, -0.20] vs. 0.00 [-0.02, 0.01]), chronic pain (-0.18 [-0.19, -0.16] vs. -0.12 [-0.13, -0.10]), post-traumatic stress disorder (PTSD; -0.20 [-0.22, -0.19] vs. -0.07 [-0.09, -0.06]), and substance use disorder (SUD; -0.21 [-0.23, -0.20] vs. -0.04 [-0.05, -0.03]). Similarly, CHS was more strongly negatively associated with physical QoL than diabetes (-0.11 [-0.10, -0.12] vs. -0.08 [-0.06, -0.09]), major depressive disorder (-0.09 [-0.10, -0.08] vs. -0.05 [-0.06, 0.03]), PTSD (-0.11 [-0.12, -0.10] vs. -0.08 [-0.09, -0.07]), and SUD (-0.12 [-0.13, -0.09] vs. -0.01 [-0.02, 0.00]). Higher hoarding severity was associated with reductions in both mental (Standardizedβ = -0.28, ΔR2 = 0.08, p < 0.0001) and physical (β = -0.12, ΔR2 = 0.02, p < 0.0001) QoL, though the strength of the relationship between hoarding symptoms and QoL varied with depression severity. Efforts to improve the overall QoL and well-being of those with CHS are needed.
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Mizobe T, Ikari K, Tomiyama H, Murayama K, Kato K, Hasuzawa S, Togao O, Hiwatashi A, Nakao T. Abnormal white matter structure in hoarding disorder. J Psychiatr Res 2022; 148:1-8. [PMID: 35081485 DOI: 10.1016/j.jpsychires.2022.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/23/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022]
Abstract
Although preliminary neuroimaging research suggests that patients with hoarding disorder (HD) show widespread abnormal task-related activity in the brain, there has been no research on alterations in the white matter tracts in these patients. The aim of this study was to investigate the characteristics of the major white matter tracts in patients with HD. Tract-based spatial statistics were used to search for white matter tract abnormalities throughout the brain in 25 patients with HD and 36 healthy controls. Post hoc analysis of regions of interest was performed to detect correlations with clinical features. Compared with the controls, patients with HD showed decreased fractional anisotropy and increased radial diffusivity in anatomically widespread white matter tracts. Post hoc analysis of regions of interest revealed a significant negative correlation between the severity of hoarding symptoms and fractional anisotropy in the left anterior limb of the internal capsule and a positive correlation between the severity of these symptoms and radial diffusivity in the right anterior thalamic radiation. Patients with HD showed a broad range of alterations in the frontal white matter tracts, including the frontothalamic circuit, frontoparietal network, and frontolimbic pathway. The findings of this study indicate associations between frontal white matter abnormalities related to the severity of hoarding symptoms in HD and the cortical regions involved in cognitive dysfunction. The insights provided would be useful for understanding the neurobiological basis of HD.
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15
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Zakrzewski JJ, Henderson R, Archer C, Vigil OR, Mackin S, Mathews CA. Subjective cognitive complaints and objective cognitive impairment in hoarding disorder. Psychiatry Res 2022; 307:114331. [PMID: 34920395 DOI: 10.1016/j.psychres.2021.114331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/24/2022]
Abstract
Individuals with Hoarding Disorder (HD) frequently complain of problems with attention and memory. These self-identified difficulties are often used as justification for saving and acquiring behaviors. Research using neuropsychological measures to examine verbal and visual memory performance and sustained attention have reported contradictory findings. Here we aim to determine the relationship between self-reported problems with memory and attention, objective memory and attention performance, and self-reported depression and anxiety symptoms in HD. Data was available for 319 individuals who participated in a treatment study of HD. Multiple regression was used to assess the relationship between self-reported complaints and objective measures, with age, education, and measures of depression and anxiety included as covariates. We found no association between self-reported memory difficulties and objective verbal or visual memory performance. Self-reported problems with attention were associated with objective attentional performance, although this relationship was partially accounted for by anxiety symptom severity. There was a small association between visual memory performance at baseline and improvements in hoardingrelated functional abilities following treatment. Improvements in subjective memory complaints pre-to-post treatment were associated with improvements in hoarding symptom severity and hoarding-related functioning. These results demonstrate a dissociation between perceived and objective functioning in HD.
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Affiliation(s)
- Jessica J Zakrzewski
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America.
| | - Rebecca Henderson
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
| | - Christian Archer
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
| | - Ofilio R Vigil
- Department of Psychiatry, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Scott Mackin
- Department of Psychiatry, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
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16
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Morein-Zamir S, Kasese M, Chamberlain SR, Trachtenberg E. Elevated levels of hoarding in ADHD: A special link with inattention. J Psychiatr Res 2021; 145:167-174. [PMID: 34923357 PMCID: PMC7612156 DOI: 10.1016/j.jpsychires.2021.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 10/29/2022]
Abstract
Hoarding Disorder (HD) is under recognised and under-treated. Though HD develops by early adulthood, patients present only later in life, resulting in research based largely on samples of predominantly older females. Whilst formerly associated with Obsessive-Compulsive Disorder (OCD), it is now recognised that individuals with HD often have inattention symptoms reminiscent of Attention Deficit/Hyperactivity Disorder (ADHD). Here, we investigated HD in adults with ADHD. Patients in an ADHD clinic (n = 88) reported on ADHD, HD and OCD-related symptoms, and compared with age, gender and education matched controls (n = 90). Findings were assessed independently in an online UK sample to verify replication using a dimensional approach (n = 220). Clinically significant hoarding symptoms were found in ∼20% versus 2% of ADHD and control groups, respectively, with those with hoarding being on average in their thirties and with approximately half being male. Greater hoarding severity was noted even in the remaining patients compared with controls (d = 0.89). Inattention was the only significant statistical predictor of hoarding severity in patients. Similarly, inattention, alongside depression and anxiety were the greatest predictors of hoarding in the independent sample where 3.2% identified as having clinically significant hoarding. Patients with ADHD had a high frequency of hoarding symptoms, which were specifically linked to inattention. HD should be routinely assessed in individuals with ADHD, as they do not typically disclose associated difficulties, despite these potentially leading to impaired everyday functioning. Research in HD should also investigate adults with ADHD, who are younger and with a greater prevalence of males than typical HD samples.
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Affiliation(s)
- Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK.
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17
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Abstract
Objectives: Hoarding disorder (HD) is conceptualized as a fear-based disorder and exposure to sorting/discarding possessions is a core part of treatment. However, there has been no investigation of age-related differences in emotional reaction to sorting. The objective of this study was to explore the association between age and affective response during a sorting task.Methods: Forty-nine adults with HD completed a standardized sorting task. Participants reported their current emotion before and after the sorting task and reported their subjective distress throughout the task.Results: Older participants reported significantly lower distress ratings. Only 43% of participants reported fear prior to the task and 22% reported fear after the task. The probability of reporting fear before and after the task decreased significantly with age.Conclusions: Fear may not be the emotion experienced when discarding items, particularly for older adults with HD. Future work should focus on mechanisms of action in HD treatment.Clinical Implications: Clinicians should not assume fear or anxiety to be the primary emotional response in older adults with HD when engaged in an exposure to sorting/discarding. Older hoarding patients with a more fear-oriented aversion to sorting possessions may require a treatment emphasis on increasing the percentage of items discarded.
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Affiliation(s)
- Mary E Dozier
- Department of Psychology, Mississippi State University, Starkville, Mississippi, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Julie Loebach Wetherell
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Mental Health Care Line, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA
| | - Nader Amir
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - V Robin Weersing
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Charles T Taylor
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA
| | - Catherine R Ayers
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Mental Health Care Line, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA
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18
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Abstract
Hoarding disorder is characterized by difficulty parting with possessions because of strong urges to save the items. Difficulty discarding often includes items others consider to be of little value and results in accumulation of a large number of possessions that clutter the home. Cognitive-behavioral therapy (CBT) with exposure and response prevention and selective serotonin reuptake inhibitor medications traditionally used to treat obsessive-compulsive disorder are generally not efficacious for people with hoarding problems. A specialized CBT approach for hoarding has shown progress in reaching treatment goals and has been modified to be delivered in group, peer-facilitated, and virtual models. Research on hoarding remains in the early phases of development. Animal, attachment, and genetic models are expanding. Special populations, such as children, older adults, and people who do not voluntarily seek treatment need special consideration for intervention. Community-based efforts aimed at reducing public health and safety consequences of severe hoarding are needed.
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Affiliation(s)
- Christiana Bratiotis
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Jordana Muroff
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Nancy X Y Lin
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
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19
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Ong CW, Krafft J, Levin ME, Twohig MP. A systematic review and psychometric evaluation of self-report measures for hoarding disorder. J Affect Disord 2021; 290:136-148. [PMID: 33993080 DOI: 10.1016/j.jad.2021.04.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/08/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hoarding disorder (HD) affects approximately 2.5% of the general population, leads to significant distress and impairment, and is notoriously difficult to treat. The crux of developing effective treatments for HD is our ability to reliably and validly measure relevant constructs in HD to better understand its presentation and, subsequently, formulate appropriate interventions. METHODS We identified measures specific to HD and evaluated their psychometric properties using rating criteria formulated by the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) group. RESULTS The 17 included measures were developed to assess adult and pediatric hoarding severity, functional impairment, and maladaptive processes (e.g., material scrupulosity). The Saving Inventory-Revised, the most widely used measure of HD severity showed the strongest psychometric properties. However, psychometric investigations were generally of poor quality across all measures and results indicated unsatisfactory performance of measures. LIMITATIONS The current review excluded non-English measures and ratings inherently contain some element of subjectivity despite use of predetermined criteria and two independent reviewers. CONCLUSIONS We suggest that clinical researchers continue to develop and modify measures used to conceptualize and, ultimately, improve treatment for HD.
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Affiliation(s)
- Clarissa W Ong
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, United States.
| | - Jennifer Krafft
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, United States
| | - Michael E Levin
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, United States
| | - Michael P Twohig
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, United States
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20
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Rodgers N, McDonald S, Wootton BM. Cognitive behavioral therapy for hoarding disorder: An updated meta-analysis. J Affect Disord 2021; 290:128-135. [PMID: 33993079 DOI: 10.1016/j.jad.2021.04.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hoarding disorder (HD) is a new disorder in DSM-5. While cognitive-behavioral therapy (CBT) is seen as the gold standard approach to treatment, the literature in this field is still emerging. METHODS The aim of the present study is to synthesize the current treatment outcome literature on CBT for HD, as well as secondary depressive symptoms, using a meta-analytic approach. Due to a lack of controlled trials only within-group effect sizes were calculated. RESULTS Sixteen studies were included in the meta-analysis (n = 505; mean age = 56 years; mean percentage female participants = 72%). Large effect sizes were found from pre-treatment to post-treatment (g = 1.11; 95% CI: 0.92-1.29) and from pre-treatment to follow-up (g = 1.25; 95% CI: 0.94-1.56) on HD symptoms. The gender distribution of the sample moderated treatment outcome, with larger effects seen in studies that included a larger proportion of female patients. Treatment modality (individual vs group), therapist training, use of home visits, trial type (efficacy vs effectiveness), number of treatment weeks, participant age, and study quality did not moderate treatment outcome. Small effect sizes were found from pre-treatment to post-treatment (g = 0.45; 95% CI: 0.28-0.61) for depressive symptoms and baseline depression severity, treatment modality, use of home visits, and assessment tool used did not moderate outcome. LIMITATIONS The study is limited by the small number of studies available in this field. CONCLUSIONS This study demonstrates that CBT for HD is an effective treatment, however, controlled trials are needed, as are trials examining the long-term efficacy of CBT for HD.
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Affiliation(s)
- Natasha Rodgers
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW 2007, Australia
| | - Sarah McDonald
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW 2007, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW 2007, Australia.
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21
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Mahnke AR, Linkovski O, Timpano K, van Roessel P, Sanchez C, Varias AD, Mukunda P, Filippou-Frye M, Lombardi A, Raila H, Anderson K, Sandhu T, Wright B, McCarthy EA, Garcia GE, Asgari S, Qiu T, Bernert R, Rodriguez CI. Examining subjective sleep quality in adults with hoarding disorder. J Psychiatr Res 2021; 137:597-602. [PMID: 33309063 DOI: 10.1016/j.jpsychires.2020.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023]
Abstract
Hoarding disorder (HD), characterized by difficulty parting with possessions and functionally impairing clutter, affects 2-6% of the population. Originally considered part of Obsessive-Compulsive Disorder (OCD), HD became a distinct diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. While sleep impacts OCD, little is known about sleep in HD. As HD patients often report poor sleep in clinical settings, understanding global subjective sleep quality and disturbances may lead to novel therapeutic targets. To address this gap, the authors used a sample of convenience: an existing data set designed to screen research study eligibility and explore the psychopathology and phenomenology of OCD and HD. The data set included information collected from individuals with HD (n = 38), OCD (n = 26), and healthy participants (n = 22) about insomnia, sleep quality, and mood using interviews and structured instruments including the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Depression Anxiety Stress Scales (DASS). In this data set, HD and OCD groups reported significantly greater insomnia symptoms and poorer sleep quality compared with healthy controls while controlling for depression, age, and gender. A sizable minority of HD and OCD individuals met criteria for comorbid sleep disorders. OCD and HD groups differed in delayed sleep phase prevalence. To our knowledge, this is the first study examining subjective sleep quality and insomnia in HD as compared to healthy individuals and those with OCD, while controlling for relevant clinical characteristics. Given that there are evidence-based treatments for insomnia and other sleep disorders, our study raises the possibility that treatment interventions targeting sleep may improve HD outcomes.
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22
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Nutley SK, Camacho MR, Eichenbaum J, Nosheny RL, Weiner M, Delucchi KL, Mackin RS, Mathews CA. Hoarding disorder is associated with self-reported cardiovascular / metabolic dysfunction, chronic pain, and sleep apnea. J Psychiatr Res 2021; 134:15-21. [PMID: 33360440 PMCID: PMC8108138 DOI: 10.1016/j.jpsychires.2020.12.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/20/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Hoarding behaviors are positively associated with medical morbidity, however, current prevalence estimates and types of medical conditions associated with hoarding vary. This analysis aims to quantify the medical morbidity of hoarding disorder (HD). Cross-sectional data were collected online using the Brain Health Registry (BHR). Among 20,745 participants who completed the Hoarding and Clutter and Medical History thematic modules, 1348 had HD (6.5%), 1268 had subclinical HD (6.1%), and 18,829 did not meet hoarding criteria (87.4%). Individuals with HD were more likely to report a lifetime history of cardiovascular/metabolic conditions: diabetes (HD adjusted odds ratio (AOR):1.51, 95% confidence interval (CI):[1.20, 1.91]; subclinical HD AOR:1.24, 95% CI:[0.95, 1.61]), and hypercholesterolemia (HD AOR:1.24, 95% CI:[1.06, 1.46]; subclinical HD AOR:1.11, 95% CI:[0.94, 1.31]). Those with HD and subclinical HD were also more to report chronic pain (HD AOR: 1.69, 95% CI:[1.44, 1.98]; subclinical HD AOR: 1.44, 95% CI:[1.22, 1.69]), and sleep apnea (HD AOR: 1.58, 95% CI:[1.31, 1.89]; subclinical HD AOR:1.30, 95% CI:[1.07, 1.58]) than non-HD participants. For most conditions, likelihood of diagnosis did not differ between HD and subclinical HD. Structural equation modeling revealed that more severe hoarding symptomatology was independently associated with increased cardiovascular/metabolic vulnerability. The assessment and management of medical complications in individuals with HD is a fundamental component in improving quality of life, longevity, and overall physical health outcomes.
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Affiliation(s)
- Sara K Nutley
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Monica R Camacho
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA.
| | - Joseph Eichenbaum
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA; University of California, San Francisco, Department of Radiology, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Rachel L Nosheny
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA; University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Michael Weiner
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA; University of California, San Francisco, Department of Radiology, 505 Parnassus Ave, San Francisco, CA, 94143, USA; University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Kevin L Delucchi
- University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - R Scott Mackin
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA; University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Carol A Mathews
- University of Florida, Department of Psychiatry, 100 Newell Dr, Gainesville, FL, 32610, USA.
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23
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Levy HC, Poppe A, Hiser J, Wootton BM, Hallion LS, Tolin DF, Stevens MC. An Examination of the Association Between Subjective Distress and Functional Connectivity During Discarding Decisions in Hoarding Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2021; 6:1013-1022. [PMID: 33771533 DOI: 10.1016/j.bpsc.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Individuals with hoarding disorder (HD) demonstrate exaggerated subjective distress and hyperactivation of cingulate and insular cortex regions when discarding personal possessions. No prior study has sought to determine whether this subjective distress is associated with specific profiles of abnormal brain function in individuals with HD. METHODS We used multimodal canonical correlation analysis plus joint independent component analysis to test whether five hoarding-relevant domains of subjective distress when deciding to discard possessions (anxiety, sadness, monetary value, importance, and sentimental attachment) are associated with functional magnetic resonance imaging-measured whole-brain functional connectivity in 72 participants with HD and 44 healthy controls. RESULTS Three extracted components differed between HD participants and healthy control subjects. Each of these components depicted an abnormal profile of functional connectivity in HD participants relative to control subjects during discarding decisions, and a specific distress response profile. One component pair showed a relationship between anxiety ratings during discarding decisions and connectivity among the pallidum, perirhinal ectorhinal cortex, and dorsolateral prefrontal cortex. Another component comprised sadness ratings during discarding decisions and connectivity in the pallidum, nucleus accumbens, amygdala, and dorsolateral prefrontal cortex. The third component linked HD brain connectivity in several dorsolateral prefrontal cortex regions with perceived importance ratings during discarding decisions. CONCLUSIONS The findings indicate that in patients with HD, the subjective intensity of anxiety, sadness, and perceived possession importance is related to abnormal functional connectivity in key frontal and emotional processing brain regions. The findings are discussed in terms of emerging neurobiological models of HD.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut.
| | - Andrew Poppe
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut
| | - Jaryd Hiser
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut
| | - Bethany M Wootton
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, South Wales, Australia
| | - Lauren S Hallion
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Michael C Stevens
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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24
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Ivanov VZ, Mataix-Cols D, Serlachius E, Brander G, Elmquist A, Enander J, Rück C. The developmental origins of hoarding disorder in adolescence: a longitudinal clinical interview study following an epidemiological survey. Eur Child Adolesc Psychiatry 2021; 30:415-425. [PMID: 32306089 PMCID: PMC8019421 DOI: 10.1007/s00787-020-01527-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/31/2020] [Indexed: 01/16/2023]
Abstract
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.
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Affiliation(s)
- Volen Z Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden.
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Gustaf Brander
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Anders Elmquist
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
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25
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Mathes BM, Schmidt NB. An investigation of the impact of social exclusion on attachment to possessions and saving behaviors. J Behav Ther Exp Psychiatry 2020; 69:101588. [PMID: 32535407 DOI: 10.1016/j.jbtep.2020.101588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Hoarding disorder (HD) is a debilitating mental illness characterized by extreme difficulty parting with possessions and clutter that can result in dangerous living conditions. One hypothesis about why individuals with HD save possessions is that they possess a pathological attachment to their belongings, which may serve to compensate for unfulfilling interpersonal relationships. However, there is a dearth of empirical work examining this. The current study examined the impact of an experimental manipulation of social exclusion on attachment to possessions and saving behaviors in a sample of individuals with elevated hoarding symptoms. METHODS Participants (n = 117) were selected for scoring above the non-clinical mean on a measure of hoarding symptoms. Participants were randomized to either be included or excluded in a game of Cyberball. They completed a behavioral discarding task and object attachment measure before and after completion of the game. RESULTS Study condition was unrelated to in vivo attachment to possessions and saving behaviors during the discarding task. However, a post hoc mediation model showed that greater feelings of rejection, regardless of condition, were associated with greater in vivo attachment to possessions and subsequent number of items saved during the lab task. LIMITATIONS Limitations include the use of a non-clinical and homogeneous sample. CONCLUSIONS Taken together, individuals prone to feelings of rejection may be at risk for developing HD as they may use possessions to cope with interpersonal stress. Results will be discussed in light of implications for theoretical models and potential treatment targets in HD.
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Nutley SK, Bertolace L, Vieira LS, Nguyen B, Ordway A, Simpson H, Zakrzewski J, Camacho MR, Eichenbaum J, Nosheny R, Weiner M, Mackin RS, Mathews CA. Internet-based hoarding assessment: The reliability and predictive validity of the internet-based Hoarding Rating Scale, Self-Report. Psychiatry Res 2020; 294:113505. [PMID: 33070108 PMCID: PMC8080473 DOI: 10.1016/j.psychres.2020.113505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
The Hoarding Rating Scale, Self Report (HRS-SR) is a 5-item assessment developed to ascertain the presence and severity of hoarding symptoms. This study aimed to evaluate the validity of an online adaptation of the HRS-SR in a remote, unsupervised internet sample of 23,214 members of the Brain Health Registry (BHR), an online research registry that evaluates and longitudinally monitors cognition, medical and psychiatric health status. Convergent validity was assessed among a sub-sample of 1,183 participants who completed additional, remote measures of self-reported hoarding behaviors. Structured clinical interviews conducted in-clinic and via video conferencing tools were conducted among 230 BHR participants; ROC curves were plotted to assess the diagnostic performance of the internet-based HRS-SR using best estimate hoarding disorder (HD) diagnoses as the gold standard. The area under the curve indicated near-perfect model accuracy, and was confirmed with 10-fold cross validation. Sensitivity and specificity for distinguishing clinically relevant hoarding were optimized using an HRS-SR total score cut-off of 5. Longitudinal analyses indicated stability of HRS-SR scores over time. Findings indicate that the internet-based HRS-SR is a useful and valid assessment of hoarding symptoms, though additional research using samples with more diverse hoarding behavior is needed to validate optimal cut-off values.
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Affiliation(s)
- Sara K Nutley
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Lyvia Bertolace
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Luis Sordo Vieira
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Binh Nguyen
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Ashley Ordway
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Heather Simpson
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Jessica Zakrzewski
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Monica R Camacho
- San Francisco VA Medical Center, San Francisco, California, United States
| | - Joseph Eichenbaum
- San Francisco VA Medical Center, San Francisco, California, United States; Department of Radiology, University of California, San Francisco, San Francisco, California, United States
| | - Rachel Nosheny
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States
| | - Michael Weiner
- Department of Radiology, University of California, San Francisco, San Francisco, California, United States; Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States
| | - R Scott Mackin
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States; Department of Mental Health, Veterans Affairs Medical Center, San Francisco, California, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States.
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Dozier ME, Davidson EJ, Pittman JOE, Ayers CR. Personality traits in adults with hoarding disorder. J Affect Disord 2020; 276:191-196. [PMID: 32697698 DOI: 10.1016/j.jad.2020.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/14/2020] [Accepted: 07/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prior research has demonstrated a link between compulsive hoarding symptoms and personality traits; however, no studies have investigated the link between hoarding and personality traits utilizing a sample of individuals diagnosed with hoarding disorder (HD) using formal diagnostic criteria. The aim of the current study was to evaluate the frequency and type of personality traits in adults diagnosed with HD and to explore the associations among hoarding severity and personality disorder traits within this sample. METHODS Seventy-two veterans enrolled in an ongoing treatment trial for HD completed a battery of self-report measures during their initial assessment. Linear regression analyses were used to determine the unique variance accounted for by hoarding severity in predicting scores on the personality disorder scales from the Millon Clinical Multiaxial Inventory-III (MCMI-III). RESULTS The majority of participants had an elevated score on at least one of the MCMI-III Personality scales. The most frequently elevated scores were for the Avoidant, Dependent, Depressive, and Schizoid scales. Hoarding severity was a significant predictor of personality traits in 10 out of 14 MCMI-III scales. LIMITATIONS Given the exploratory nature of the investigation, we did not control for multiple comparisons or the presence of mood or anxiety disorders. CONCLUSIONS The elevated prevalence of co-occurring personality pathology in adults with HD indicates the importance of considering underlying personality structure when developing individualized treatment plans.
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Affiliation(s)
- Mary E Dozier
- Department of Psychology, Mississippi State University, P.O. Box 6161, Mississippi State, MS 39762, United States; Research Service, VA San Diego Healthcare System, United States.
| | - Eliza J Davidson
- Research Service, VA San Diego Healthcare System, United States; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, United States
| | - James O E Pittman
- Mental Healthcare Line, VA San Diego Healthcare System, United States; Department of Psychiatry, University of California, San Diego School of Medicine, United States
| | - Catherine R Ayers
- Mental Healthcare Line, VA San Diego Healthcare System, United States; Department of Psychiatry, University of California, San Diego School of Medicine, United States
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Abstract
BACKGROUND Past research links hoarding disorder (HD) to indecisiveness and difficulty with decision-making. However, it remains unclear what contributes to difficulty making decisions in HD. Decision-making research suggests that some individuals have a maximizing decision-making style (seeking the best option through an exhaustive search of all existing alternatives) while others "satisfice" (choosing options that are satisfactory even without seeing all options). Past work has linked the dispositional tendency to maximize in decisions to elevated depression, anxiety and obsessive-compulsive disorder (OCD) symptoms, but no study has investigated whether maximizing may be relevant for hoarding behaviors. METHOD We administered measures of hoarding behaviors, decision-making style (maximizing vs satisficing), generalized difficulty with decision-making (indecisiveness), distress (depression, anxiety and stress symptoms) and OCD symptoms to a sample of community adults (N = 1113) recruited through Amazon Mechanical Turk (MTurk). RESULTS The tendency to maximize in decision-making was significantly correlated with hoarding symptoms (including difficulty discarding possessions, excessive acquisition, and clutter). Moreover, regression results showed that maximizing predicted hoarding severity after controlling for indecisiveness, general distress and OCD symptoms. LIMITATIONS We utilized self-report questionnaires in an unscreened community sample. Replication in a clinical sample is needed. CONCLUSIONS The dispositional tendency to maximize in decisions may represent a specific aspect of decision-making relevant for hoarding behaviors. Implications for improving cognitive-behavioral models and treatments are discussed.
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Abstract
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.
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Affiliation(s)
- Keong Yap
- University of New South Wales, School of Psychology, Sydney, NSW 2034, Australia; Australian Catholic University, School of Behavioural and Health Sciences, Strathfield, NSW 2035, Australia.
| | - Jessica R Grisham
- University of New South Wales, School of Psychology, Sydney, NSW 2034, Australia
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Kuwano M, Nakao T, Yonemoto K, Yamada S, Murayama K, Okada K, Honda S, Ikari K, Tomiyama H, Hasuzawa S, Kanba S. Clinical characteristics of hoarding disorder in Japanese patients. Heliyon 2020; 6:e03527. [PMID: 32181397 PMCID: PMC7063155 DOI: 10.1016/j.heliyon.2020.e03527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/19/2019] [Accepted: 02/28/2020] [Indexed: 11/30/2022] Open
Abstract
Previous studies have reported clinical characteristics of hoarding disorder (HD), such as early onset, a chronic course, familiality, high unmarried rate, and high rates of comorbidities. However, clinical research targeting Japanese HD patients has been very limited. As a result, there is a low recognition of HD in Japan, leading to insufficient evaluation and treatment of Japanese HD patients. The aim of the current study was to delineate the clinical characteristics of Japanese HD patients. Thirty HD patients, 20 obsessive-compulsive disorder (OCD) patients, and 21 normal controls (NC) were targeted in this study. The HD group had a tendency toward higher familiality, earlier onset, and longer disease duration compared to the OCD group. In addition, the HD group showed a significantly higher unmarried rate than the NC group. The top two comorbidities in the HD group were major depressive disorder (56.7%) and attention-deficit/hyperactivity disorder (26.7%). The HD group had significantly higher scores on hoarding rating scales and lower scores on the Global Assessment of Functioning Scale than the other two groups. The current study showed a clinical trend in Japanese HD patients similar to previous studies in various countries, suggesting that HD may be a universal disease with consistent clinical symptoms.
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Affiliation(s)
- Masumi Kuwano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Nagasaki Support Center for Children, Women and People with Disabilities, Nagasaki, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yonemoto
- Advanced Medical Research Center, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.,Division of Biostatistics, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Satoshi Yamada
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Fukuoka Prefectural Psychiatric Center Dazaifu Hospital, Fukuoka, Japan
| | - Keitaro Murayama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kayo Okada
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Okehazama Hospital Fujita Mental Care Center, Aichi, Japan
| | - Shinichi Honda
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neuropsychiatry, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Keisuke Ikari
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Tomiyama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Suguru Hasuzawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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J Zakrzewski J, A Gillett D, R Vigil O, C Smith L, Komaiko K, Chou CY, Y Uhm S, Bain LD, J Stark S, Gause M, Howell G, Vega E, Chan J, B Eckfield M, Y Tsoh J, Delucchi K, Mackin RS, A Mathews C. Visually mediated functioning improves following treatment of hoarding disorder. J Affect Disord 2020; 264:310-7. [PMID: 32056766 DOI: 10.1016/j.jad.2019.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hoarding disorder (HD) is a highly debilitating psychiatric disorder that affects 2-6% of adults. Neuropsychological deficits in visual memory, detection, and categorization have been reported in HD. To date, no study has examined the relationship between neurocognitive functioning and treatment for HD. We aim to determine the association between neurocognitive functioning and treatment outcomes, as well as the impact of HD-specific treatment on cognitive functioning. METHODS 323 individuals with HD were randomized to 20 weeks of peer- or clinician-led group behavioral treatment. 242 participants completed pre- and post-treatment neuropsychological testing covering eight neurocognitive domains. Rates of cognitive impairment (CI) were assessed for each neurocognitive domain. The association of baseline neurocognitive function on treatment response was examined using multiple regression. MANOVA and post-hoc tests were used to determine neurocognitive performance change pre- to post treatment. RESULTS Sixty-seven percent of participants had CI on ≥1 cognitive domain. There was no significant effect of pre-treatment neurocognitive functioning on treatment outcome. Post-treatment improvements were observed in visual memory, visual detection, decision making, information processing speed, visuospatial processing, attention/working memory (p≤.001). Declines in performance were found in visual reaction time and categorization. LIMITATIONS This was a non-inferiority trial to examine two treatment types with no normative comparison group. Treatment seeking individuals are more likely to be insightful, motivated, and have other features which limit generalizability. CONCLUSIONS Patterns of cognitive impairment in HD are similar to previous reports. Pre-treatment neurocognitive functioning did not impact treatment response. Neuropsychological functioning improved across multiple domains following targeted treatment.
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Piacentino D, Pasquini M, Cappelletti S, Chetoni C, Sani G, Kotzalidis GD. Pharmacotherapy for Hoarding Disorder: How did the Picture Change since its Excision from OCD? Curr Neuropharmacol 2020; 17:808-815. [PMID: 30678629 PMCID: PMC7059160 DOI: 10.2174/1570159x17666190124153048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 01/10/2023] Open
Abstract
This brief review deals with the various issues that contributed to the creation of the new Diagnostic and Statistical Manual condition of hoarding disorder (HD) and attempts at reviewing its pharmacotherapy. It appears that after the newly founded diagnosis appeared in the literature as an autonomous entity, distinct from obsessive-compulsive disorder, drug trials are not being conducted and the disorder is left in the hands of psychotherapists, who on their part, report fair results in some core dimensions of HD. The few trials on HD specifically regard the serotonin-noradrenaline reuptake inhibitor venlafaxine, and, possibly due to the suggestion of a common biological background of HD with attention-deficit/hyperactivity disorder, the psychostimulant methylphenidate and the noradrenaline reuptake inhibitor atomoxetine. For all these drugs, positive results have been reported, but the evidence level of these studies is low, due to small samples and non-blind designs. Regretfully, there are currently no future studies aiming at seriously testing drugs in HD.
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Affiliation(s)
- Daria Piacentino
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA) Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse (NIDA) Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
| | - Massimo Pasquini
- Department of Neurosciences, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Simone Cappelletti
- Anatomical, Histological, Forensic Medicine, and Orthopedic Sciences (SAIMLAL) Department, Sapienza University, Rome, Italy
| | - Chiara Chetoni
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
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Abstract
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.
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Affiliation(s)
- Eliza J Davidson
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Mary E Dozier
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - James O E Pittman
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Tina L Mayes
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Brian H Blanco
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - John D Gault
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Lauren J Schwarz
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive 116B, San Diego, CA, 92161, USA
| | - Catherine R Ayers
- Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA.
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Levy HC, Stevens MC, Glahn DC, Pancholi K, Tolin DF. Distinct resting state functional connectivity abnormalities in hoarding disorder and major depressive disorder. J Psychiatr Res 2019; 113:108-116. [PMID: 30928618 PMCID: PMC6486431 DOI: 10.1016/j.jpsychires.2019.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/27/2019] [Accepted: 03/21/2019] [Indexed: 02/03/2023]
Abstract
Emerging research suggests that hoarding disorder (HD) is associated with abnormal hemodynamic activity in frontal brain regions. Prior studies have not examined intrinsic network connectivity in HD during unstructured "resting state" fMRI. Furthermore, it remains unclear whether previously observed HD abnormalities might be better explained by the presence of other disorders frequently comorbid with HD, such as major depressive disorder (MDD). The current study compared resting state functional connectivity in HD-only patients (n = 17), MDD-only patients (n = 8), patients with co-occurring HD and MDD (n = 10), and healthy control participants (n = 18). Using independent component analysis, we found that HD-only patients exhibited lower functional connectivity in a "task positive" cognitive control network, compared to the other three groups. The HD group also had greater connectivity in regions of the "task negative" default mode network than did the other groups. Findings suggest that HD is associated with a unique neurobiological profile, and are discussed in terms of recent neurological and neuropsychological findings and models in HD and related disorders.
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Affiliation(s)
- Hannah C. Levy
- Anxiety Disorders Center, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106 USA,Correspondence concerning this article should be addressed to Hannah Levy, Anxiety Disorders Center, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106. Tel.: 860-545-7847. Fax: 860-545-7105.
| | - Michael C. Stevens
- Olin Neuropsychiatry Research Center, Institute of Living/Hartford Hospital, 400 Washington Street, Hartford, CT 06106 USA,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511 USA
| | - David C. Glahn
- Olin Neuropsychiatry Research Center, Institute of Living/Hartford Hospital, 400 Washington Street, Hartford, CT 06106 USA,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511 USA
| | - Krishna Pancholi
- Olin Neuropsychiatry Research Center, Institute of Living/Hartford Hospital, 400 Washington Street, Hartford, CT 06106 USA
| | - David F. Tolin
- Anxiety Disorders Center, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106 USA,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511 USA
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Reedy SS, Spassini W, Berruti N, Stefano B, Polotti R, Zanetti O. An 87-year-old female with interest in music, botany, trekking stories, politics and … junk. Aging Clin Exp Res 2019; 31:571-573. [PMID: 30006763 DOI: 10.1007/s40520-018-0996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - William Spassini
- Geriatric Rehabilitation Unit "Anni Azzurri", Rezzato, Brescia, Italy
| | | | - Berti Stefano
- Nursing Home "Anni Azzurri", Rezzato, Brescia, Italy
| | - Renzo Polotti
- Nursing Home "Anni Azzurri", Rezzato, Brescia, Italy
| | - Orazio Zanetti
- IRCCS Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy.
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Abstract
BACKGROUND Intolerance of uncertainty (IU) has been proposed as a transdiagnostic risk and maintenance factor underlying various forms of psychopathology. Few studies, however, have examined IU in hoarding disorder (HD)-a condition characterized by excessive urges to acquire and difficulties discarding possessions-core symptoms that may be fueled by inflated IU. We examined cross-sectional relationships between IU and different symptom facets of HD, controlling for anxiety and depression severity, and explored whether pre-treatment levels of IU predicted response to exposure-based treatment for HD. METHOD Fifty-seven individuals seeking treatment for HD completed baseline measures of hoarding symptoms, IU, anxiety and depression. Participants then completed 26 sessions of group exposure-based treatment for HD with or without compensatory cognitive training. Hoarding symptoms were assessed following the final treatment session to index treatment response. RESULTS IU was positively and significantly associated with greater urges to acquire and greater difficulties discarding possessions, beyond shared variance accounted for by anxiety and depression. IU was not significantly related to clutter symptom severity. Higher pre-treatment IU predicted increased odds of treatment non-response. CONCLUSIONS Elevated IU is associated with specific hoarding symptom clusters and may be an important target for HD treatment.
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Affiliation(s)
| | - Mary E. Dozier
- Research Service, VA San Diego Healthcare System, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Charles T. Taylor
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
| | - Tina Mayes
- Research Service, VA San Diego Healthcare System, USA
| | - Catherine R. Ayers
- Research Service, VA San Diego Healthcare System, USA
- Psychology Service, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
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Mathes BM, Kennedy GA, Cougle JR, Schmidt NB. An examination of the relationship between hoarding symptoms and hostility. J Psychiatr Res 2019; 111:121-127. [PMID: 30721849 DOI: 10.1016/j.jpsychires.2019.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
Hoarding disorder (HD) is a persistent and severe psychiatric condition in which individuals are unable to discard possessions, which results in considerable clutter. Individuals who hoard often endorse interpersonal difficulties and social isolation. However, little research has examined mechanisms that may help to explain this relationship. One possible mechanism is hostility, which is characterized by increased sensitivity to real or perceived social threats. The current study examined the relationship between hoarding symptoms and hostility across two undergraduate samples. In study 1, unselected undergraduates (N = 195) were administered measures of hoarding symptoms, hostile interpretations, and depression and anxiety symptoms. Participants in study 2 (N = 117) were selected for reporting elevated hoarding symptoms. Study 2 participants were administered the same measures as in study 1, and were additionally randomized to an inclusion or exclusion condition in a social exclusion manipulation. Total hoarding symptoms and hostile interpretations were positively associated across both samples, even when controlling for depression and anxiety. Further, greater hoarding symptoms were associated with increased feelings of hostility in response to social exclusion in study 2. Results suggest that increased sensitivity to social threat may confer risk for hoarding. These findings add to a growing body of research implicating interpersonal factors in the development and maintenance of hoarding disorder.
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Hombali A, Sagayadevan V, Tan WM, Chong R, Yip HW, Vaingankar J, Chong SA, Subramaniam M. A narrative synthesis of possible causes and risk factors of hoarding behaviours. Asian J Psychiatr 2019; 42:104-114. [PMID: 31003207 DOI: 10.1016/j.ajp.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 03/07/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hoarding is a disorder characterized by excessive acquisition and persistent difficulty in discarding possessions. The behaviour has adverse emotional, physical, social, financial, and legal outcomes for the person with the disorder and family members, and might pose a significant public health problem. Hoarding has been included as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM-5). The prevalence of hoarding disorder is approximately 2-6% globally. The current state of the evidence does not offer clear understanding of the causes of hoarding behaviours. A systematic review of the extant literature was carried out to determine the possible causal factors of hoarding behaviours. METHODS This review is conducted in line with PRISMA guidelines. The following electronic databases: Medline through Ovid, EMBASE and PsycINFO were searched for relevant articles published between January 2000 and November 2018. Only articles published in English language were included. Two reviewers independently scrutinized the studies and included them in this review. RESULTS Our search strategy returned a total of 396 references. Preliminary findings suggest that individuals with hoarding behaviours may have a genetic susceptibility; abnormal neural activity in the fronto-temporal, para-hippocampal gyrus and insular parts of the brain has also been identified. Traumatic life experiences have also been posited to predispose individuals to hoard. CONCLUSION Although the understanding of hoarding disorder hasgrown in recent years, greater efforts are still needed to clarify the etiology and mechanisms of hoarding disorder as these may help in planning of more holistic interventions to treat the problem.
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Affiliation(s)
- Aditi Hombali
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Vathsala Sagayadevan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Weng Mooi Tan
- Agency for Integrated Care, Community Mental Health Division, Singapore
| | - Rebecca Chong
- Agency for Integrated Care, Community Mental Health Division, Singapore
| | - Hon Weng Yip
- Policy & Planning Division, Municipal Services Office, Singapore
| | - Janhavi Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
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Levy HC, Nett A, Tolin DF. Discarding personal possessions increases psychophysiological activation in patients with hoarding disorder. Psychiatry Res 2019; 272:499-506. [PMID: 30616116 DOI: 10.1016/j.psychres.2018.12.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/11/2018] [Accepted: 12/29/2018] [Indexed: 11/23/2022]
Abstract
Difficulty discarding is the core behavioral symptom of hoarding disorder (HD). Patients with HD report greater subjective distress when discarding their own possessions as compared to others' possessions. To date, no prior studies have examined psychophysiological activation, an objective measure of anxious arousal, during discarding among individuals with HD. The current study assessed psychophysiological responses during a baseline resting period and two discarding tasks, one involving personal possessions and the other involving matched control ("experimenter-owned") items in 52 patients with a primary diagnosis of HD. Results showed that, compared to discarding control items, discarding personal possessions increased skin conductance and heart rate and decreased end tidal carbon dioxide. There were no differences in heart rate variability, respiratory sinus arrhythmia, and respiration rate between the two discarding tasks. Despite the fact that discarding increased psychophysiological arousal, self-reported HD symptoms (including difficulty discarding) failed to predict psychophysiological responses during the discarding tasks. The findings suggest that there may be discordance between objective and subjective measures of hoarding-related distress, and are discussed in terms of incorporating psychophysiological measures into the assessment and treatment of HD.
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Dozier ME, Bratiotis C, Broadnax D, Le J, Ayers CR. A description of 17 animal hoarding case files from animal control and a humane society. Psychiatry Res 2019; 272:365-368. [PMID: 30599440 PMCID: PMC7299063 DOI: 10.1016/j.psychres.2018.12.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/29/2018] [Accepted: 12/23/2018] [Indexed: 11/17/2022]
Abstract
This study describes 17 publicly available cases of animal hoarding, a special manifestation of hoarding disorder. The cases, which included court documents, animal service documents, photographs, and newspaper clippings, were reviewed by Masters-level clinicians and a veterinarian in private practice. The veterinarian rated the animals in the case files for possible neglect. Over half of the homes had signs of object hoarding. The most commonly hoarded animals were cats, dogs, and rabbits. The majority of animals in the cases reviewed required veterinary care. Individuals with animal hoarding often lack insight about the condition of their animals and require community intervention.
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Affiliation(s)
- Mary E Dozier
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA; Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.
| | - Christiana Bratiotis
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Dominique Broadnax
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; School of Social Work, University of British Columbia, Vancouver, BC, Canada; Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Jenny Le
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; School of Social Work, University of British Columbia, Vancouver, BC, Canada; Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Catherine R Ayers
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; School of Social Work, University of British Columbia, Vancouver, BC, Canada; Mental Healthcare Line, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Thorpe S, Bolster A, Neave N. Exploring aspects of the cognitive behavioural model of physical hoarding in relation to digital hoarding behaviours. Digit Health 2019; 5:2055207619882172. [PMID: 31636918 PMCID: PMC6785915 DOI: 10.1177/2055207619882172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Susan Thorpe
- Department of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Alexander Bolster
- Department of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Neave
- Hoarding Research Group, Northumbria University, Newcastle upon Tyne, UK
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Turna J, Patterson B, Simpson W, Pullia K, Khalesi Z, Grosman Kaplan K, Van Ameringen M. Prevalence of hoarding behaviours and excessive acquisition in users of online classified advertisements. Psychiatry Res 2018; 270:194-7. [PMID: 30261409 DOI: 10.1016/j.psychres.2018.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022]
Abstract
An estimated 2-6% of the general population is thought to suffer from clinically significant hoarding symptoms, with 80-90% engaging in excessive acquisition. Minimal research has examined the excessive acquisition component of hoarding disorder (HD). Many individuals with HD have limited insight into their condition and are reluctant to seek help, making prevalence estimates difficult to obtain. Online classified advertisement networks provide a venue to list items for sale, often for free. We examined the prevalence of hoarding behaviours among users of online classified advertisements. A link to an online survey was posted between June 26, 2015-March 10, 2017. Participants provided demographic information and completed the Hoarding Rating Scale (HRS); individuals with clinically significant hoarding (High HRS) also completed the Saving Inventory-Revised (SI-R) and Clutter Image Rating (CIR). Feedback regarding hoarding behaviours was provided. The survey was completed by 729 adults and 12.3% (n = 90) self-identified as experiencing clinically significant hoarding as per the HRS (High HRS). Of those in the High HRS group, most (66.7%) were categorized to the 'high acquisition' group based on the SI-R excessive acquisition subscale. Overall this sample revealed high rates of significant hoarding behaviours, almost double that of community samples. Excessive acquisition was prominent and associated with greater hoarding severity, highlighting the need to further study this specifier.
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Linkovski O, Zwerling J, Cordell E, Sonnenfeld D, Willis H, La Lima CN, Baker C, Ghazzaoui R, Girson R, Sanchez C, Wright B, Alford M, Varias A, Filippou-Frye M, Shen H, Jo B, Shuer L, Frost RO, Rodriguez CI. Augmenting Buried in Treasures with in-home uncluttering practice: Pilot study in hoarding disorder. J Psychiatr Res 2018; 107:145-150. [PMID: 30419524 PMCID: PMC7437985 DOI: 10.1016/j.jpsychires.2018.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/22/2018] [Accepted: 10/01/2018] [Indexed: 12/01/2022]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions and by clutter that impairs the functionality of living spaces. Cognitive behavioral therapy conducted by a therapist (individual or in a group) for hoarding symptoms has shown promise. For those who cannot afford or access the services of a therapist, one alternative is an evidence-based, highly structured, short-term, skills-based group using CBT principles but led by non-professional facilitators (the Buried in Treasures [BIT] Workshop). BIT has achieved improvement rates similar to those of psychologist-led CBT. Regardless of modality, however, clinically relevant symptoms remain after treatment, and new approaches to augment existing treatments are needed. Based on two recent studies - one reporting that personalized care and accountability made treatments more acceptable to individuals with hoarding disorder and another reporting that greater number of home sessions were associated with better clinical outcomes, we tested the feasibility and effectiveness of adding personalized, in-home uncluttering sessions to the final weeks of BIT. Participants (n = 5) had 15 sessions of BIT and up to 20 hours of in-home uncluttering. Reductions in hoarding symptoms, clutter, and impairment of daily activities were observed. Treatment response rate was comparable to rates in other BIT studies, with continued improvement in clutter level after in-home uncluttering sessions. This small study suggests that adding in-home uncluttering sessions to BIT is feasible and effective.
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Affiliation(s)
- Omer Linkovski
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Jordana Zwerling
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Elisabeth Cordell
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Danae Sonnenfeld
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY, USA
| | - Henry Willis
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY, USA
| | - Christopher N. La Lima
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY, USA
| | - Colleen Baker
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY, USA
| | - Rassil Ghazzaoui
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Robyn Girson
- New York State Psychiatric Institute, New York, NY, USA
| | - Catherine Sanchez
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Brianna Wright
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Mason Alford
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Andrea Varias
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Maria Filippou-Frye
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Hanyang Shen
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Lee Shuer
- ServiceNet: Innovative Mental Health and Human Services, Northampton, MA, USA
| | - Randy O. Frost
- Department of Psychology, Smith College, Northampton, MA, USA
| | - Carolyn I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Martin AM, Zakrzewski JJ, Chou CY, Uhm SY, Gause RM, Chan J, Eckfield M, Salazar M, Vigil O, Bain D, Stark SJ, Mackin RS, Vega E, Delucchi KL, Tsoh JY, Mathews CA. Recruiting under-represented populations into psychiatric research: Results from the help for hoarding study. Contemp Clin Trials Commun 2018; 12:169-175. [PMID: 30480164 PMCID: PMC6240798 DOI: 10.1016/j.conctc.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022] Open
Abstract
This study compares the effectiveness of approaches used to recruit a diverse sample for a randomized clinical trial for Hoarding Disorder (HD) in the San Francisco Bay Area. Of the 632 individuals who inquired about the study, 313 were randomized and 231 completed treatment. Most participants heard about the study via flyering (N = 161), followed by advocacy groups (N = 113), word of mouth (N = 84), health care professionals (N = 78), online (N = 68), and media (N = 11). However, those that heard about the study via advertising methods, such as flyers, were less likely to complete the study, p = .01, while those recruited via advocacy groups were most likely to be randomized, p = .03. No source proved more effective in recruiting underrepresented groups such as men, p = .60; non-whites, p = .49; or Hispanics, p = .97. Advertising recruited the youngest individuals, p < 0.001, and word of mouth was most likely to recruit unemployed, disabled, or retired individuals, p = .01. Thus, results suggest an ongoing multimodal approach is likely to be most effective in both soliciting and retaining a diverse sample. Future studies should compare recruitment methods across greater geographical regions too, as well as in terms of financial and human costs.
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Affiliation(s)
- Anna M Martin
- Department of Psychiatry, University of Florida, United States
| | | | - Chia-Ying Chou
- Department of Psychiatry, University of California, San Francisco, United States
| | - Soo Y Uhm
- Department of Psychiatry, University of California, San Francisco, United States
| | - R Michael Gause
- Mental Health Association of San Francisco, United States.,Sonoma County Community Development Commission, United States
| | - Joanne Chan
- Mental Health Association of San Francisco, United States
| | - Monika Eckfield
- Department of Psychiatry, University of California, San Francisco, United States.,California State University, East Bay, United States
| | - Mark Salazar
- Mental Health Association of San Francisco, United States
| | - Ofilio Vigil
- Department of Psychiatry, University of California, San Francisco, United States.,Cancer Care Network, University of California, Davis, United States
| | - David Bain
- Mental Health Association of San Francisco, United States
| | - Sandra J Stark
- Mental Health Association of San Francisco, United States
| | - R Scott Mackin
- Department of Psychiatry, University of California, San Francisco, United States
| | - Eduardo Vega
- Mental Health Association of San Francisco, United States.,Dignity Recovery Action Intl, United States
| | - Kevin L Delucchi
- Department of Psychiatry, University of California, San Francisco, United States
| | - Janice Y Tsoh
- Department of Psychiatry, University of California, San Francisco, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, United States.,Department of Psychiatry, University of California, San Francisco, United States
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45
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Frost RO, Gabrielson I, Deady S, Dernbach KB, Guevara G, Peebles-Dorin M, Yap K, Grisham JR. Scrupulosity and hoarding. Compr Psychiatry 2018; 86:19-24. [PMID: 30041077 DOI: 10.1016/j.comppsych.2018.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/07/2018] [Accepted: 06/20/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Recent evidence suggests that avoiding waste may be a prominent motive to save in hoarding disorder. Such beliefs are reminiscent of scrupulosity obsessions in OCD. This paper reports on three studies examining scrupulosity-like beliefs in hoarding and the development and validation of a measure of material scrupulosity. METHODS Study one examined the reliability and validity of a measure of material scrupulosity (MOMS) and its relationship to hoarding in a college student sample, as well as the relationship between hoarding and OCD-base scrupulosity. Study 2 examined the psychometric properties of the MOMS in a replication of study 1 with a sample of people with hoarding problems. Study 3 examined the reliability and validity of the MOMS in a large nonclinical/community sample. RESULTS Findings across the studies provided evidence for the reliability and validity of the MOMS. It was highly correlated with hoarding symptoms, especially difficulty discarding, and hoarding related beliefs, especially responsibility beliefs. It accounted for significant variance in hoarding symptoms independent of other correlates, including other hoarding beliefs. OCD-based scrupulosity was correlated with hoarding in sample 1, but not in the hoarding sample in study 2. CONCLUSIONS Material Scrupulosity refers to an exaggerated sense of duty or moral/ethical responsibility for the care and disposition of possessions to prevent their being harmed or wasted. It appears to be distinct from other hoarding-related beliefs and a significant predictor of hoarding symptoms. The MOMS appears to possess good reliability and validity in both clinical and nonclinical samples.
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46
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Zakrzewski JJ, Datta S, Scherling C, Nizar K, Vigil O, Rosen H, Mathews CA. Deficits in physiological and self-conscious emotional response to errors in hoarding disorder. Psychiatry Res 2018; 268:157-64. [PMID: 30029063 DOI: 10.1016/j.psychres.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/11/2018] [Accepted: 07/06/2018] [Indexed: 11/22/2022]
Abstract
Hoarding disorder (HD) has been hypothesized to arise from deficits in error monitoring and abnormalities in emotional processing, but the relationship between error monitoring and emotional processing has not been examined. We examined measures of self-report, as well as behavioral, physiological, and facial responses to errors during a Stop-Change Task. 25 participants with HD and 32 healthy controls (HC) were recruited. Participants reported on number of errors committed and pre/post emotional response to errors. Skin conductance response (SCR) during correct and error commission trials was examined. Facial expression during task performance was coded for self-conscious and negative emotions. HD and HC participants had significantly different error rates but comparable error correction and post-error slowing. SCR was significantly lower for HD during error commission than for HC. During error trials, HD participants showed a significant deficit in displays of self-conscious emotions compared to HC. Self-reported emotions were increased in HD, with more negative and self-conscious emotion reported than was reported for HC participants. These findings suggest that hypoactive emotional responding at a physiological level may play a role in how errors are processed in individuals with HD.
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47
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Ayers CR, Dozier ME, Pittman JOE, Mayes TL, Twamley EW. Comparing clinical characteristics and treatment outcomes between Veterans and non-Veterans with hoarding disorder. Compr Psychiatry 2018; 86:1-5. [PMID: 30041076 PMCID: PMC7293764 DOI: 10.1016/j.comppsych.2018.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/31/2018] [Accepted: 07/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Because Veterans have higher rates of mental health conditions and both physical and mental health comorbidities are known to affect treatment outcomes, the purpose of this investigation was to compare the rates of risk factors for poor hoarding treatment outcomes between Veterans and non-Veterans with hoarding disorder (HD). This is the first study to investigate differences between Veterans and non-Veterans with HD. MATERIAL AND METHODS Baseline data were used from three different treatment studies of adults with hoarding disorder (n = 159). Demographic characteristics, baseline hoarding symptom severity, baseline medical and psychiatric comorbidities, and treatment attrition and response were compared between Veterans and non-Veterans. RESULTS Veterans were significantly less likely to be employed than non-Veterans. Veterans did not report significantly more severe hoarding symptoms at baseline when compared to non-Veterans. Veterans reported having a greater mean number of overall medical and psychiatric comorbidities. Veterans were more likely than non-Veterans to meet criteria for major depressive disorder and post-traumatic stress disorder. There was no significant difference in the rate of attrition between Veterans and non-Veterans and Veterans were not significantly more likely to be classified as treatment responders. CONCLUSION Many similarities were observed between the two groups, including demographic characteristics, hoarding symptom severity, and rates of treatment response. Given that Veterans with HD may suffer from greater medical and psychiatric comorbidities, clinicians should ensure that their clients are receiving adequate medical care and that any other psychiatric comorbidities should be addressed in conjunction for treatment with HD.
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Affiliation(s)
- Catherine R Ayers
- Mental Health Care Line, VA San Diego Healthcare System, United States of America; Department of Psychiatry, University of California San Diego School of Medicine, United States of America.
| | - Mary E Dozier
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, United States of America; Research Service, VA San Diego Healthcare System, United States of America
| | - James O E Pittman
- Mental Health Care Line, VA San Diego Healthcare System, United States of America; Department of Psychiatry, University of California San Diego School of Medicine, United States of America
| | - Tina L Mayes
- Mental Health Care Line, VA San Diego Healthcare System, United States of America
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, United States of America; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, United States of America; Department of Psychiatry, University of California San Diego School of Medicine, United States of America
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48
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Grisham JR, Roberts L, Cerea S, Isemann S, Svehla J, Norberg MM. The role of distress tolerance, anxiety sensitivity, and intolerance of uncertainty in predicting hoarding symptoms in a clinical sample. Psychiatry Res 2018; 267:94-101. [PMID: 29886277 DOI: 10.1016/j.psychres.2018.05.084] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/05/2018] [Accepted: 05/30/2018] [Indexed: 12/18/2022]
Abstract
Hoarding disorder (HD) is characterized primarily by difficulty discarding possessions, leading to severe clutter and significant distress and impairment. Although promising psychological treatments have emerged, treating HD remains a clinical challenge. A greater understanding of the role of psychological vulnerability factors in predicting hoarding symptoms in a clinical HD sample could further enhance treatments. To investigate the role of proposed individual difference factors (i.e., distress tolerance, anxiety sensitivity, intolerance of uncertainty), we administered a diagnostic and self-report battery to 73 individuals diagnosed with HD who were seeking treatment for hoarding at a community clinic. Results indicated that when controlling for depression and anxiety symptoms, only distress tolerance predicted the severity of hoarding symptoms. Furthermore, meditation analyses revealed that the impact of distress tolerance on hoarding severity was partially mediated by hoarding beliefs. These results have important theoretical and clinical implications for HD.
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Affiliation(s)
| | - Lynette Roberts
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Silvia Cerea
- Department of General Psychology, University of Padua, Padua, Italy
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49
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Ayers CR, Pittman JO, Davidson EJ, Dozier ME, Mayes TL, Almklov E. Predictors of treatment outcome and attrition in adults with hoarding disorder. J Obsessive Compuls Relat Disord 2018; 23:10.1016/j.jocrd.2019.100465. [PMID: 32670783 PMCID: PMC7362989 DOI: 10.1016/j.jocrd.2019.100465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Catherine R. Ayers
- Research Service, VA San Diego Healthcare System, USA
- Mental Healthcare Line, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
| | - James O.E. Pittman
- Mental Healthcare Line, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
| | - Eliza J. Davidson
- Research Service, VA San Diego Healthcare System, USA
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Mary E. Dozier
- Research Service, VA San Diego Healthcare System, USA
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
- Psychology Service, South Texas Veterans Health Care System, USA
- Department of Psychology, Mississippi State University, USA
| | - Tina L. Mayes
- Research Service, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
| | - Erin Almklov
- Research Service, VA San Diego Healthcare System, USA
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50
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Crone C, Norberg MM. Scared and surrounded by clutter: The influence of emotional reactivity. J Affect Disord 2018; 235:285-292. [PMID: 29660644 DOI: 10.1016/j.jad.2018.04.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/16/2018] [Accepted: 04/07/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Home visits can improve treatment outcomes for hoarding disorder, but factors influencing the success of home visits remain unknown. As home visits expose individuals to clutter and fear, the present study examined the effect that fear and emotional reactivity have on the relationship between clutter and discarding behaviour. METHODS Participants with at least subclinical discarding problems (n = 143) were asked to save or discard personal possessions of varying value following an emotional induction that took place in either a tidy or cluttered context. Participants also completed questionnaires assessing hoarding severity, emotional state, and emotional reactivity, as defined by one's sensitivity, persistence, and intensity of reactions to emotional stimuli. RESULTS As expected, participants discarded more items in the presence of clutter and when feeling fearful. However, emotional reactivity moderated the relations between environmental context, acute emotional state, and discarding. Low sensitivity, low persistence, and high emotional intensity negatively influenced discarding in the cluttered context. When feeling fearful, low dispositional emotional intensity negatively influenced discarding in the tidy context. LIMITATIONS Individuals in the tidy environment reported higher levels of fear and anxiety than individuals in the cluttered environment after the fear induction. These differences could have contributed to the difference noted between the two contexts when examining the effect of emotional intensity tendencies. CONCLUSIONS Providing treatment in an environment more representative of the cluttered home can improve discarding or at the very least give therapists a more accurate picture of what clients do in the context that matters most.
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Affiliation(s)
- Cassandra Crone
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales 2109, Australia.
| | - Melissa M Norberg
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales 2109, Australia.
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