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.

Download full-text


Available from: Sabine Wilhelm, Jun 19, 2015
  • Source
    [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
    [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
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: As one of the most widely accepted neuroanatomical models on obsessive-compulsive disorder (OCD), it has been hypothesized that imbalance between an excitatory direct (ventral) pathway and an inhibitory indirect (dorsal) pathway in cortico-striato-thalamic circuit underlies the emergence of OCD. Here we examine the structural network in drug-free patients with OCD in terms of graph theoretical measures for the first time. We used a measure called efficiency which quantifies how a node transfers information efficiently. To construct brain networks, cortical thickness was automatically estimated using T1-weighted magnetic resonance imaging. We found that the network of the OCD patients was as efficient as that of healthy controls so that the both networks were in the small-world regime. More importantly, however, disparity between the dorsal and the ventral networks in the OCD patients was found in terms of graph theoretical measures, suggesting a positive evidence to the imbalance theory on the underlying pathophysiology of OCD.
    Frontiers in Human Neuroscience 07/2013; 7:302. DOI:10.3389/fnhum.2013.00302 · 2.90 Impact Factor