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.

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Available from: David F Tolin, Dec 19, 2014
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    • "In that referral, the caseworker noted that Jocelyn had successfully avoided eviction proceedings due to the progress she had made with de-cluttering. He reported that the Clutter Image Rating (CIR; Frost et al. 2008) assessments of the rooms in her apartment began at the severe end of the scale (CIR = 8), and based on the most recent visit, the rooms are now at a CIR of 6. He stated that while Jocelyn was not mandated into treatment at this time, he believed she needed continued support so that she could pass annual housing inspections and continue to make progress. "
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    ABSTRACT: A recent addition to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), hoarding disorder (HD) is characterized by difficulty discarding possessions and associated distress, cluttered living space, and substantial functional impairment. This chapter focuses on Jocelyn, a 60-year-old single female with HD and comorbid major depressive disorder, posttraumatic stress disorder, attention deficit disorder, and history of polysubstance abuse, living in an urban, Section 8 housing. This case example illustrates the manifestations and course of HD as well as the specialized cognitive behavioral treatment (CBT) strategies for HD in a community mental health clinic. The core components of specialized CBT for hoarding (developed by Steketee and Frost, 2007a,b; 2013a,b;) include assessment, psychoeducation and case formulation, motivational enhancement, goal setting, skills training (organizing, problem solving, decision making), behavioral exposure practice for discarding and non-acquisition, cognitive strategies to challenge thoughts and beliefs, and relapse prevention. The CBT techniques portrayed are aimed to address specific aspects of Jocelyn’s personal hoarding model which include personal and family vulnerabilities, information-processing problems, beliefs about possessions, emotional responses (positive and negative), and learned behaviors. The role of case management and other human service personnel are also discussed.
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    • "However, the difference between the two groups in degree of clutter was small and not practically meaningful (2.26 in hoarding group vs. 1.44 in nonhoarding group). Furthermore, the mean composite CIR score reported by the hoarding group in our study was lower than those reported by hoarding groups in previous studies (e.g., 4.01 inFrost et al. (2008), 3.67 in Nordsletten et al. (2013), and did not meet the clinical cutoff of 4, indicating low levels of clutter despite prominent hoarding symptoms. In other words, hoarding participants in our sample were differentiated by greater difficulty discarding and excessive acquisition (behavioral dispositions associated with HD) rather than by amount of clutter (consequence of Table 5Partial rank correlations among measures of hoarding, functional impairment due to clutter, and quality of life, controlling for anxiety and depression a . "
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    ABSTRACT: Hoarding symptoms commonly co-occur with other psychiatric disorders, such as major depressive disorder, and have been observed across cultures. Yet, few studies have examined hoarding in other disorders or in an Asian context. The present study aimed to determine: (1) the prevalence of clinically significant hoarding, (2) differences between participants with and without significant hoarding, and (3) predictors of hoarding severity in a Singaporean clinical sample. Five hundred outpatients with anxiety disorders, depressive disorders, schizophrenia, and pathological gambling completed a battery of questionnaires on hoarding, anxiety, depression, functional impairment due to clutter, and quality of life. Thirty percent of our sample reported significant hoarding. However, clutter levels in the hoarding group were low, and hoarding severity was not significantly linked to quality of life, after adjusting for anxiety and depression. In addition, depression - but not anxiety - predicted hoarding severity. Our results provide a cross-cultural perspective on hoarding symptoms, and replicate findings that support a link between depression and hoarding. The differential presentation of hoarding in our sample could be due to true cultural differences in hoarding pathology or to variant psychometric properties of the measures used. Further research evaluating hoarding in Asian contexts with different methodology is needed.
    Full-text · Article · Dec 2015 · Journal of Obsessive-Compulsive and Related Disorders
    • "Hoarding participant-and CSO-rated clutter severity were assessed using the CIR; participants with hoarding problems reported on their own clutter severity, whereas CSOs reported on their perceptions of hoarding participants' clutter severity. The CIR has strong internal consistency , test–retest reliability, and interrater reliability (Frost et al., 2008). Internal consistency for the hoarding participantrated and CSO-rated CIR composite score were found to be good in the present study (α ¼.80, and α¼.88, respectively). "
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    ABSTRACT: Problem hoarding is associated with significant family dysfunction and burden on family members. Currently, little is known about the effect that family members have on individuals' hoarding symptoms and functioning, and vice versa. The present study examined the nature and frequency of accommodation in hoarding. Fifty-two individuals with self-reported hoarding problems and their close significant others (CSOs) completed the Family Accommodation Interview for Hoarding (FAI-H), which was adapted from a previously validated measure for this study, and a series of self-report questionnaires. The FAI-H was found to be a reliable and valid measure of accommodation in problem hoarding. CSOs who lived with the individual with the hoarding problem reported engaging in accommodating behaviors more frequently than those who did not live with the individual. Accommodation was positively associated with hoarding symptom severity, relationship functioning, and CSOs' rejecting attitudes toward the individual with hoarding problems, and it partially mediated the association between hoarding symptom severity and relationship conflict. These results inform our understanding of accommodation and interpersonal processes in hoarding, and suggest that accommodation may play an important role in problem hoarding.
    No preview · Article · Aug 2015 · Journal of Obsessive-Compulsive and Related Disorders
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