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
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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.

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Available from: Kiara R Timpano, Oct 06, 2015
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    • "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). "
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    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
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    • "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]. "
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    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
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    • "The most consistently replicated OC symptom dimensions, which are associated with a specific pattern of comorbidity, genetic transmission, neural substrates, and treatment response (Mataix-Cols et al., 2005), are contamination obsessions and washing/cleaning compulsions, obsessions about responsibility for causing harm or making mistakes and checking compulsions, obsessions about order and symmetry and ordering/arranging compulsions, and repugnant obsessional thoughts concerning sex, religion, and violence along with mental compulsive rituals and other covert neutralizing strategies (e.g., thought replacement) (Abramowitz et al., 2010). Although in the last decade some have considered hoarding as an OC symptom dimension, research suggests that hoarding is not a symptom or manifestation of OCD (e.g., Rachman et al., 2009; Wheaton et al., 2011), since it seems to be more strongly related to other types of psychopathology (e.g., personality disorders; Frost et al., 2000), it is associated with an earlier age of onset, it tends to show distinct neural activity patterns and genetic susceptibility loci (Wheaton et al., 2008), and it has a weaker response to pharmacological and psychological treatments with demonstrated efficacy for OCD (Abramowitz et al., 2003; Mataix-Cols et al., 1999). Abramowitz and co-workers (2010) pointed out that the aforementioned measures of OC symptoms have a number of shortcomings that impair their ability to provide a time efficient, empirically consistent, and conceptually clear assessment of OC symptom severity: (1) In comparison to respondents with fewer or more circumscribed types of obsessions and compulsions, patients with multiple types of symptoms will endorse a greater number of scale items and therefore will spuriously obtain more severe scores. "
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    ABSTRACT: Analyses of traditional OCD subtypes (washers, checkers, hoarders, etc.) have been criticized for two main reasons. First, OCD symptoms appear to exist on a continuum from subclinical to severe, therefore discrete subtypes may be inadequate to describe this continuum. Second, most OCD patients do not fit neatly into specific symptom categories. Rather, the majority of patients report multiple symptoms of different kinds. Obsessions, compulsions, and avoidance strategies are thematically heterogeneous and tend to reflect the individual’s highly idiosyncratic concerns. Structural analyses indicate that obsessive-compulsive symptoms are dimensional and that specific types of obsessions and compulsions tend to co-occur. Therefore, examination of OCD symptom dimensions, rather than symptom subtypes, may be preferable. A dimensional model allows each subject to be rated on the severity, rather on the mere presence or absence, of a symptom. The heterogeneity and idiosyncratic nature of OCD symptoms present unique challenges to the development of content valid assessment instruments. Although an array of self-report and interview measures have been developed to assess OC symptoms, these measures have a number of important drawbacks. In the present paper, we discuss the implications of these topics for the assessment of OCD and report on the development and Italian validation of a new self-report scale — the Dimensional Obsessive-Compulsive Scale (Abramowitz et al., 2010) — which aims to address the aforementioned needs.
    Psicoterapia Cognitiva e Comportamentale 01/2012; 18(3):99-110.
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