Development and Validation of the Clutter Image Rating

Journal of Psychopathology and Behavioral Assessment (Impact Factor: 1.55). 09/2008; 30(3):193-203. DOI: 10.1007/s10862-007-9068-7


Few instruments are available to assess compulsive hoarding and severity of clutter. Accuracy of assessment is important to
understanding the clinical significance of the problem. To overcome problems associated with over- and under-reporting of
hoarding symptoms, the clutter image rating (CIR) was developed. This pictorial scale contains nine equidistant photographs
of severity of clutter representing each of three main rooms of most people’s homes: living room, kitchen, and bedroom. The
psychometric properties of this measure were examined in two studies. Internal consistency, test–retest, and interobserver
reliabilities were good and convergent validity with other questionnaire and interview measures was also good. The CIR correlated
more strongly with measures of clutter than with other hoarding and psychopathology scales. The CIR’s very brief pictorial
assessment method makes it useful in clinical and treatment contexts for measuring the clutter dimension of compulsive hoarding.

Download full-text


Available from: David F Tolin, Dec 19, 2014
644 Reads
  • Source
    • "Findings on the third point, meanwhile, indicated higher clinician-rated insight (based on SIHD interviews with HD relatives) for participants with HD, than for HD individuals who declined to participate in this investigation. Our findings of generally strong agreement between self and informant ratings of clutter are consistent with previous studies (DiMauro et al., 2013; Frost et al., 2008; Mataix-Cols et al., 2013). The resemblance of ratings on the HRS, between the HD and HD relative groups, adds to this literature and suggests that this level of accord may also be expected for other key hoarding features such as difficulty discarding, excessive acquisition, distress, and functional impairment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Previous literature on Hoarding Disorder (HD) has largely recruited individuals with self-identified hoarding difficulties or informant-ratings of individuals who are not seeking help. Little is known about the reliability of self- and informant-ratings of hoarding severity and insight, and whether individuals who self-identify with HD differ from those who do not. Method Twenty-four pairs of individuals meeting criteria for HD and their relatives took part in the study, plus 40 relatives of individuals meeting likely criteria for HD who did not agree to participate. All participants completed a clinician-administered diagnostic interview for HD and online questionnaires assessing hoarding severity, squalor and insight. Results Good correspondence was found between self- and informant-ratings of hoarding severity, although informants gave significantly higher squalor ratings. Relative to clinician-ratings, informants under-estimated the insight of HD individuals. Higher hoarding severity and lower insight informant-ratings were made for individuals with HD who did agree to participate, compared to those who did. Conclusions A multi-informant approach guided by expert clinicians is desirable for the assessment of HD, particularly in low-insight individuals. When individuals do not seek help for HD, family members may benefit from education and support to help them understand how best to assist their relatives.
    Journal of Obsessive-Compulsive and Related Disorders 04/2015; 5(1):37-42. DOI:10.1016/j.jocrd.2015.01.005 · 1.18 Impact Factor
  • Source
    • "Self-report measures completed by HD and collector groups Individuals meeting criteria for HD and healthy collectors completed three measures assessing hoarding symptoms: a measure relating to the diagnostic criteria for HD, the Hoarding Rating Scale – Self Report (HRS-SR; Tolin et al., 2008), a measure of hoarding-related beliefs, the Saving Cognitions Inventory (SCI; Steketee et al., 2003), and a visual measure of the severity of clutter, the Clutter Image Rating (CIR; Frost et al., 2008). The HRS- SR was selected as a measure of hoarding severity since it is widely used, is very brief, has excellent psychometric properties, has both self-and informant report versions (e.g., Tolin et al., 2008, 2010), and to permit direct comparison with the findings of Tolin et al. (2008), who also examined family burden in hoarding. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Hoarding Disorder (HD), a new diagnostic entity in DSM-5, is associated with substantial functional impairment and family frustration but data from well-characterized samples is lacking. Method Participants were 37 individuals meeting DSM-5 criteria for HD, 55 relatives of individuals meeting criteria for HD, and comparison groups of 51 self-identified collectors and 25 relatives of collectors. All participants completed a clinician-administered diagnostic interview for HD and an online battery of standardized measures of health, well-being, and impairment. Results Substantial functional impairment was found for both HD individuals and their relatives. HD relatives reported significantly greater carer burden and accommodation of hoarding behaviors than relatives of collectors. Perceived level of squalor, co-habiting with, and increasing age of the HD individual were significant predictors of carer burden and functional impairment in the relatives. Limitations The use of self-identified HD individuals may have produced a bias towards participants with relatively good insight. Subjective biases in self-reported symptoms cannot be ruled out, although the use of informant-report data provided some independent validation. Conclusions HD is associated with substantial functional impairment for both sufferers and their relatives. The level of carer burden experienced by HD relatives was comparable to or greater than that reported in the literature by relatives of individuals with dementia. The findings indicate that relatives of individuals with HD may benefit from increased support and suggest that it may be beneficial to involve family members in the treatment of HD.
    Journal of Affective Disorders 04/2014; 159:7–14. DOI:10.1016/j.jad.2014.01.023 · 3.38 Impact Factor
  • Source
    • "Difficulty Discarding (a ¼.83), and Excessive Acquisition (a¼ .84). The Clutter Image Rating (CIR; Frost et al., 2008 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Research on hoarding over the last two decades has shown that hoarding disorder appears to be a distinct disorder that burdens the individual, the community and the families of people who hoard. Although hoarding clearly interferes with the daily functioning, especially in the context of extensive clutter, no validated measures of this interference have been developed. The present research examined the psychometric properties of the Activities of Daily Living in Hoarding scale (ADL-H) in two large samples of individuals with significant hoarding problems, one identified through the internet (n=363) and a second through clinical diagnostic interviews (n=202). The ADL-H scale test-retest (1-12 weeks), interrater and internal reliabilities ranged from 0.79 to 0.96. Convergent and discriminant validity were established through analyses of correlational data collected for measures of hoarding severity and non-hoarding psychopathology (obsessive compulsive disorder [OCD], mood state, attention deficit, and perfectionism/uncertainty), as well as through comparisons of scores among individuals with hoarding, hoarding plus OCD, OCD without hoarding, and community controls. The ADL-H scale appears to have strong psychometric properties and to be useful in clinical and research settings. Suggestions are made for expansion of the scale, and study limitations are noted.
    Journal of Obsessive-Compulsive and Related Disorders 04/2013; 2(2):85-90. DOI:10.1016/j.jocrd.2012.12.004 · 1.18 Impact Factor
Show more