Neuropsychological and Neural Correlates of Hoarding: A Practice-Friendly Review

Department of Psychosis Studies, King's College London, Institute of Psychiatry, PO 69, De Crespigny Park Road, London SE5 8AF, United Kingdom.
Journal of Clinical Psychology (Impact Factor: 2.12). 05/2011; 67(5):467-76. DOI: 10.1002/jclp.20791
Source: PubMed


Hoarding can be a symptom of multiple neurological and psychiatric disorders, including obsessive-compulsive disorder (OCD). Recent evidence suggests that, in many cases, hoarding can also be a standalone problem that presents independently from other conditions; this has led to the proposal of a new diagnostic entity named hoarding disorder. This article reviews the neuropsychological and neuroimaging research on pathological hoarding. Most research in humans has been conducted in the context of individuals with brain damage, dementia, or OCD. Studies of well-characterized samples of individuals with hoarding disorder are extremely rare. Although not possible to establish firm conclusions at this stage, we conclude with a series of observations and recommendations for clinical practice.

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Available from: David Mataix-Cols, Oct 14, 2014
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    • "A probabilistic learning and reversal task was also employed, as evidence for deficits in OCD have been inconsistent in both behaviour and functional brain imaging (Clarke et al., 2004; Remijnse et al., 2006; Chamberlain et al., 2007a; Ersche et al., 2011). Such tasks depend on intact orbitofrontal and cingulate function (Cools et al., 2002; Fellows and Farah, 2003), which is believed to be impaired in OCD, particularly in hoarders (An et al., 2009; Mataix-Cols et al., 2011). In sum, this study investigated the cognitive profile of OCD patients with prominent hoarding symptoms and of individuals with hoarding disorder who do not have comorbid OCD. "
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    ABSTRACT: Hoarding disorder is a new mental disorder in DSM-5. It is classified alongside OCD and other presumably related disorders in the Obsessive-Compulsive and Related Disorders chapter. We examined cognitive performance in two distinct groups comprising individuals with both OCD and severe hoarding, and individuals with hoarding disorder without comorbid OCD. Participants completed executive function tasks assessing inhibitory control, cognitive flexibility, spatial planning, probabilistic learning and reversal and decision making. Compared to a matched healthy control group, OCD hoarders showed significantly worse performance on measures of response inhibition, set shifting, spatial planning, probabilistic learning and reversal, with intact decision making. Despite having a strikingly different clinical presentation, individuals with only hoarding disorder did not differ significantly from OCD hoarders on any cognitive measure suggesting the two hoarding groups have a similar pattern of cognitive difficulties. Tests of cognitive flexibility were least similar across the groups, but differences were small and potentially reflected subtle variation in underlying brain pathology together with psychometric limitations. These results highlight both commonalities and potential differences between OCD and hoarding disorder, and together with other lines of evidence, support the inclusion of the new disorder within the new Obsessive-Compulsive and Related Disorders chapter in DSM-5.
    Full-text · Article · Dec 2013
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    • "The emphasis of this boundary-refinement work has been the delineation of primary hoarding from other medical conditions and mental disorders that can also result in excessive object accumulation (for example, secondary to brain damage, or to fears of contamination in obsessive– compulsive disorder) [3] [6] [7] [8] [9]. Meanwhile, the diagnostic line separating pathology from normality has received much less attention. "
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    ABSTRACT: Objective: A new diagnostic category called Hoarding Disorder (HD) has been proposed for inclusion in DSM-5. It is paramount that this addition does not result in an over-pathologization of normative behavior. Collectors constitute a valid population within which to test the diagnostic boundaries of HD. The current study explored the features that differentiate pathological hoarding from normative collecting. Methods: Participants were 29 individuals with a diagnosis of HD and 20 individuals who self-identified as collectors who enrolled in the London Field Trial for HD. A series of semi-structured interviews (often in the participants' homes) were conducted, including a detailed assessment of the typical elements of the collecting process. Participants also completed a battery of self-report questionnaires. Results: Collectors were more likely than those with HD to be male, partnered, and free of psychiatric conditions or medication. Like those with HD, collectors reported the acquisition of, attachment to, and reluctance to discarding objects. However, the resulting clutter and impairment were minimal in this group and ultimately insufficient to garner an HD diagnosis. Collectors were, additionally, more focused in their acquisitions (e.g., confining their accumulations to a narrow range of items), more selective (e.g., planning and purchasing only pre-determined items), more likely to organize their possessions and less likely to accumulate in an excessive manner. Conclusions: There are important quantitative and qualitative differences between HD and normative collecting. For this reason, collectors are unlikely to be inappropriately pathologized by the introduction of HD.
    Full-text · Article · Sep 2012 · Comprehensive psychiatry
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    ABSTRACT: The inclusion of a new mental disorder in the nomenclature is not a trivial matter. Many have highlighted the risks of an ever-increasing number of mental disorders and of overpathologizing human behaviour. Given the proposed inclusion of a new hoarding disorder (HD) in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), it is pertinent to discuss the potential benefits and pitfalls of such a development. In this article, we examine whether HD fits with the current DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and proposed DSM-5 definitions of 'mental disorder'. We next discuss the potential benefits and risks of the creation of this diagnosis. Finally, we address some additional considerations that may arise when proposing a new disorder for the nomenclature and identify some of the gaps in the knowledge base.   HD fits the current DSM-IV and proposed DSM-5 definitions for a mental disorder. On balance, the potential benefits of creating the new diagnosis (e.g. identification of the majority of cases who clearly suffer and need help but are currently missed out by the existing diagnostic categories) outweigh the potential harms (e.g. pathologizing normal behaviour). Whether the criteria will need modification for their use in children/adolescents is unclear and more research is needed to address this question.
    Full-text · Article · Sep 2011 · Journal of Child Psychology and Psychiatry
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