Hoarding disorder: A new diagnosis for DSM-V?

Depression and Anxiety (Impact Factor: 4.29). 06/2010; 27(6):556 - 572. DOI: 10.1002/da.20693
Source: PubMed

ABSTRACT This article provides a focused review of the literature on compulsive hoarding and presents a number of options and preliminary recommendations to be considered for DSM-V. In DSM-IV-TR, hoarding is listed as one of the diagnostic criteria for obsessive–compulsive personality disorder (OCPD). According to DSM-IV-TR, when hoarding is extreme, clinicians should consider a diagnosis of obsessive–compulsive disorder (OCD) and may diagnose both OCPD and OCD if the criteria for both are met. However, compulsive hoarding seems to frequently be independent from other neurological and psychiatric disorders, including OCD and OCPD. In this review, we first address whether hoarding should be considered a symptom of OCD and/or a criterion of OCPD. Second, we address whether compulsive hoarding should be classified as a separate disorder in DSM-V, weighing the advantages and disadvantages of doing so. Finally, we discuss where compulsive hoarding should be classified in DSM-V if included as a separate disorder. We conclude that there is sufficient evidence to recommend the creation of a new disorder, provisionally called hoarding disorder. Given the historical link between hoarding and OCD/OCPD, and the conservative approach adopted by DSM-V, it may make sense to provisionally list it as an obsessive–compulsive spectrum disorder. An alternative to our recommendation would be to include it in an Appendix of Criteria Sets Provided for Further Study. The creation of a new diagnosis in DSM-V would likely increase public awareness, improve identification of cases, and stimulate both research and the development of specific treatments for hoarding disorder. Depression and Anxiety, 2010.© 2010 Wiley-Liss, Inc.

  • Source
    • "Por isso, as intervenções psicoterapêuticas são focadas na diminuição do sofrimento apresentado pelo indivíduo ao descartar as coisas que acumulam. Esses sujeitos creem que qualquer item coletado servirá para algum propósito futuramente, justificando a importância de se utilizarem intervenções que contemplem as suas crenças disfuncionais sobre os objetos acumulados (Tolin et al., 2007; Pertusa et al., 2008; Valente, 2009; Pogosian, 2010; Mataix‐Cols et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hoarding Disorder (HD) is characterized by the compulsive acquisition of unnecessary objects, clutter, and difficulty in discarding possessions. Previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) showed no specific diagnosis for subjects presenting these symptoms, which were usually classified as Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD). This work consists on a literature review based on international indexing databases, and it aims to discuss the epidemiological, clinical, and treatment aspects of HD. Although there is no consensual in the literature, the findings suggest that the disorder is an independent disease, and with high prevalence of comorbidities, requiring therapeutic interventions focused on the cognitive and behavioral characteristics of these subjects. Finally, carrying out researches with this profile of patients, emphasizing the reality of Brazil is suggested.
  • Source
    • "Here we examined the executive function profile of OCD patients with prominent and severe hoarding symptoms, comparing them to a healthy control group. Given that hoarding is now considered a distinct disorder (Pertusa et al., 2008; Mataix-Cols et al., 2010; American Psychiatric Association, 2013), a separate group of patients meeting criteria for hoarding disorder but no comorbid OCD was also assessed. Performance measures were obtained for response inhibition, cognitive flexibility, spatial planning and decision-making, on executive functions tasks previously used to characterize cognitive deficits in non-hoarding OCD patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hoarding disorder is a new mental disorder in DSM-5. It is classified alongside OCD and other presumably related disorders in the Obsessive-Compulsive and Related Disorders chapter. We examined cognitive performance in two distinct groups comprising individuals with both OCD and severe hoarding, and individuals with hoarding disorder without comorbid OCD. Participants completed executive function tasks assessing inhibitory control, cognitive flexibility, spatial planning, probabilistic learning and reversal and decision making. Compared to a matched healthy control group, OCD hoarders showed significantly worse performance on measures of response inhibition, set shifting, spatial planning, probabilistic learning and reversal, with intact decision making. Despite having a strikingly different clinical presentation, individuals with only hoarding disorder did not differ significantly from OCD hoarders on any cognitive measure suggesting the two hoarding groups have a similar pattern of cognitive difficulties. Tests of cognitive flexibility were least similar across the groups, but differences were small and potentially reflected subtle variation in underlying brain pathology together with psychometric limitations. These results highlight both commonalities and potential differences between OCD and hoarding disorder, and together with other lines of evidence, support the inclusion of the new disorder within the new Obsessive-Compulsive and Related Disorders chapter in DSM-5.
    12/2013; 215(3). DOI:10.1016/j.psychres.2013.12.026
  • Source
    • "Prior work indicates that the subscales of the OCIR are valid measures of OCD subtypes (Huppert et al., 2007); thus, subscales were used for that purpose in the present investigation. The neutralizing and hoarding subscales were excluded from analyses because of psychometric limitations of the neutralizing subscale and evidence suggesting that hoarding be considered separately from OCD (Wu and Watson, 2003; Huppert et al., 2007; Mataix-Cols et al., 2010; Pertusa et al., 2010). Further, there is some evidence that the hoarding subscale of the OCI-R does not have a latent dimensional structure (Olatunji et al., 2008), whereas other measures of hoarding symptoms were found to have a latent dimensional structure (Timpano et al., 2013), suggesting that the OCI-R hoarding subscale has psychometric limitations. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A growing body of research has linked poor distress tolerance (DT) to obsessions, but not other OC symptom domains. However, limited research has been conducted with clinical samples. Further, there is a dearth of research regarding the moderating influence of DT on the contribution of stress to OC symptoms. In Study 1, we sought to test the specificity of the link between poor DT and greater obsessions relative to other OC symptom domains in a clinical sample. In Study 2, we conducted a longitudinal investigation with a non-clinical sample examining DT and daily stressors in the prediction of daily obsessions. For Study 1, 22 outpatients with an OCD diagnosis and 37 healthy controls completed measures of DT, depression, and OC symptoms. For Study 2, 102 undergraduates completed measures of DT at baseline and daily assessments of OC symptoms and stressors twice weekly for one-month. In Study 1, OCD diagnosis was not a significant predictor of DT, though greater obsessions, but not other OC symptoms, were uniquely associated with lower DT. In Study 2, lower baseline DT predicted greater daily obsessions among those experiencing greater daily negative life events, though this relationship was absent among those with elevated DT. The specific association between DT and obsessions was replicated in a clinical sample. Further, results suggest that low DT increases obsessions in the context of life stress.
    Journal of Psychiatric Research 07/2013; 47(10). DOI:10.1016/j.jpsychires.2013.06.019 · 4.09 Impact Factor
Show more

Questions & Answers about this publication

  • Rafael Ferreira-Garcia added an answer in Obsessive-Compulsive Disorder:
    Is there any research available on the connection between hoarding and mental health?
    Hoarding has been linked to obsessive compulsive disorder.
    Rafael Ferreira-Garcia · Federal University of Rio de Janeiro

    Yes, there is.

    (Excessive) Hoarding was until recently considered a symptom dimension of Obsessive-Compulsive disorder (OCD) (Like washing/fear of contamination or symmetry/repetition). 

    In the last 10 years, though, a substantial body of research points to a categorical differentiation between Hoarding and OCD. There are clinical, epidemiological and almost certainly genetic differences between the two conditions. This was acknowledged by the DSM-V, and the diagnosis of Hoarding Disorder was created, under OCD related conditions.

    People showing clinical significant hoarding are prone to display obsessive-compulsive behavior, and about 20% of them meet criteria for obsessive-compulsive disorder. On the other hand, major depressive disorder and anxiety disorders are more frequent. Excessive Hoarding is also associated with functional impairment and lower quality of life. We do not know much yet about the neurobiological correlates of hoarding disorder, but it is likely different from Obsessive-compulsive disorder in general, as it is evidenced by neuroimage and neuropsychology studies.

    Even fewer studies address specific treatments to hoarding disorders. Cognitive-Behavioral therapy is usually effective, but poorly tolerated. Pharmacotherapy is thought to be less effective than in OCD and other anxiety disorders.