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Background: A new diagnostic category, hoarding disorder (HD), has been proposed for inclusion in DSM-5. This study field-tested the validity, reliability and perceived acceptability of the proposed diagnostic criteria for HD. Method Fifty unselected individuals with prominent hoarding behavior and 20 unselected, self-defined 'collectors' participated in thorough psychiatric assessments, involving home visits whenever possible. A semi-structured interview based on the proposed diagnostic criteria for HD was administered and scored by two independent raters. 'True' diagnoses were made by consensus according to the best-estimate diagnosis procedure. The percentage of true positive HD cases (sensitivity) and true negative HD cases (specificity) was calculated, along with inter-rater reliability for the diagnosis and each criterion. Participants were asked about their perceptions of the acceptability, utility and stigma associated with the new diagnosis. Results: Twenty-nine (58%) of the hoarding individuals and none of the collectors fulfilled diagnostic criteria for HD. The sensitivity, specificity and inter-rater reliability of the diagnosis, and of each individual criterion and the specifiers, were excellent. Most participants with HD (96%) felt that creating a new disorder would be very or somewhat acceptable, useful (96%) and not too stigmatizing (59%). Conclusions: The proposed HD criteria are valid, reliable and perceived as acceptable and useful by the sufferers. Crucially, they seem to be sufficiently conservative and unlikely to overpathologize normative behavior. Minor changes in the wording of the criteria are suggested.
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... Similarly, in a study assessing the clinical correlations of hoarding in a pediatric sample, it was thought that this criterion might be difficult to determine because the parents could control the degree of cluttering, so it was not used as a diagnostic criterion [17]. It has been stated that the C criterion is strict and conservative not only in childhood and adolescence, but also in adulthood and that the rewriting the cluttering criterion can provide a balance between false positives and false negatives [37]. Consistent with the scientific literature, the results of our study suggest that DSM-5 criteria can be adapted specifically for childhood and adolescence and that parental intervention can be considered an important element when endorsing the diagnostic criteria. ...
... Another important issue in two-stage epidemiological studies is the questionnaire or scales used to move to the second stage evaluation. Although multiple self-report hoarding questionnaires have been developed in adults [37], there is only one parent-report questionnaire for the pediatric population. CSI is the first and only measurement tool developed to evaluate the hoarding behavior of children [32]. ...
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Although hoarding symptoms are reported to begin in childhood and adolescence, the true prevalence of the disorder in this age group is unknown. This study aims to estimate the prevalence of hoarding disorder (HD) in children and adolescents. The present study was planned as a two-stage epidemiological research. In the first stage, the Children’s Saving Inventory (CSI) and informed consent forms were delivered to a group of students’ parents. In the second stage, one-on-one psychiatric interviews with a physician were planned with the families and children who had hoarding behavior (HB), as described by their parents. The DSM-5-based HD interview and the Development and Well-Being Assessment (DAWBA) diagnostic tool were used to detect prevalence of HD and comorbid psychiatric disorders. A total of 3249 children were included in the study, and 318 children and their parents were evaluated in the second stage. As a result of the second assessment, 32 out of 318 children met the HD diagnostic criteria. The estimated prevalence of HD was 0.98% (95% CI 0.7–1.4). Hoarding disorder was found more frequently in females (F/M = 3/1). After a logistic regression analysis, variables such as female sex and the presence of any psychopathology were identified as independent correlates of HD. More than half (56.2%) of the children diagnosed as having HD also had a comorbid psychiatric disorder. In the present study, the two-stage evaluation method was used in a large pediatric sample to determine the estimated prevalence of HD, as well as the factors associated with the disorder and comorbid psychiatric disorders.
... Hoarding Disorder is characterized by persistent difficulty discarding objects resulting in object accumulation and compromised living areas (American Psychiatric Association [APA], 2013;Mataix-Cols et al., 2013). Researchers have speculated that the development or exacerbation of hoarding symptoms may be influenced by traumatic life events which may disrupt healthy attachments and contribute to the belief that people are less reliable for emotional comfort than objects (Frost & Hartl, 1996;Kehoe & Egan, 2019). ...
Article
Background Individuals with hoarding report stressful and traumatic life events at an elevated rate compared with those with obsessive‐compulsive disorder and healthy controls, but have not been compared with other clinical groups. This study compared rates of traumatic life events between those with clinically significant hoarding, anxiety disorders, or posttraumatic stress disorder (PTSD), hypothesizing that rates would be higher in the hoarding and PTSD groups than the anxiety group. Methods Rates of traumatic and stressful events were compared across groups. Results All comparisons across groups on types of events were significant (partial‐eta squared 0.051–0.162). The hoarding group endorsed significantly more crime‐related events but similar rates of other events as compared to the PTSD and anxiety disorder groups. Conclusion These findings suggest that many stressful and traumatic life events are not uniquely elevated in hoarding when compared with other clinical populations.
... Hoarding can involve not only items of no value but also animals in the most severe cases, interfering with basic household activities and cleaning. Other hazards such as fires, structural failures in floors, and rodent and insect infestations can create significant risks not only for the home's occupants but also for persons living nearby (Frost et al. 2004Lacombe and Cossette 2018;Mataix-Cols et al. 2013;Rasmussen et al. 2014;Scuri et al. 2018;Snowdon and Halliday 2009). ...
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The aims of this work were to apply the Environmental Cleanliness and Clutter Scale (ECCS) in order to assess domestic squalor in dwellings of hoarders, prevent sanitary risks, and intervene in solving the problem. Methods The ECCS is a domestic squalor scale, developed as a quantitative descriptive tool, based on ten items and a four-point scale. ECCS was applied in addition to the usual procedure during 40 site inspections in Milan, in two different surveys of dwellings of hoarders (2016 and 2019). A correction only for companion animal hoarders was introduced. Results In the first investigation, which included animal accumulation, our 20 raters reported six cases of mild squalor and six and eight respectively of moderate and severe squalor. After our correction for animal hoarders’ dwellings, we identified six cases of mild, four of moderate, and ten of severe squalor. In the second part of our assessment involving another 20 home visits, object hoarding only was assessed in order to evaluate the reliability of the ECCS method. We found varying total scores between the operators with different experience on this issue, but the same evaluation of the severity of the squalor in 14/15 (93%) cases therefore resulted in the same type of intervention. Conclusion The ECCS score made an evaluation of the severity of hoarding/squalor, and supported the Local Health Protection Agency personnel in making decisions about timing and type of intervention.
... Hoarding is found in multiple comorbidities, such as schizophrenia, social phobia, organic mental disorders, eating disorders, depression, and dementia. 3,4,11,16,22 Hoarding traits are also found in 30% of people diagnosed with OCD. 23 In children, hoarding characteristics are seen in children with attention deficit hyperactivity, autism, anorexia nervosa, and ...
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The aim of the present study was to provide an overview of the compulsive hoarding syndrome, including manifestations of the problem, comorbidity and diagnostic issues, treatment approaches, epidemiology, course, and demographic features of compulsive hoarding. Material and Method: A literature review was conducted on both Greek and English languages, through Pubmed, Scopus, Science Direct and Google Scholar databases, using the keywords: "com-pulsive hoarding", "treatment" "community". Results: Compulsive hoarding is a disabling psychological disorder characterized by acquisition, clutter, excessive collection of items, and inability to discard. Associated with increased risk of injury due to the severe clutter and unsanitary conditions, social isolation and disorganization, compulsive hoarding can be devastating for individuals, family members, and communities. Treatment may be affected by the accuracy of the community nurse's understanding of this complex disorder and educating individual hoarders, family and community members and other health care professionals as the effects of hoarding often extend outside the home. Conclusions: Compulsive hoarding is a serious public health problem that poses significant health and safety risks for individuals , families, and communities and has a profound effect on public health in terms of poor physical health, occupational impairment, and health care service involvement. Community health nurses play a unique role in the identification and care of hoarders. Περίληψη Σκοπός της παρούσας ανασκόπησης ήταν η διερεύνηση των βιβλιογραφικών δεδομένων αναφορικά με τα συμπτώματα, τη συννοσηρότητα, τα διαγνωστικά προβλημάτα, τις θεραπευτικές προσεγγίσεις, την επιδημιολογία, την πορεία και τα δημογραφικά χαρακτηριστικά του Συνδρόμου Αποθησαύρισης. Υλικό και μέθοδος: Πραγματοποιήθηκε βιβλιογραφική ανασκόπηση άρθρων στην ελληνική και αγγλική γλώσσα συναφών με το θέμα στις ηλεκτρονικές βάσεις δεδομένων Pubmed, Scopus, Science Direct και Google Scolar, χρησιμοποιώντας ως λέξεις-κλειδιά: «Σύνδρομο Αποθησαύρισης», «θεραπεία», «κοινότητα». Αποτελέσματα: Το Σύνδρομο Αποθησαύρισης είναι μια εκπτωτική ψυχιατρική διαταραχή, που χαρακτηρίζεται από συσσώρευση, ακατάστατους και βρώμικους χώρους διαβίωσης, υπερβολική συλλογή αντικειμένων και αδυναμία απόρριψης. Η συσχέτιση του συνδρόμου με αυξημένο κίνδυνο τραυματισμού εξαιτίας της σοβαρής ακαταστασίας και των ανθυγιεινών συνθηκών κάτω από τις οποίες διαβιώνει το άτομο, της κοινωνικής απομόνωσης μπορεί να αποβεί καταστροφική για το άτομο, την οικογένειά του και την κοινότητα. Η θεραπευτική προσέγγιση μπορεί να επηρεαστεί από το βαθμό που ο κοινοτικός(-ή) νοσηλευτής(-τρια) κατανοεί αυτή την πολύπλοκη διαταραχή και εκπαιδεύει τον πάσχοντα, την οικογένεια, την κοινότητα και τους άλλους επαγγελματίες υγείας, καθώς οι επιπτώσεις της ασθένειας συχνά εκτείνονται και γίνονται αντιληπτές και έξω από το σπίτι του πάσχοντα. Συμπεράσματα: Το Σύνδρομο Αποθησαύρισης αποτελεί σοβαρό πρόβλημα δημόσιας υγείας που δημιουργεί σημαντικούς κινδύνους για την υγεία και την ασφάλεια των ατόμων, των οικογενειών και της κοινότητας, λόγω της σημαντικής επίδρασης που ασκεί στην επιδείνωση της σωματικής υγείας του πάσχοντα, στη διατάραξη της επαγγελματικής του κατάστασης και στη χρήση των υπηρεσιών υγείας. Οι κοινοτικοί νοσηλευτές διαδραματίζουν έναν μοναδικό ρόλο στην ταυτοποίηση και τη φροντίδα των πασχόντων.
Chapter
Collecting has been recognised as a widespread activity since ancient times. In fact, most people know a friend, colleague, or acquaintance who owns a proper collection of some sort. The question is why do people invest money, time, and energy in such a curious and probably never-ending activity? In this chapter, we attempt to answer this query, or to at least shed some light on this topic from the point of view of the psychological literature, of which we offer a short review, and from which we believe it is possible to develop hypotheses for future multidisciplinary research and application.
Article
Hoarding disorder (HD) is characterised by excessive acquisition and distress associated with discarding objects, resulting in significant clutter. At present, cognitive behavioural therapy (CBT) represents the strongest evidence base for treating HD, although some limitations exist. Little research has examined the effectiveness of remote-CBT interventions for HD in older adults. This case study focuses on Mary, an older female adult presenting with clinically significant hoarding behaviours which severely impact her daily functioning and quality of life. Assessment and intervention followed a structured CBT approach. Despite the complicating factor of COVID-19, Mary responded well to a remote-CBT intervention, with progress indicators suggesting modest improvements in personal, social and occupational functioning. These findings support the use of remote-CBT for HD in both reducing frequency and intensity of hoarding behaviours and improving wellbeing. Key learning aims (1) Hoarding disorder (HD) is a poorly understood disorder that can significantly impact an individual’s personal, social and occupational functioning. (2) According to a cognitive behavioural model, HD emanates from information-processing deficits, emotional attachment difficulties, behavioural avoidance and maladaptive beliefs about objects and the self (Frost and Hartl, 1996). (3) Observations from this case study suggest the acceptability and effectiveness of a remote cognitive behavioural therapy (CBT) intervention for HD, with outcomes appearing congruous with those produced by face-to-face intervention. (4) While research attests to the effectiveness of a CBT intervention for HD, an augmented account of the mechanisms through which these outcomes are achieved is required.
Article
Background: It is suggested that the different psychological vulnerability factors of intolerance of uncertainty (IU), anxiety sensitivity (AS) and distress tolerance (DT) may be in important in hoarding disorder (HD). However, the extent to which these factors are specific to HD compared with other disorders remains unclear. Aims: The current study aimed to investigate differences in IU, AS and DT in three groups: HD (n=66), obsessive compulsive disorder (OCD; n=59) and healthy controls (HCs; n=63). Method: Participants completed an online battery of standardised self-report measures to establish the independent variable of group membership (HD, OCD and HC) and the dependent variables (IU, AS and DT). Results: A MANOVA analysis indicated statistically significant differences in IU, AS and DT between the clinical groups and HCs. Follow-up analyses showed no statistically significant differences between the HD and OCD group for any of the three constructs. The results remained the same when examining the effects of co-morbid HD and OCD. An unexpected finding was the trend for IU, AS and DT to be more severe when HD and OCD were co-morbid. Conclusions: The evidence suggests the absence of a specific relationship between IU, AS or DT in HD and instead is consistent with existing research which suggests that these psychological vulnerability factors are transdiagnostic constructs across anxiety disorders. The implications of the findings are discussed.
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Evidence based treatments for pediatric Obsessive-Compulsive Disorder (OCD) are delivered with varying levels of expertise. This paper is part of the phase two series by the International OCD Accreditation Task Force (ATF) to advance a standardized high level of care globally. This paper presents specific knowledge and competencies recommended for specialized practice for pediatric psychopharmacologists working with OCD, developed by an international group of clinicians with extensive expertise in assessment and treatment of OCD. Tabulated knowledge and competency standards are operationalized as clinician abilities with specification of evidence for each standard. The distinction between current practice guidelines and ATF standards is discussed. Drug treatment has a solid evidence base. However, it should not be applied isolated, but informed by broad competence in general child and adolescent psychiatry and pediatrics. Other treatment relevant areas such as specialty CBT, family functioning, developmental issues, and neurobiology require consideration. Drug treatment includes several phases with varying degrees of evidence: Starting up medication, titration to maximum tolerated dose, maintenance, termination, and relapse prevention. In complex cases, pharmacotherapy with weak evidence may be needed to target symptoms and/or co-morbidity. The ATF knowledge and competency standards presented will be reviewed and updated commensurate with research.
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Individuals with hoarding disorder (HD) typically perform worse than peers on neuropsychological tasks involving visual perception. Functional neuroimaging shows diffusely increased activity in the visual cortex, consistent with inefficient visual processing in HD. The temporal locus of these inefficiencies in HD is unknown. This study examined the temporal unfolding of visual event‐related brain potentials (ERPs) to help better define the neurophysiological mechanisms underlying visual dysfunction in HD. Thirty‐three individuals with HD and 35 healthy controls (HC) were assessed using a 64‐channel EEG during a modified flanker task. Permutation‐controlled analyses were conducted to detect group differences in visual evoked ERPs on a millisecond‐to‐millisecond basis. Bayesian ANCOVAs and linear regressions that included hoarding and age were conducted to identify the best‐fit model for the identified VEPs, compared to a null model that included depression and anxiety severity. Three temporal regions (175 ms, 270 ms, and 440 ms), showed differences in amplitude between HD and HC and were consistent with ERP components N1, P1/N2, and a late negative slow wave (LNSW), respectively. After controlling for depression and anxiety, HD demonstrated an enhanced ERP amplitude at N1 and an attenuated amplitude in LNSW compared to HC but did not show differences at P1/N2. For the N1 and LNSW, there was also a primary effect of the interaction between hoarding and age. This study indicates that altered visuocortical reactivity in HD first occurs at the level of visuocortical processing after 170 ms, indicating alterations of middle and later, but not early, processing in occipitotemporal visual cortex.
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Hoarding disorder (HD) is characterised by difficulties in discharging or parting with possessions irrespective of their actual value, urges to save and acquire new items and excessive clutter in living areas. There is an urgent need to advance the understanding of HD in child and adolescent populations. The aim of this paper is to cover the assessment, treatment strategies and tools currently available. In general, data on assessment of paediatric HD are scant. Only one psychometrically sound scale, the Child Savings Inventory, which is a parent-rated scale used to assess the severity of hoarding symptoms, was found. However, this scale is not sufficient to produce a diagnosis of HD. Regarding treatment, there was only a limited number of case studies suggesting the effectiveness of cognitive behavioural therapy that includes exposure to discarding and not collecting new items, using contingency management for exposure and oppositional behaviour, cognitive training and instructing parents to assist with home-based exposures. In conclusion, there is an urgent need for properly validated Diagnostic and Statistical Manual of Mental Disorders assessment tools, and we encourage practitioners and researchers to develop and test a Cognitive behavioral therapy (CBT) protocol for paediatric HD based on the aforementioned components.
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A new diagnosis termed Hoarding Disorder has been proposed for inclusion in the upcoming DSM-5 to cover the majority of cases where severe hoarding occurs in the absence of, or independently from other mental disorders. Much effort has been directed to ensuring that the proposed criteria discriminate Hoarding Disorder from other mental disorders, particularly those historically associated with hoarding (e.g. OCD, OCPD). Considerably less attention, however, has been paid to addressing the suitability of the proposed criteria for effectively differentiating pathological hoarding from normative collecting behavior. This is crucial in order to avoid false positives or the overpathologization of this widespread human activity. Collecting behavior mirrors many of the core features of hoarding (e.g. the acquisition of and emotional attachment to a potentially large number of objects), is highly prevalent and is generally considered a normative form of object amassment; as such, it represents a valid population with which to explore the diagnostic boundaries of Hoarding Disorder. Examination of the collecting literature, within the context of the hoarding diagnostic criteria, indicates that, for the majority of collectors, a diagnosis of Hoarding Disorder is likely to be effectively ruled out. For a minority of 'extreme' collectors, a diagnosis may potentially be adequate. This review highlights the similarities and differences between hoarding and collecting and offers suggestions for further research in this group.
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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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McElroy, Keck, and Phillips (1995) hypothesized that compulsive buying belongs to a compulsive-impulsive spectrum and should be related to obsessive-compulsive disorder (OCD). This study compared compulsive buyers to noncompulsive buyers on hoarding and OCD symptoms. Compulsive buyers scored higher on both types of symptoms, but the relationship between buying and OCD was mainly mediated by hoarding. A measure of buying that emphasized financial consequences correlated highly with measures emphasizing the psychological function of possessions and the acquisition of free things (e.g., handouts at a lecture, free newspapers, etc.). The latter 2 buying measures were more closely associated with hoarding and OCD than the buying measure emphasizing financial concerns. A reconceptualization of compulsive buying is proposed incorporating the broader construct of acquisition.
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Compulsive hoarding is a little studied phenomenon within the research literature. The information available on compulsive hoarding is diverse and not well integrated. In the present article we propose a tentative cognitive-behavioral model of compulsive hoarding. The purpose of such a model is to provide a framework for the development and testing of hypotheses about compulsive hoarding. In this model hoarding is conceptualized as a multifaceted problem stemming from: (1) information processing deficits; (2) problems in forming emotional attachments; (3) behavioral avoidance; and (4) erroneous beliefs about the nature of possessions. Specific hypotheses about each of these are discussed.