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HOARD Quesonnaire – A Screening Tool for Hoarding Disorder
Dr Himanshu Tyagi MRCPsych, Dr Lynne M Drummond MRCP FRCPsych
South West London and St Georges Mental Health NHS Trust, London United Kingdom
BACKGROUND
Compulsive Hoarding is a complex psycho-social problem which has re-
ceived signicant aenon from academics and media alike in past few
years. In parcular, inclusion of Hoarding disorder as a separate diagnosis
in DSM-V has renewed interest in this debilitang illness which can have fa-
tal consequences. Hoarding disorder is almost always chronic by nature.
The available treatment opons are limited and largely ineectual. There
are a number of quesonnaires available to aid the diagnosis and treat-
ment of hoarding disorder, but no exisng1 quesonnaire provides a relia-
ble way to idenfy the problem before the emergence of observable be-
havioural consequences.
UNMET NEED FOR AN EARLY SCREENING OF HOARDING DISORDER
1. High prevalence
It is esmated that the prevalence of undetected hoarding is about three
mes that of eang disorders. Epidemiological studies suggest that up to
2-5% of general populaon can exhibit compulsive hoarding behaviours2.
A recent study on German populaon against3 of the proposed DSM-5
criteria revealed a populaon esmate of 5.8% in a naonally repre-
sentave sample4.
2. Underdiagnosed
Hoarding is commonly underdiagnosed. Individuals with Hoarding disor-
der do not necessarily seek treatment on their own. They typically pre-
sent to services aer the problem becomes observable by others. An eas-
ily administered screening tool can help in idenfying the risk of chronic
hoarding and also aid in developing appropriate pathways to access
health services early.
3. Late diagnosis & treatment
Diagnosis of hoarding disorder is usually made late in the lifecycle of this
disorder, which usually runs into several decades. It is therefore surpris-
ing that there is an absence of an easily administrable tool to detect the
risk of chronic hoarding and start intervenons at an earlier stage of this
disorder, when they are more likely to be eecve. A large body of re-
search evidence from the general eld of cognive behavioural therapy
(CBT) clearly suggests that dysfunconal core beliefs are more amenable
to change if they are addressed early5.
4. Need to change the focus of treatment
Individuals with chronic hoarding problems are commonly recalcitrant to
exisng psychological treatment methods. In addion there is a signi-
cant rate of recurrence (relapse) of Hoarding behaviour following suc-
cessful treatment episodes. A possible reason for this could be the limita-
on posed by a late presentaon, which in most cases makes it dicult
to focus on strategies other than those dealing with containment and
management of the behavioural consequences. We strongly believe that
new treatment techniques would develop by facilitang an early diagno-
sis of Hoarding disorder.
Hoarding disorder has a large esmated lifeme prevalence rate, a chronic nature to the illness, problems with
a late diagnosis and treatment ineecveness. All these factors make a strong case to have a screening tool for
this disorder. We present one such tool which is developed for this purpose at the Naonal OCD Service in
United Kingdom by clinicians well experienced in the treatment of Hoarding Disorder.
HOARD
A SCREENING QUESTIONNAIRE TO ASSESS THE RISK OF
CHRONIC HOARDING
Question 1. [Keyword: Hurt]
Are you easily Hurt if others comment on the excessiveness of your
saved items?
Question 2. [Keyword: Organise]
Have you always wanted to Organise your things in a meaningful
way but are unable to do so because of any reason (e.g. limited time
and resources)?
Question 3. [Keyword: Acquisition]
Are you usually not able to stop yourself from Acquiring new items
which have no immediate use but might be put to some use in fu-
ture?
Question 4: [Keyword: Running out of space]
Do you find that you are constantly Running out of space to store
your belongings?
Question 5: [Keyword: Difficulty Discarding]
Do you find it difficult to Discard things which you haven’t used for a
long time?
Use: Any positive answer should trigger a more detailed assessment of hoarding problems.
KEY FEATURES
Very simple binary quesonnaire with yes and no answers with only 5 items, de-
signed in simple to understand English with no technical words, can be printed
on one side of a A4 sheet of paper or t on a single computer screen above the
fold (no need for scrolling), can be administered by a trained clinician or a non-
trained person. Self administraon is also possible.
Deals only with the problems a hoarder would recognise, not the problems a
hoarder would nd dicult to accept.
Avoids the “inventory” style quesons on which most diagnosc quesonnaires
are based on as suerers can perceive them to be “crical”.
Quesons asking to quanfy hoarding or focussing on obvious manifestaons of
hoarding behaviour do not foster empathy with the client. Therefore in this ques-
onnaire we limited the quesons to the subjecve experience of the hoarding
problems but sll kept it precise by basing the quesons on aributes idened
by research to be the core features of hoarding.
As each queson measures a dierent dimension of hoarding problem, it can in-
form the choice of CBT techniques and focus of treatment.
Easy to remember because the acronym HOARD includes all key aributes it is
measuring.
Less than ve minutes to administer and rate.
Feedback from 50 mental health clinicians and general praconers has been
overwhelmingly posive4.
feedback and comments: himanshutyagi@nhs.net