Hoarding disorder: A new diagnosis for DSM-V?

Depression and Anxiety (Impact Factor: 4.41). 06/2010; 27(6):556 - 572. DOI: 10.1002/da.20693
Source: PubMed


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.

    • "DSM-5 introduced hoarding disorder for the first time. This was supported by a literature indicating that hoarding disorder differs in important respects from OCD, and that hoarding disorder is also not the same as normal collecting (Mataix-Cols et al., 2010). There is considerable evidence, including data on diagnostic validators such as associated impairment and underlying psychobiology, to indicate that hoarding is a dysfunction. "
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    ABSTRACT: Biological explanations address not only proximal mechanisms (for example, the underlying neurobiology of obsessive-compulsive disorder), but also distal mechanisms (that is, a consideration of how particular neurobiological mechanisms evolved). Evolutionary medicine has emphasized a series of explanations for vulnerability to disease, including constraints, mismatch, and tradeoffs. The current paper will consider compulsive symptoms in obsessive-compulsive and related disorders and behavioral addictions from this evolutionary perspective. It will argue that while obsessive-compulsive disorder (OCD) is typically best conceptualized as a dysfunction, it is theoretically and clinically valuable to understand some symptoms of obsessive-compulsive and related disorders in terms of useful defenses. The symptoms of behavioral addictions can also be conceptualized in evolutionary terms (for example, mismatch), which in turn provides a sound foundation for approaching assessment and intervention.
    No preview · Article · Dec 2015 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
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    • "As três principais formas de aquisição de objetos relatadas por indivíduos com TA são compra compulsiva, coleta livre e, até mesmo, furto (Pertusa et al., 2010; APA, 2013a). Destacam-se, ainda, características como o consumismo, o desejo de organização, a falta do controle de impulsos e a ausência de limites e juízo crítico (Grisham et al., 2007; Mueller et al., 2009; Valente, 2009; Mataix‐Cols et al., 2010; Frost et al., 2011; Lima, 2011). Pesquisas apontam correlação entre TA e diagnósticos comórbidos de Tricotilomania e Dermatotilexomania (Mataix‐Cols et al., 2010), Transtorno Dismórfico Corporal (Nakata et al., 2007), Cleptomania (Steketee & Frost, 2003), Compras Compulsivas (Mueller et al., 2009; Frost et al., 2011), Transtorno de Déficit de Atenção com Hiperatividade (Grisham et al., 2007; Frost et al., 2011; APA, 2013b) e Dependência de Álcool (Samuels et al., 2008; Pertusa et al., 2010; APA, 2013b). "
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    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.
    Full-text · Article · Oct 2014
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    • "Recent studies [42,43] have found ample evidence that hoarding should not be conceptualized only as an OCD symptom. Indeed, hoarding is considered a stand-alone disorder in the DSM-5 [44,45], which is supported by our findings. The Hoarding subscale of the OCI-J should be interpreted cautiously due to the evidence of its inability to discriminate groups in a Japanese sample. "
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    ABSTRACT: Background The Obsessive-Compulsive Inventory (OCI) was designed to evaluate the severity of obsessive-compulsive symptoms in both clinical and non-clinical samples. The aim of the study was to develop a Japanese version of this scale (OCI-J) and validate it in both non-clinical and clinical Japanese samples. Findings In Study 1, the OCI-J, the Maudsley Obsessional Compulsive Inventory (MOCI), and measures of anxiety and depression were administered to 150 undergraduate students (non-clinical sample) in order to investigate the internal consistency and convergent validity of the OCI-J. Furthermore, 118 non-clinical participants completed the OCI-J after a 2-week interval to determine the test-retest reliability. In Study 2, OCD participants (n = 35), anxiety control participants with panic disorder (n = 22), and healthy control participants (n = 37) completed the OCI-J in order to test its clinical discrimination ability. Correlational analysis indicated moderate to high correlations between the subscales and total scores of the OCI-J and MOCI. In addition, the OCI-J and its subscales demonstrated satisfactory test-retest reliabilities. Finally, the OCI-J showed good clinical discrimination for patients with OCD from healthy and anxiety controls. Conclusions The OCI-J is a valid and reliable instrument for measuring OCD symptoms in both clinical and non-clinical samples of Japanese.
    Full-text · Article · May 2014 · BMC Research Notes
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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

    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.

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      ABSTRACT: Compulsive hoarding patients have been found in previous studies to have substantial disability and functional impairment. However, no prior study has examined subjective and objective quality of life (QOL) in patients with compulsive hoarding. This present study compared compulsive hoarders and non-hoarding OCD patients across a variety of QOL domains. Subjects were 171 consecutive adult patients (34 compulsive hoarders, 137 non-hoarding patients with DSM-IV OCD) treated openly between 1998 and 2004 in the UCLA OCD Partial Hospitalization Program (OCD PHP), a specialized, intensive, multi-modal treatment program for treatment-refractory patients. Scores on the Quality of Life Scale and other symptom severity measures on admission were compared between compulsive hoarders and non-hoarding OCD patients. Compulsive hoarders were older and had lower global functioning than non-hoarding OCD patients. Both groups had low overall QOL scores across multiple domains. Compulsive hoarders had significantly lower levels of satisfaction with their safety than non-hoarding OCD patients, were more often the victims of both violent and non-violent crime, felt less safe in their neighborhoods, and felt less protected against attack. Compulsive hoarders were also much less satisfied with their living arrangements than non-hoarding OCD patients. No differences were found on financial variables, but the vast majority of patients in both groups were unemployed. Compulsive hoarders have lower QOL than non-hoarding OCD patients in the domains of safety and living situation. Psychosocial rehabilitation that focuses on problems with victimization, safety, employment, and financial areas may be a beneficial augmentation to treatment for compulsive hoarding.
      Full-text · Article · Apr 2011 · Journal of Psychiatric Research

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