Recent hoarding research: abstracts

COH & ACOA Joined: Jul 22, 2006 Posts: 2031 Location: Cabo

The economic and social burden of compulsive hoarding.
Tolin DF, Frost RO, Steketee G, Gray KD, Fitch KE.
The Institute of Living/Hartford Hospital, Hartford, CT, USA; Yale University School of Medicine, New Haven, CT, USA.

The aim of the present study was to determine the economic and social burden of compulsive hoarding in a large sample of individuals with self-identified hoarding, as well as a separate sample of family members of individuals who hoard. Self-identified hoarding participants (N=864, 94% female, 65% met research criteria for clinically relevant compulsive hoarding) and family informants (N=655, 58% described a relative who appeared to meet research criteria for compulsive hoarding), completed an internet survey. Questions were derived in part from those used in the National Comorbidity Survey (NCS), and when possible, hoarding participants were compared to NCS participants. Compulsive hoarding was associated with an average 7.0 work impairment days in the past month, equivalent to that reported by individuals with psychotic disorders and significantly greater than that reported by female NCS participants with all other anxiety, mood, and substance use disorders. Severity of hoarding predicted the degree of work impairment after controlling for age, sex, and non-psychiatric medical conditions. Hoarding participants were nearly three times as likely to be overweight or obese as were family members. Compared to female NCS participants, hoarding participants were significantly more likely to report a broad range of chronic and severe medical concerns and had a five-fold higher rate of mental health service utilization. Eight to 12% had been evicted or threatened with eviction due to hoarding, and 0.1-3.0% had a child or elder removed from the home. These results suggest that compulsive hoarding represents a profound public health burden in terms of occupational impairment, poor physical health, and social service involvement.
PMID: 18597855 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18597855?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Recent advances in compulsive hoarding.
Saxena S.
Department of Psychiatry, University of California at San Diego, 8950 Villa La Jolla Village Drive, Suite C-207, San Diego, CA 92037, USA. ssaxena@ucsd.edu

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.

PMID: 18627667 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18627667?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

The quality of the DSM-IV obsessive-compulsive personality disorder construct as a prototype category.
Hummelen B, Wilberg T, Pedersen G, Karterud S.
Department of Research and Education, Psychiatric Division, Ullevål University Hospital, Oslo, Norway. benjamin.hummelen@medisin.uio.no

The study evaluated the quality of the DSM-IV obsessive-compulsive personality disorder (OCPD) construct as a prototype category. A sample of 2237 patients from the Norwegian Network of Psychotherapeutic Day Hospitals was examined by a variety of psychometric analyses. A high number of OCPD patients (77%) had co-occurrent PDs, but only the co-occurrence with paranoid was significantly higher than expected. Exploratory factor analysis of the PD criteria indicated that OCPD consists of 2 dimensions. The first dimension, perfectionism, was constituted by OCPD criteria only and was significantly related to obsessive-compulsive disorder. The second dimension, aggressiveness, included 2 OCPD criteria, reluctance to delegate and stubbornness, but was also defined by criteria from paranoid, antisocial, and borderline PD. Confirmatory factor analysis of the OCPD criteria indicated a poor fit of both a unitary model and a 3-dimensional model. Overall, the OCPD criteria had poor psychometric properties. Although it seems that the quality of the DSM-IV OCPD as a prototype construct is insufficient, it may be improved by deleting the criteria hoarding behavior and miserliness . Alternative criteria could be related to problems in close relationships involving the need for predictability. Such revisions may add a third dimension to the 2 dimensions of perfectionism and aggressiveness.

PMID: 18552621 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/18552621?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Further development of YBOCS dimensions in the OCD Collaborative Genetics Study: Symptoms vs. categories.
Pinto A, Greenberg BD, Grados MA, Bienvenu OJ 3rd, Samuels JF, Murphy DL, Hasler G, Stout RL, Rauch SL, Shugart YY, Pauls DL, Knowles JA, Fyer AJ, McCracken JT, Piacentini J, Wang Y, Willour VL, Cullen B, Liang KY, Hoehn-Saric R, Riddle MA, Rasmussen SA, Nestadt G.
Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA.

Despite progress in identifying homogeneous subphenotypes of obsessive-compulsive disorder (OCD) through factor analysis of the Yale Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC), prior solutions have been limited by a reliance on presupposed symptom categories rather than discrete symptoms. Furthermore, there have been few attempts to evaluate the familiality of OCD symptom dimensions. The purpose of this study was to extend prior work by this collaborative group in category-based dimensions by conducting the first-ever exploratory dichotomous factor analysis using individual OCD symptoms, comparing these results to a refined category-level solution, and testing the familiality of derived factors. Participants were 485 adults in the six-site OCD Collaborative Genetics Study, diagnosed with lifetime OCD using semi-structured interviews. YBOCS-SC data were factor analyzed at both the individual item and symptom category levels. Factor score intraclass correlations were calculated using a subsample of 145 independent affected sib pairs. The item- and category-level factor analyses yielded nearly identical 5-factor solutions. While significant sib-sib associations were found for four of the five factors, Hoarding and Taboo Thoughts were the most robustly familial (r(ICC)>/=0.2). This report presents considerable converging evidence for a five-factor structural model of OCD symptoms, including separate factor analyses employing individual symptoms and symptom categories, as well as sibling concordance. The results support investigation of this multidimensional model in OCD genetic linkage studies.

PMID: 18514325 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18514325?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Prevalence and correlates of hoarding behavior in a community-based sample.
Samuels JF, Bienvenu OJ, Grados MA, Cullen B, Riddle MA, Liang KY, Eaton WW, Nestadt G.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 109, Baltimore, MD 21287-7228, USA.

Little is known about the prevalence and correlates of hoarding behavior in the community. We estimated the prevalence and evaluated correlates of hoarding in 742 participants in the Hopkins Epidemiology of Personality Disorder Study. The prevalence of hoarding was nearly 4% (5.3%, weighted) and was greater in older than younger age groups, greater in men than women, and inversely related to household income. Hoarding was associated with alcohol dependence; paranoid, schizotypal, avoidant, and obsessive-compulsive personality disorder traits; insecurity from home break-ins and excessive physical discipline before 16 years of age; and parental psychopathology. These findings suggest that hoarding may be relatively prevalent and that alcohol dependence, personality disorder traits, and specific childhood adversities are associated with hoarding in the community.

http://www.ncbi.nlm.nih.gov/pubmed/18495084?ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

An exploratory study of the neural mechanisms of decision making in compulsive hoarding.
Tolin DF, Kiehl KA, Worhunsky P, Book GA, Maltby N.
Yale University School of Medicine, New Haven, CT, USA.

BACKGROUND: Prior studies have suggested unique patterns of neural activity associated with compulsive hoarding. However, to date no studies have examined the process of making actual decisions about whether to keep or discard possessions in patients with hoarding symptoms. An increasing body of clinical data and experimental psychopathology research suggests that hoarding is associated with impaired decision making; therefore, it is important to understand the neural underpinnings of decision-making abnormalities in hoarding patients.MethodTwelve adult patients diagnosed with compulsive hoarding, 17% of whom also met criteria for obsessive-compulsive disorder (OCD), and 12 matched healthy controls underwent functional magnetic resonance imaging (fMRI) while making decisions about whether or not to discard personal paper items (e.g. junk mail) brought to the laboratory as well as control items that did not belong to them. Items were either saved or destroyed following each decision.
RESULTS: When deciding about whether to keep or discard personal possessions, compulsive hoarding participants displayed excessive hemodynamic activity in lateral orbitofrontal cortex and parahippocampal gyrus. Among hoarding participants, decisions to keep personal possessions were associated with greater activity in superior temporal gyrus, middle temporal gyrus, medial frontal gyrus, anterior cingulate cortex, precentral gyrus, and cerebellum than were decisions to discard personal possessions.
CONCLUSIONS: These results provide partial support for an emerging model of compulsive hoarding based on complications of the decision-making process. They also suggest that compulsive hoarding may be characterized by focal deficits in the processing of reward and changes in reward contingencies, particularly when these are perceived to be punishing.

PMID: 18485263 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/18485263?ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Compulsive Hoarding: OCD Symptom, Distinct Clinical Syndrome, or Both?
Pertusa A, Fullana MA, Singh S, Alonso P, Menchón JM, Mataix-Cols D.
Objective Compulsive hoarding is a debilitating problem that is often associated with obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder. However, the precise nosology of compulsive hoarding has yet to be determined. Method Participants were 25 patients with severe compulsive hoarding with OCD and 27 patients with severe compulsive hoarding without OCD. Both groups were carefully characterized and compared on the following sociodemographic and clinical variables: precise phenomenology of hoarding behavior, severity of other OCD symptoms, axis I and axis II psychopathology, and adaptive functioning. For comparison purposes, the following individuals were also recruited: 71 patients with OCD without hoarding, 19 patients with anxiety disorder, and 21 community participants. Results Overall, the phenomenology of hoarding behavior was similar in the two hoarding groups. The majority of participants in both groups reported hoarding common items as a result of their emotional and/or intrinsic value. However, approximately one-fourth of participants in the compulsive hoarding with OCD group showed a different psychopathological profile, which was characterized by the hoarding of bizarre items and the presence of other obsessions and compulsions related to their hoarding, such as fear of catastrophic consequences, the need to perform checking rituals, and the need to perform mental compulsions before discarding any item. These patients had a more severe and disabling form of the disorder. The strong relationship between compulsive hoarding and obsessive-compulsive personality disorder was explained entirely by the overlapping item content. Conclusions In most individuals, compulsive hoarding appears to be a syndrome separate from OCD, which is associated with substantial levels of disability and social isolation. However, in other individuals, compulsive hoarding may be considered a symptom of OCD and has unique clinical features . These findings have implications for the classification of OCD and compulsive hoarding in the next edition of DSM.

PMID: 18483134 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/18483134?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

1: Gen Hosp Psychiatry. 2008 May-Jun;30(3):288-90
Diogenes syndrome in a patient with obsessive-compulsive disorder without hoarding.
Fontenelle LF.
Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM/UFF), Niterói, RJ, Brazil. lfontenelle@gmail.com

Diogenes syndrome (DS) is characterized by self-neglect, classically portrayed by a filthy personal appearance, dirty home, and hoarding of rubbish. We report a patient with DS who presented obsessive-compulsive disorder and Tourette syndrome in the absence of hoarding. We suggest that hoarding may be a symptom of the conditions that are frequently comorbid with DS, but is not one of its fundamental features.

PMID: 18433664 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18433664?ordinalpos=21&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Aust Fam Physician. 2008 Apr;37(4):237-41.Links
Pathological hoarding .
Jefferys D, Moore KA.
School of Psychology, Deakin University, The Melbourne Clinic Consulting Suite, Richmond, Victoria.

BACKGROUND: Compulsive hoarding is defined, in most cases, as 'the inability to resist the urge to acquire possessions and to discard possessions'. Compulsive hoarding has an early age onset, chronic course and significant levels of comorbidity and morbidity. OBJECTIVE: This article outlines the essential features of compulsive hoarding occurring as a symptom factor of obsessive compulsive disorder (OCD) and alludes to hoarding co-occurring in a range of disorders other than OCD. A test screening for compulsive hoarding is provided. DISCUSSION: Compulsive hoarding occurs in illnesses other than OCD. Limited treatment studies have been completed only when compulsive hoarding is a symptom factor of OCD. These studies suggest that a pharmacological approach and multimodal cognitive behavioural therapy can achieve a moderate treatment outcome. The illness however is difficult to treat.

PMID: 18398520 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/18398520?ordinalpos=23&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Active Member Joined: Apr 29, 2008 Posts: 440

So, hoarding is a symptom of multiple overlying conditions. Now we know. I have a problem with the indecisive theory. It seems like they would hire a professional organizer, if that were the case. But they don't want to throw it out so they refuse to choose that option. Having it makes them feel good, so why should they have to make the decision to get rid of something that they have made the strong decision to keep? They may not make logical decisions, but they have strong ones. This is an excellent article though.

COH & ACOA Joined: Jul 22, 2006 Posts: 2031 Location: Cabo

7/28/08
Genetic susceptibility to obsessive-compulsive hoarding: the contribution of neurotrophic tyrosine kinase receptor type 3 gene.

Alonso P, Gratacòs M, Menchón JM, Segalàs C, González JR, Labad J, Bayés M, Real E, de Cid R, Pertusa A, Escaramís G, Vallejo J, Estivill X.

OCD Clinical and Research Unit, Psychiatry Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain.

Recent work suggests that neurotrophic factors may contribute to the genetic susceptibility to obsessive-compulsive disorder (OCD). Among other clinical dimensions, the presence of hoarding obsessions and compulsions has been shown to be correlated with a number of clinical and neuroimaging findings, as well as with a different pattern of genetic inheritance.

We used a linkage disequilibrium (LD)-mapping approach to investigate whether neurotrophic tyrosine kinase receptor type 3 (NTRK3), the high-affinity receptor of neurotrophin 3 (NT-3), plays a role in increasing susceptibility to hoarding in OCD. We performed an association study of 52 tag single nucleotide polymorphisms (tagSNPs) covering the whole NTRK3 gene in a sample comprising 120 OCD patients and 342 controls. Single nucleotide polymorphism association and haplotype analysis were performed.

Thirty-six of our patients (30%) exhibited significant hoarding obsessions and compulsions. A significant association of two SNPs in the 3' downstream region of NTRK3 gene and obsessive-compulsive hoarding was identified: rs1017412 [odds ratio (OR) = 2.16; P = 0.001] and rs7176429 (OR = 2.78; P = 0.0001), although only the latter remained significant after Bonferroni correction. Although the haplotype analysis did not show significant results, a more extended block of LD in the OCD hoarders with respect to the control group was observed, suggesting a lower haplotype diversity in these individuals.

Our findings suggest that NTRK3 may contribute to the genetic susceptibility to hoarding in OCD and may constitute an interesting gene to focus on in studies of the genetic basis of obsessive-compulsive hoarding.

PMID: 18616610 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/18616610