Article

Quality of life and functional impairment in compulsive hoarding

Department of Psychiatry, University of California at San Diego, 140 Arbor Drive, San Diego, CA 92103, United States.
Journal of Psychiatric Research (Impact Factor: 3.96). 04/2011; 45(4):475-80. DOI: 10.1016/j.jpsychires.2010.08.007
Source: PubMed

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.

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Available from: Tanya Vapnik, Nov 01, 2014
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    • "Early estimates suggest that HD is more common in the general population than previously thought, with prevalence rates as high as 5.8% (Nordsletten et al., 2013b; Timpano et al., 2011). Individuals with hoarding symptoms often experience substantial functional impairment and reduced quality of life (Saxena et al., 2011). In addition , severe hoarding can result in substantial costs to the community in terms of public health problems and social services utilization (Tolin et al., 2008). "
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    ABSTRACT: Background: Hoarding disorder (HD) is a common, debilitating mental illness and public health burden. Understanding the factors that contribute to hoarding is critical for identifying treatment targets. As a relatively new diagnostic entity, this research remains in its initial stages. Intolerance of uncertainty (IU) is thought to be a vulnerability factor for generalized anxiety disorder (GAD) and obsessive–compulsive disorder (OCD), and may also be relevant to HD. We investigated the possible association between IU and hoarding in two sets of analyses. Method: First, we administered self-report measures of IU and hoarding symptoms to unscreened un- dergraduate students (N1⁄4456) and used regressions to probe their association controlling for relevant covariates. Second, in a clinical sample, we compared IU across groups of patients with HD (N1⁄426), GAD (N1⁄426), OCD (N1⁄451), other anxiety disorders (N1⁄491) and healthy controls (N1⁄429). Results: In the student sample, IU predicted hoarding symptoms above and beyond relevant covariates, including hoarding-related beliefs. In the clinical sample, HD patients evidenced greater IU relative to healthy individuals and the mixed anxiety group, and comparable levels of IU to the GAD and OCD groups. Limitations: This study relied exclusively on self-report questionnaires and a cross-sectional design. Conclusions: IU is associated with hoarding behavior and, as we discuss, conceptual models might benefit from the study of IU as a potentially contributing factor. Directions for future research are dis- cussed.
    Full-text · Article · Dec 2015 · Journal of Affective Disorders
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    • "As a result of their particular challenges in maintaining a clean home, individuals with hoarding difficulties have also been found to be at increased risk for chronic medical conditions and higher rates of health care utilization compared to non-hoarding individuals (Tolin et al., 2008). A study of individuals with Obsessive-Compulsive Disorder (OCD) treated in an intensive multimodal program found that those with hoarding symptoms and OCD reported lower quality of life than nonhoarding OCD individuals, particularly on domains assessing safety and living arrangements (Saxena et al., 2011). "
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    ABSTRACT: Background Hoarding Disorder (HD), a new diagnostic entity in DSM-5, is associated with substantial functional impairment and family frustration but data from well-characterized samples is lacking. Method Participants were 37 individuals meeting DSM-5 criteria for HD, 55 relatives of individuals meeting criteria for HD, and comparison groups of 51 self-identified collectors and 25 relatives of collectors. All participants completed a clinician-administered diagnostic interview for HD and an online battery of standardized measures of health, well-being, and impairment. Results Substantial functional impairment was found for both HD individuals and their relatives. HD relatives reported significantly greater carer burden and accommodation of hoarding behaviors than relatives of collectors. Perceived level of squalor, co-habiting with, and increasing age of the HD individual were significant predictors of carer burden and functional impairment in the relatives. Limitations The use of self-identified HD individuals may have produced a bias towards participants with relatively good insight. Subjective biases in self-reported symptoms cannot be ruled out, although the use of informant-report data provided some independent validation. Conclusions HD is associated with substantial functional impairment for both sufferers and their relatives. The level of carer burden experienced by HD relatives was comparable to or greater than that reported in the literature by relatives of individuals with dementia. The findings indicate that relatives of individuals with HD may benefit from increased support and suggest that it may be beneficial to involve family members in the treatment of HD.
    Full-text · Article · Apr 2014 · Journal of Affective Disorders
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    • "Mean age of onset estimates range from 11 to 15 years, and symptoms typically begin to manifest between middle adolescence and adulthood (Grisham, Frost, Steketee, Kim, & Hood, 2006; Tolin, Meunier, Frost, & Steketee, 2010). Compared to nonhoarding patients with obsessive–compulsive disorder (OCD), those with hoarding endorse lower satisfaction in the quality of life domains of personal safety and living conditions in addition to more severe functional impairment (Saxena et al., 2011), the latter holding especially true among those with late-life hoarding (Ayers, Schiehser, Liu, & Wetherell, 2012). Hoarding problems have historically responded poorly to treatment (Steketee & Frost, 2003), although cognitive-behavior therapy adapted for hoarding has shown promise (Steketee, Frost, Tolin, Rasmussen, & Brown, 2010). "
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    ABSTRACT: Hoarding is a serious and potentially life-threatening mental health problem that, until recently, was considered a subtype of OCD. However, recent research suggests it is distinct and more prevalent than OCD. Three key defining features have emerged in factor analytic studies of hoarding scales: excessive acquisition, difficulty discarding, and excessive clutter. Covariation among these defining features has received limited attention. The primary aim of the current study was to examine the role of the three key features in defining hoarding disorder. Convergent and discriminant validity of the three hoarding factors were examined in a multitrait-multimethod matrix. A secondary aim was to examine the extent to which each hoarding feature distinguished individuals meeting criteria for hoarding from those with OCD and community controls. Although the three-factor model provided an adequate fit for the data and convergent validities were high, the hoarding factors evidenced poor discriminant validity across measures. The findings provide preliminary support for a more parsimonious merging of the clutter, acquisition, and discarding subscales versus parsing out subscale scores. Specifically, the active acquisition of items, buildup of clutter, and difficulty discarding accumulated possessions co-occurred strongly enough to be considered a unidimensional construct. Thus, these symptoms were less attributable to separate phenomena and better conceived as part of a cohesive hoarding phenotype. Each of the three factors discriminated hoarding participants from OCD patients and community controls, but did not discriminate the latter two groups. The findings have implications for treating acquisition as a specifier in DSM-5.
    Full-text · Article · Jul 2013 · Journal of Obsessive-Compulsive and Related Disorders
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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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      [Show abstract] [Hide abstract]
      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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