Recent advances in compulsive hoarding

Department of Psychiatry, University of California at San Diego, 8950 Villa La Jolla Village Drive, Suite C-207, San Diego, CA 92037, USA.
Current Psychiatry Reports (Impact Factor: 3.24). 08/2008; 10(4):297-303. DOI: 10.1007/s11920-008-0048-8
Source: PubMed


Compulsive hoarding is a common and often disabling neuropsychiatric disorder. This article reviews the conceptualization, phenomenology, diagnosis, etiology, neurobiology, and treatment of compulsive hoarding. Compulsive hoarding is part of a discrete clinical syndrome that includes difficulty discarding, urges to save, excessive acquisition, indecisiveness, perfectionism, procrastination, disorganization, and avoidance. It was thought to be part of obsessive-compulsive disorder or obsessive-compulsive personality disorder, but recent evidence indicates that it should be classified as a separate disorder with its own diagnostic criteria. Compulsive hoarding is a genetically discrete, strongly heritable phenotype. Neuroimaging and neuropsychological studies are elucidating its neurobiology, implicating dysfunction of ventral and medial prefrontal cortical areas that mediate decision-making, attention, and emotional regulation. Effective treatments include pharmacotherapy and cognitive-behavioral therapy. More research will be required to determine the prevalence, etiology, and pathophysiology of compulsive hoarding and to develop better treatments.

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    • "In contrast to the argument outlined above, research over the past ten years has increasingly and consistently called the association between hoarding and OCD into question (Pertusa et al., 2010). The current suggestion within the field is that hoarding should be considered a separate disorder (Mataix-Cols et al., 2010; Pertusa et al., 2008; Rachman et al., 2009; Saxena, 2008). First and foremost, effective psychopharmacological and psychotherapeutic treatments for OCD have had little efficacy for hoarding (Mataix- Cols et al., 2005). "
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    ABSTRACT: The proposed hoarding disorder represents a serious psychiatric condition and considerable public health burden. Although tremendous strides have been made in understanding the phenomenology and treatment of this condition, many features regarding the etiology and nosology remain unclear. In particular, the association between impulsivity and hoarding, as well as the differential role of impulsivity versus compulsivity has yet to be fully considered. The current investigation sought to fill this gap in the literature by examining the relationship between hoarding and impulsivity across two independent, cross-cultural investigations. Two separate conceptualizations of the impulsivity construct were considered, including the Barratt Impulsivity Scale and the UPPS Impulsive Behavior Scale. Across Study 1 (US young adult sample; N = 372) and Study 2 (German young adult sample; N = 160) results revealed that hoarding was associated with greater rates of impulsivity, despite controlling for theoretically relevant covariates. More fined-grained analyses revealed a differential relationship with respect to the various facets of impulsivity, such that hoarding was most strongly linked with attentional and motor impulsivity, as well as urgency (i.e., impulsive behaviors in response to negative affect) and lack of perseverance. When considered simultaneously, both impulsivity and non-hoarding OCD symptoms explained unique variance in hoarding. The implications of impulsivity for hoarding are discussed from a classification perspective, as well as from a vulnerability standpoint.
    Full-text · Article · Mar 2013 · Journal of Psychiatric Research
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    • "Indeed, most of the studies published in the last 2 decades have considered hoarding a symptom of OCD, and hoarding is included in most structured interviews and questionnaires of OCD symptoms [5]. Although there is little doubt that hoarding can be a symptom of OCD or secondary to other typical obsessivecompulsive fears such as difficulties discarding items for fear of contaminating others [6], there is an increasing body of evidence supporting the view that, in most cases, hoarding symptoms are not OCD related [1] [5] [7] [8]. Most individuals (N 80%) with hoarding problems do not display other OCD symptoms [9] [10] [11]. "
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    ABSTRACT: Background: Hoarding is frequently conceptualized as a symptom of obsessive-compulsive disorder (OCD), but recent evidence indicates that, in most cases, hoarding may be better conceptualized as a distinct disorder that can coexist with OCD. Most of the research on hoarding is from the Western countries. This study aimed to provide data on the prevalence and correlates of clinically significant hoarding in a large sample of patients with OCD from the Indian subcontinent. Methods: We examined 200 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition OCD for clinically significant hoarding using the Saving Inventory-Revised, followed by a clinical interview. Results: Twenty patients (10%) had clinically significant hoarding. In all cases, hoarding did not appear to be related or secondary to other OCD symptoms. None of the cases consulted for their hoarding problems. Compared with nonhoarders, hoarders hailed exclusively from an urban background and had a significantly higher frequency of certain obsessions and compulsions, bipolar disorder, generalized anxiety disorder, cluster C personality disorders, and a higher number of lifetime suicidal attempts. They also had a more severe OCD along with poorer global functioning and somewhat poorer insight into obsessive-compulsive symptoms. Conclusions: The results suggest that clinically significant hoarding is relatively prevalent in Indian patients with OCD and that it appears to be largely unrelated to the OCD phenotype. However, the presence of comorbid hoarding is associated with more severe OCD, high comorbidity, more suicidal attempts, and a lower level of functioning. The results contribute to the current nosologic debate around hoarding disorder and provide a unique transcultural perspective.
    Full-text · Article · Jul 2012 · Comprehensive psychiatry
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    • "Hoarding is defined as the acquisition of and failure to discard possessions of little use or value to others, usually associated with an important degree of clutter in the living area of the individual's home (Frost and Gross, 1993). This complex and heterogeneous phenomenon has already been described in a number of neuropsychiatry conditions (Damecour and Charron, 1998; Samuels et al., 2002; Maier, 2004; Grishan et al., 2005; Saxena, 2008; Abramowitz et al., 2008; Pertusa et al., 2010a), including obsessive-compulsive disorder (OCD). Factor analyses of obsessive-compulsive symptoms (OCS) have consistently shown that hoarding characterizes a separate factor or dimension (Bloch et al., 2008). "
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    ABSTRACT: Factor analyses indicate that hoarding symptoms constitute a distinctive dimension of obsessive-compulsive disorder (OCD), usually associated with higher severity and limited insight. The aim was to compare demographic and clinical features of OCD patients with and without hoarding symptoms. A cross sectional study was conducted with 1001 DSM-IV OCD patients from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (CTOC), using several instruments. The presence and severity of hoarding symptoms were determined using the Dimensional Yale-Brown Obsessive-Compulsive Scale. Statistical univariate analyses comparing factors possibly associated with hoarding symptoms were conducted, followed by logistic regression to adjust the results for possible confounders. Approximately half of the sample (52.7%, n = 528) presented hoarding symptoms, but only four patients presented solely the hoarding dimension. Hoarding was the least severe dimension in the total sample (mean score: 3.89). The most common lifetime hoarding symptom was the obsessive thought of needing to collect and keep things for the future (44.0%, n = 440). After logistic regression, the following variables remained independently associated with hoarding symptoms: being older, living alone, earlier age of symptoms onset, insidious onset of obsessions, higher anxiety scores, poorer insight and higher frequency of the symmetry-ordering symptom dimension. Concerning comorbidities, major depressive, posttraumatic stress and attention deficit/hyperactivity disorders, compulsive buying and tic disorders remained associated with the hoarding dimension. OCD hoarding patients are more likely to present certain clinical features, but further studies are needed to determine whether OCD patients with hoarding symptoms constitute an etiologically discrete subgroup.
    Full-text · Article · Mar 2012 · Journal of Psychiatric Research
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