Characterizing the hoarding phenotype in individuals with OCD: Associations with comorbidity, severity and gender

Laboratory of Clinical Science, National Institute of Mental Health, USA.
Journal of Anxiety Disorders (Impact Factor: 2.96). 02/2008; 22(2):243-52. DOI: 10.1016/j.janxdis.2007.01.015
Source: PubMed


Hoarding frequently occurs in obsessive-compulsive disorder (OCD), and some evidence suggests that it constitutes a distinct OCD subtype, with genetic contributions. This study investigated differences between OCD patients with and without hoarding symptoms. Of the 473 OCD patients studied, 24% were classified as hoarders according to combined interviewer and self-ratings, which were validated with the Savings Inventory-Revised in a subsample. Hoarders suffered from significantly more severe OCD symptoms, (especially compulsions) and had greater impairment and dysphoria. Hoarders also had more comorbid psychiatric disorders. Further study revealed that many of these differences were attributable to the female subjects: Compared to female non-hoarders, female hoarders were more likely to suffer from bipolar I, substance abuse, panic disorder, binge-eating disorder, and had greater OCD severity. Male hoarders had an increased prevalence of social phobia compared to non-hoarding males. These results suggest that there are gender-specific differences in the hoarding sub-phenotype of OCD.

Download full-text


Available from: Kiara R Timpano,
  • Source
    • "In a study of 418 participants (Hasler et al., 2007), aggressive, sexual and religious obsessions, and checking compulsions were linked to affective disorders, whereas symmetry, ordering and arranging compulsions were associated with attention deficit hyperactivity disorder (ADHD), alcohol dependence and bulimia nervosa. The symmetry-ordering dimension has also been previously associated with tic disorders (Miguel et al., 1997; Coffey et al., 1998), whereas the hoarding dimension has been linked to depressive (Winsberg et al., 1999; Coles et al., 2003; Frost et al., 2011; Tolin and Villavicencio , 2011; Hall et al., 2013) and bipolar disorders (Fontenelle et al., 2004; LaSalle-Ricci et al., 2006; Samuels et al., 2007; Wheaton et al., 2008; Chakraborty et al., 2012), generalized anxiety disorder (GAD; Samuels et al., 2007; Chakraborty et al., 2012), panic disorder (Storch et al., 2007; Samuels et al., 2014), specific phobia (Samuels et al., 2014), social phobia (Coles et al., 2003; Samuels et al., 2007; Wheaton et al., 2008), BDD (LaSalle-Ricci et al., 2006; Samuels et al., 2007), substance use disorders (Wheaton et al., 2008), tic disorders (Samuels et al., 2007; 2014), ADHD (Hartl et al., 2005; Tolin and Villavicencio, 2011, Hacker et al., 2012; Frank et al., 2014), posttraumatic stress disorder (PTSD; LaSalle-Ricci et al., 2006) and impulse-control disorders (ICD; Winsberg et al., 1999; Grisham et al., 2007; Tolin and Villavicencio, 2011; Timpano et al., 2014), particularly " grooming behaviors " (Samuels et al., 2002, 2007), compulsive buying (Winsberg et al., 1999; Mueller et al., 2009; Frost et al., 2009, 2011; Bulli et al., 2014) and kleptomania (Frost et al., 2011). Despite the relevant contributions of these above studies, several methodological limitations exist. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Obsessive-compulsive disorder (OCD) has a heterogeneous and complex phenomenological picture, characterized by different symptom dimensions and comorbid psychiatric disorders, which frequently co-occur or are replaced by others over the illness course. To date, very few studies have investigated the associations between specific OCD symptom dimensions and comorbid disorders. Methods: Cross-sectional, multicenter clinical study with 1001 well-characterized OCD patients recruited within the Brazilian Research Consortium on Obsessive-Compulsive and Related Disorders. The primary instruments were the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses between symptom dimensions and comorbidities were followed by logistic regression. Results: The most common comorbidities among participants (56.8% females) were major depression (56.4%), social phobia (34.6%), generalized anxiety disorder (34.3%), and specific phobia (31.4%). The aggressive dimension was independently associated with posttraumatic stress disorder (PTSD), separation anxiety disorder, any impulse-control disorder and skin picking; the sexual-religious dimension was associated with mood disorders, panic disorder/agoraphobia, social phobia, separation anxiety disorder, non-paraphilic sexual disorder, any somatoform disorder, body dysmorphic disorder and tic disorders; the contamination-cleaning dimension was related to hypochondriasis; and the hoarding dimension was associated with depressive disorders, specific phobia, PTSD, impulse control disorders (compulsive buying, skin picking, internet use), ADHD and tic disorders. The symmetry-ordering dimension was not independently associated with any comorbidity. Limitations: Cross-sectional design; participants from only tertiary mental health services; personality disorders not investigated. Conclusions: Different OCD dimensions presented some specific associations with comorbid disorders, which may influence treatment seeking behaviors and response, and be suggestive of different underlying pathogenic mechanisms.
    Journal of Affective Disorders 11/2015; 190:508-516. DOI:10.1016/j.jad.2015.10.051 · 3.38 Impact Factor
  • Source
    • "Based on the literature, we hypothesized that OCD patients with comorbid SP, compared to OCD patients without SP would: (1) be more frequently male (T ¨ ukel et al., 2004), single, unemployed and have lower educational level (Wittchen and Beloch, 1996; Lecrubier et al., 2000; Wittchen et al., 2000; Lipsitz and Schneier, 2000; Acarturk et al., 2008); (2) present earlier age at onset of OCD symptoms (Jaisoorya et al., 2003), longer duration of OCD (Diniz et al., 2004), greater clinical severity, greater suicidality (Angst, 1993; Nelson et al., 2000; Dunner, 2001; Stein et al., 2001) and more symptoms of the hoarding dimension (Samuels et al., 2002, 2007; Wheaton et al., 2008); (3) be more likely to present comorbidity with depression (Pigott et al., 1994; Merikangas and Angst, 1995; Essau et al., 1999; Lecrubier et al., 2000; Lipsitz and Schneier, 2000; Nelson et al., 2000; Stein et al., 2001; Dunner, 2001; Wittchen and Fehm, 2001, 2003; Chartier et al., 2003; Hong et al., 2004) and other anxiety disorders (Merikangas and Angst, 1995; Chartier et al., 2003), body dysmorphic disorder (Wilhelm et al., 1997; Gunstad and Phillips, 2003), eating disorders (O'Brien and Vincent, 2003; Baldwin et al., 2008) and alcohol use disorders (Mullaney and Trippett, 1979; Merikangas and Angst, 1995; Lé pine and Pé lissolo, 1998; Essau et al., 1999; Lecrubier et al., 2000; Lipsitz and Schneier, 2000; Nelson et al., 2000; Wittchen and Fehm, 2001, 2003; Myrick and Brady, 2003; Chartier et al., 2003; Buckner et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Social Phobia (SP) is an anxiety disorder that frequently co-occurs with obsessive-compulsive disorder (OCD); however, studies that evaluate clinical factors associated with this specific comorbidity are rare. The aim was to estimate the prevalence of SP in a large multicenter sample of OCD patients and compare the characteristics of individuals with and without SP. METHOD: A cross-sectional study with 1001 patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders using several assessment instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Structured Clinical Interview for DSM-IV Axis I Disorders. Univariate analyses were followed by logistic regression. Results: Lifetime prevalence of SP was 34.6% (N=346). The following variables remained associated with SP comorbidity after logistic regression: male sex, lower socioeconomic status, body dysmorphic disorder, specific phobia, dysthymia, generalized anxiety disorder, agoraphobia, Tourette syndrome and binge eating disorder. LIMITATIONS: The cross-sectional design does not permit the inference of causal relationships; some retrospective information may have been subject to recall bias; all patients were being treated in tertiary services, therefore generalization of the results to other samples of OCD sufferers should be cautious. Despite the large sample size, some hypotheses may not have been confirmed due to the small number of cases with these characteristics (type 2 error). Conclusion: SP is frequent among OCD patients and co-occurs with other disorders that have common phenomenological features. These findings have important implications for clinical practice, indicating the need for broader treatment approaches for individuals with this profile.
    Journal of Affective Disorders 08/2012; 143(1-3). DOI:10.1016/j.jad.2012.05.044 · 3.38 Impact Factor
  • Source
    • "Hoarders also show a greater prevalence of DSM-IV [35] Axis I disorders such as social phobia, brief depression, and hypomania [15] [33]; major depressive disorder, dysthymia, specific phobia, and generalized anxiety disorder [34]; bipolar disorder [25] [28]; tic disorder [33]; substance use [28]; eating disorders [25] [28]; pathological grooming behaviors such as skin picking or nail biting [15]; body dysmorphic disorder [36]; and posttraumatic stress disorder [36]. Personality disorders such as borderline, histrionic, narcissistic [15], obsessive-compulsive [15] [28] [34] [37], anxious avoidant [37], schizotypal [26], and dependent [26] [28] have been reported to be more prevalent in hoarders than in nonhoarders. Hoarding is found to be more frequent in firstdegree relatives of hoarding than nonhoarding patients [13] [15] [33] [38] [39]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Hoarding is frequently conceptualized as a symptom of obsessive-compulsive disorder (OCD), but recent evidence indicates that, in most cases, hoarding may be better conceptualized as a distinct disorder that can coexist with OCD. Most of the research on hoarding is from the Western countries. This study aimed to provide data on the prevalence and correlates of clinically significant hoarding in a large sample of patients with OCD from the Indian subcontinent. Methods: We examined 200 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition OCD for clinically significant hoarding using the Saving Inventory-Revised, followed by a clinical interview. Results: Twenty patients (10%) had clinically significant hoarding. In all cases, hoarding did not appear to be related or secondary to other OCD symptoms. None of the cases consulted for their hoarding problems. Compared with nonhoarders, hoarders hailed exclusively from an urban background and had a significantly higher frequency of certain obsessions and compulsions, bipolar disorder, generalized anxiety disorder, cluster C personality disorders, and a higher number of lifetime suicidal attempts. They also had a more severe OCD along with poorer global functioning and somewhat poorer insight into obsessive-compulsive symptoms. Conclusions: The results suggest that clinically significant hoarding is relatively prevalent in Indian patients with OCD and that it appears to be largely unrelated to the OCD phenotype. However, the presence of comorbid hoarding is associated with more severe OCD, high comorbidity, more suicidal attempts, and a lower level of functioning. The results contribute to the current nosologic debate around hoarding disorder and provide a unique transcultural perspective.
    Comprehensive psychiatry 07/2012; 53(8). DOI:10.1016/j.comppsych.2012.05.006 · 2.25 Impact Factor
Show more