Search

Hoarding disorder is marked by strong attachments to everyday objects, extreme difficulties discarding, and impairing levels of clutter. We examined the associations between hoarding symptoms and associated clinical features using network analysis in a large sample of individuals with established hoarding disorder (n = 217) and matched healthy controls (n = 130). Network nodes included the three core features of hoarding (difficulties discarding, clutter, and acquiring), along with comorbid symptoms, impairment, and saving and acquiring motives. Models showed hoarding and comorbid symptoms as separate syndromes. Healthy and patient networks differed significantly in both global network strength and structure. For the hoarding patient network, the comorbidity and hoarding clusters were connected by acquiring and anxiety, which served as bridge symptoms. Clutter was the only hoarding node associated with impairment. Hoarding beliefs were not central to the model, and only difficulties discarding was associated with saving and acquiring motives, including emotional attachment and wastefulness beliefs. Our findings indicate that the network approach to mental disorders provides a new and complementary way to improve our understanding of the etiological model of hoarding, and may present novel hypotheses to examine in treatment development research.

Hoarding disorder (HD) is a multifaceted problem that presents challenges both for understanding its dimensions and for developing effective treatments. We are grateful to have known Dr. Stanley J. Rachman and his incredibly thoughtful approach to clinical psychology and research on anxiety, obsessive-compulsive disorders (OCD) and their treatment. His work has helped set the stage for our own efforts to study this challenging condition. The discussion below reviews a range of mysteries we and others have encountered in working with people who exhibit HD symptoms. Of particular interest to us are questions about biological vulnerabilities like heritability and the high rate of concurrent health problems and whether hoarded objects might serve as safety signals that protect people from traumatic life events. We are curious about the attachment process in HD and whether attachment to objects is related to early parental experiences that affect self-concept. We raise questions about the several information processing problems often seen in people with HD - attention focusing, memory, and associative responses to objects and information. Raising many questions are observations about strong emotional attachments to objects and multiple reasons given for saving them, as well as what sometimes appears to be remarkable aesthetic appreciation and creative interest in objects. Emotions in HD seem to range more widely than in some psychological disorders as both positive and negative reactions appear to reinforce excessive acquisition and difficulty discarding. Clutter blindness may be an effort to avoid confrontation with overwhelming clutter in the home. Finally, we comment on difficulty achieving more positive outcomes following a carefully designed cognitive and behavioral treatment for HD and encourage the next generation of researchers to follow in Jack Rachman's footsteps as they try to unravel these mysteries.

An essential criterion for hoarding disorder (HD) is difficulty parting with possessions, but relatively little research has been conducted on responses by people with HD during actual efforts to discard objects. Frost et al. (Behav Res Therapy 85:13–22, 2016) reported quantitative findings from a discarding task comparing those with HD to community control participants without significant hoarding symptoms (CC) on discarding behavior. The present study used qualitative data analysis of the verbal statements made by HD and CC participants while talking aloud about whether to discard or keep a personal object of low monetary value. Data were coded and analyzed using Atlas.ti software via an iterative process in order to examine thoughts reported during decision-making. Findings indicated that participants made more comments about reasons for saving than discarding and that HD participants reported more reasons to save and fewer reasons to discard than did CC participants. They also voiced more thoughts about emotions, both negative and positive, than did controls, especially for anxiety, anger and guilt and general distress. HD participants expressed more ambivalence about discarding compared to controls. Findings are discussed in relation to the cognitive and behavioural model for hoarding, previous findings regarding reasons for saving, and treatment implications.

Objective: Recent evidence suggests that avoiding waste may be a prominent motive to save in hoarding disorder. Such beliefs are reminiscent of scrupulosity obsessions in OCD. This paper reports on three studies examining scrupulosity-like beliefs in hoarding and the development and validation of a measure of material scrupulosity. Methods: Study one examined the reliability and validity of a measure of material scrupulosity (MOMS) and its relationship to hoarding in a college student sample, as well as the relationship between hoarding and OCD-base scrupulosity. Study 2 examined the psychometric properties of the MOMS in a replication of study 1 with a sample of people with hoarding problems. Study 3 examined the reliability and validity of the MOMS in a large nonclinical/community sample. Results: Findings across the studies provided evidence for the reliability and validity of the MOMS. It was highly correlated with hoarding symptoms, especially difficulty discarding, and hoarding related beliefs, especially responsibility beliefs. It accounted for significant variance in hoarding symptoms independent of other correlates, including other hoarding beliefs. OCD-based scrupulosity was correlated with hoarding in sample 1, but not in the hoarding sample in study 2. Conclusions: Material Scrupulosity refers to an exaggerated sense of duty or moral/ethical responsibility for the care and disposition of possessions to prevent their being harmed or wasted. It appears to be distinct from other hoarding-related beliefs and a significant predictor of hoarding symptoms. The MOMS appears to possess good reliability and validity in both clinical and nonclinical samples. Keywords: Hoarding, Hoarding disorder, Scrupulosity

Excessive acquiring is a common symptom of hoarding disorder (HD). Little is known about subjective distress associated with acquiring in HD. The present study examined acquiring- related distress and reactions to cognitive restructuring (CR) in 92 individuals with HD and 66 community control (CC) participants. All participants identified an item of interest at a high-risk acquiring location and then decided whether or not to acquire the item. HD participants completed the acquiring task while receiving a CR-based intervention or a thought-listing (TL) control condition. Results showed that HD participants reported more severe distress and greater urges to acquire the item of interest than did CC participants. Nevertheless, subjective distress decreased in both groups following the acquiring task. There were no differences in acquiring- related distress between the CR and TL conditions. The findings indicate that subjective distress may decrease after relatively short periods of time in individuals with HD, but that a single session of CR may not alleviate acquiring-related distress in HD participants.

Hoarding disorder (HD), a new DSM-5 classification, is characterized by difficulty discarding and the excessive acquisition of possessions to the extent that living spaces are compromised by clutter. Individuals with hoarding difficulties have a variety of motivations for object ownership, including emotional attachment towards their possessions which sometimes manifests through imbuing possessions with human-like terms. Limited extant evidence suggests that anthropomorphism, attributing human qualities to non-human objects, is related to hoarding, possibly because of difficulties with interpersonal attachment and social isolation. The current study investigated the relationship between hoarding behaviors (i.e., difficulty discarding, excessive acquisition, and clutter), hoarding beliefs (i.e., motivations for ownership including responsibility, emotional attachment, memory, control), anthropomorphism (i.e., generally in childhood, generally in adulthood, and towards three different personally-owned objects), and loneliness. Moderation analyses examined whether hoarding beliefs or loneliness impacted how anthropomorphism related to hoarding symptoms. Results suggested that all dimensions of anthropomorphism were related to hoarding behaviors. Regression analyses indicated that anthropomorphism in adulthood and of personally owned-objects were the best predictors of hoarding behavior. Mixed evidence was found for hoarding beliefs and loneliness moderating these associations. Findings successfully replicated and extended previous literature and provide a novel measure of anthropomorphism specifically incorporating personal ownership.

The present study tested the psychometric properties of an expanded version of the Hoarding Rating Scale (HRS-I), a semistructured interview for hoarding disorder (HD). Eighty-seven adults with HD and 44 healthy control (HC) participants were assessed using the HRS-I and completed a battery of self-report measures of HD severity, negative affect, and functional impairment. All interviews were audio recorded. From the HD participants, 21 were randomly selected for inter-rater reliability (IRR) analysis and 11 for test-retest reliability (TRR) analysis. The HRS-I showed excellent internal consistency (α = 0.87). IRR and TRR in the HD sample were good (intra-class coefficients = 0.81 and 0.85, respectively). HRS-I scores correlated strongly with scores on the self-report Saving Inventory-Revised (SI-R); partial correlations indicated that the HRS-I clutter, difficulty discarding, and acquiring items correlated significantly and at least moderately with corresponding SI-R subscales, when controlling for the other SI-R subscales. The HD group scored significantly higher on all items than did the HC group, with large effect sizes (d = 1.28–6.58). ROC analysis showed excellent sensitivity (1.00) and specificity (1.00) for distinguishing the HD and HC groups with a cutoff score of 11. Results and limitations are discussed in light of prior research.

Hoarding disorder is a new DSM-5 disorder that causes functional impairment and affects 2 to 6% of the population (Frost and Steketee 2014). The current study evaluated a multiple mediation model with 243 undergraduate women in which indecisiveness (VOCI; Thordarson et al. Behaviour Research and Therapy, 42(11), 1289-1314, 2004) and decisional procrastination (DPS; Mann 1982) mediated the relationship between dimensions of perfectionism (F-MPS-B; Burgess et al. 2016a) and hoarding behavior (SI-R; Frost et al. Behaviour Research And Therapy, 42(10), 1163–1182, 2004) and excessive acquiring (CAS; Frost et al. Annual Review of Clinical Psychology, 8, 219–242, 2012). Multiple mediational analyses indicated a significant indirect effect for decisional procrastination, but not indecisiveness, in mediating evaluative concerns (but not striving) to SI-R Total, SI-R Clutter, SIR Excessive Acquisition, and both CAS subscales. Both mediators were significant pathways between evaluative concerns and SI-R Difficulty Discarding. These findings support a cognitive behavioral model of hoarding, suggesting that evaluative concerns produces problems in decision-making that influence acquisition, discarding, and clutter.

Cognitive-behavioral therapy (CBT) is an empirically-supported treatment for hoarding disorder (HD). However, meta-analytic studies suggest that CBT is only modestly effective, and a significant number of individuals with HD remain symptomatic following treatment. To inform the development of more effective and targeted treatments, it will be important to clarify the mechanisms of treatment response in CBT for HD. To this end, the current study examined whether change in maladaptive saving beliefs mediated symptom change in CBT for HD. Sixty-two patients with primary HD completed measures of maladaptive saving cognitions and hoarding severity at pre-, mid-, and post-CBT. Results showed that change in saving cognitions mediated change in all three domains of HD symptoms (i.e., acquiring, difficulty discarding, and excessive clutter), suggesting that cognitive change may be a mechanism of treatment response in CBT. The findings indicate that cognitive change may have an impact on treatment outcomes, and are discussed in terms of cognitive-behavioral theory of HD and potential ways in which to enhance belief change in treatment.

This study used archival data from three different research groups and case file data from three independent community organizations to explore how well research samples reflect cases of hoarding that come to community attention. Using data from 824 individuals with hoarding, we found that research volunteers differ from community clients in several ways: community clients are older, more likely to be male and less likely to be partnered; they have lower socio-economic status and are less likely to demonstrate good or fair insight regarding hoarding severity and consequences. The homes of community clients had greater clutter volume and were more likely to have problematic conditions in the home, including squalor and fire hazards or fire safety concerns. Clutter volume was a strong predictor of these conditions in the home, but demographic variables were not. Even after accounting for the influence of clutter volume, the homes of community-based clients were more likely to have squalor. These findings suggest limitations on the generalizability of research samples to hoarding as it is encountered by community agencies.

The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience. ispartof: CNS SPECTRUMS vol:24 issue:4 pages:374-379 ispartof: location:United States status: published

Twenty-five years ago, one of the first empirically validated measures of perfectionism, the Frost et al. Multidimensional Perfectionism Scale (F-MPS) was published. Since that time, psychometric studies of the original F-MPS have provided a plethora of evidence to support the potential development of a shorter yet still psychometrically robust version of the measure. Using confirmatory factor analyses across community and clinical samples, the current study identifies an eight-item F-MPS-Brief with two dimensions (i.e., striving and evaluative concerns) that evidences good internal consistency, measurement equivalence across ethnicities, and concurrent and convergent validity. This new, short version of the F-MPS captures well the bidimensional model of perfectionism that has emerged across studies over the past two decades and is suggested for use when a short yet high-performing assessment tool for this model is desired.

Hoarding symptoms commonly co-occur with other psychiatric disorders, such as major depressive disorder, and have been observed across cultures. Yet, few studies have examined hoarding in other disorders or in an Asian context. The present study aimed to determine: (1) the prevalence of clinically significant hoarding, (2) differences between participants with and without significant hoarding, and (3) predictors of hoarding severity in a Singaporean clinical sample. Five hundred outpatients with anxiety disorders, depressive disorders, schizophrenia, and pathological gambling completed a battery of questionnaires on hoarding, anxiety, depression, functional impairment due to clutter, and quality of life. Thirty percent of our sample reported significant hoarding. However, clutter levels in the hoarding group were low, and hoarding severity was not significantly linked to quality of life, after adjusting for anxiety and depression. In addition, depression – but not anxiety – predicted hoarding severity. Our results provide a cross-cultural perspective on hoarding symptoms, and replicate findings that support a link between depression and hoarding. The differential presentation of hoarding in our sample could be due to true cultural differences in hoarding pathology or to variant psychometric properties of the measures used. Further research evaluating hoarding in Asian contexts with different methodology is needed.

Background The Saving Inventory – Revised (SI-R) is the most widely used self-report measure of hoarding symptom severity. The goal of this study is to establish a firm empirical basis for a cutoff score on the SI-R and to examine the functioning of the SI-R as a screening tool and indicator of hoarding symptom severity across the lifespan. Methods This study used archival data from 1,116 participants diagnosed with a clinical interview in 14 studies conducted by research groups who focus on hoarding. We used receiver operating characteristic (ROC) analysis and the Youden's J statistic to determine optimal cutoff scores for classifying participants who would be likely to receive a hoarding diagnosis. Results Overall, the discriminant performance of the SI-R Total score and each of the three subscales was high, confirming the status of the SI-R is an excellent screening tool for differentiating hoarding from non-hoarding cases. The optimal SI-R Total cutoff score is 39, although analyses suggested that older adults require a significantly lower cutoff and adults younger than 40 years require a significantly higher cutoff score. Limitations The confidence interval around the optimal cutoff for the SI-R Total score for oldest age group was wide in comparison to those reported for the younger groups, creating more uncertainty around the optimal cutoff score for this group. Conclusions This paper provides investigators and clinicians with the data necessary to select evidence-based cutoff scores on the SI-R that optimally suit their relative need for sensitivity and specificity in different age groups.

Hoarding disorder is characterized by difficulty parting with possessions and by clutter that impairs the functionality of living spaces. Cognitive behavioral therapy conducted by a therapist (individual or in a group) for hoarding symptoms has shown promise. For those who cannot afford or access the services of a therapist, one alternative is an evidence-based, highly structured, short-term, skills-based group using CBT principles but led by non-professional facilitators (the Buried in Treasures [BIT] Workshop). BIT has achieved improvement rates similar to those of psychologist-led CBT. Regardless of modality, however, clinically relevant symptoms remain after treatment, and new approaches to augment existing treatments are needed. Based on two recent studies - one reporting that personalized care and accountability made treatments more acceptable to individuals with hoarding disorder and another reporting that greater number of home sessions were associated with better clinical outcomes, we tested the feasibility and effectiveness of adding personalized, in-home uncluttering sessions to the final weeks of BIT. Participants (n = 5) had 15 sessions of BIT and up to 20 hours of in-home uncluttering. Reductions in hoarding symptoms, clutter, and impairment of daily activities were observed. Treatment response rate was comparable to rates in other BIT studies, with continued improvement in clutter level after in-home uncluttering sessions. This small study suggests that adding in-home uncluttering sessions to BIT is feasible and effective.

The cognitive-behavioural model of hoarding disorder incorporates information processing difficulties, maladaptive attachment to possessions, erroneous beliefs about the nature of possessions, and mood problems as etiologically significant factors, although developmental experiences such as a compromised early family environment have also been proposed in an augmented model. This study examined the specificity and relevance of variables highlighted in the augmented cognitive-behavioural model. Various clinical participants (n = 89) and community controls (n = 20) were assessed with structured clinical interviews to verify diagnosis. Participants completed self-report measures of hoarding severity, cognitions, meta-memory, and early developmental experiences (e.g., memories of warmth and security in one's family). Hoarding cohorts (with and without obsessive-compulsive disorder) reported poor confidence in memory, but relative to other groups (obsessive-compulsive disorder without hoarding disorder, anxiety disorders, and healthy controls), hoarding-relevant cognitions, need to keep possessions in view, and concerns about the consequences of forgetting were significantly higher. Hoarding groups reported the lowest recollections of warmth in their family, although no differences were found between hoarding and non hoarding clinical cohorts for uncertainty about self and others. Nonetheless, clinical cohorts reported generally higher scores of uncertainty than healthy controls. When predicting hoarding severity, after controlling for age and mood, recollections of lack of warmth in one's family was a significant predictor of hoarding severity, with hoarding-related cognitions and fears about decision-making being additional unique predictors. The study supports the augmented cognitive-behavioural model of hoarding, inclusive of the importance of early developmental influences in hoarding.

Background Previous research suggests that hoarding aggregates in families and is associated with health and safety risks and family problems. The present study examined gender- and diagnosis-related differences in reports of hoarding symptoms among first-degree relatives of people who hoard, and of clinical and community samples. Methods The present study included 443 participants in a study of hoarding behavior: 217 with hoarding disorder (HD), 96 with obsessive-compulsive disorder (OCD), and 130 nonclinical community controls (CC). Assessment included a detailed interview of familial patterns of hoarding behaviors among parents and siblings and measures of hoarding severity. Results In the combined sample, participants reported more hoarding among female (mothers, sisters) than male (fathers, brothers) relatives. Significantly more female than male participants indicated they had a parent or any first-degree relative with hoarding behaviors. However, within the HD sample no significant gender effects were found for household, safety, and functioning variables, or for hoarding symptom severity. In an age- and gender-matched subsample (total n = 150), HD participants reported more hallmark hoarding symptoms (difficulty discarding and saving/clutter), and acquiring among their relatives compared to OCD and CC samples, and parents had higher rates than siblings. Conclusions Hoarding symptoms appear to be common among first-degree relatives of people who hoard and are also found among relatives of control samples. The predominance of hoarding symptoms among female relatives may indicate genetic or modeling transmission but this requires further study using large twin samples. Clinicians should consider that family members may also have significant hoarding symptoms.

Background Hoarding Disorder (HD) is currently under consideration for inclusion as a distinct disorder in DSM-5 (1). Few studies have examined comorbidity patterns in people who hoard, and the ones that have suffer from serious methodological shortcomings including drawing from populations already diagnosed with obsessive compulsive disorder (OCD), using outdated definitions of hoarding, and relying on inadequate assessments of hoarding. The present study is the first large-scale study of comorbidity in a sample of people meeting recently proposed criteria for hoarding disorder (1) and relying on validated assessment procedures. Methods We compared psychiatric comorbidity in a large HD sample (n = 217) to 96 participants meeting criteria for OCD without HD. Results High comorbidity rates were observed for major depressive disorder (MDD) as well as acquisition-related impulse control disorders (compulsive buying, kleptomania, and acquiring free things). Fewer than 20% of HD participants met criteria for OCD, and the rate of OCD in HD was higher for men than women. Rates of MDD and acquisition-related impulse control disorders were higher among HD than OCD participants. No specific anxiety disorder was more frequent in HD, but social phobia was more frequent among men with HD than among men with OCD. Inattentive ADHD was diagnosed in 28% of HD participants and was significantly more frequent than among OCD participants (3%). Conclusions These findings form important base rates for developing research and treatments for hoarding disorder.

Background Hoarding disorder (HD) is a new diagnosis in DSM-5 (American Psychiatric Association, 2013). Cognitive-behavioral therapy (CBT) appears promising for the treatment of HD, and has been tested in both individual and group settings. Methods The present study used meta-analytic techniques to examine the overall strength of effect of CBT on HD, as well as on its component symptoms (clutter, difficulty discarding, and acquiring) and associated functional impairment. Potential demographic and treatment-related moderators of CBT response, as well as the presence of clinically significant change were also examined. From 114 published articles, 10 articles comprising 12 distinct HD samples (N = 232) met inclusion criteria and were retained for analysis. Results HD symptom severity decreased significantly across studies with a large effect size. The strongest effects were seen for difficulty discarding, followed by clutter and acquiring. Functional impairment showed the smallest effect in the moderate range. Female gender, younger age, a greater number of CBT sessions, and a greater number of home visits were associated with better clinical outcomes. Reliable change was found in the majority of samples for each outcome domain. Rates of clinically significant change, however, were lower (percentage ranged from 24 to 43). Thus, in most cases, study patients’ post-treatment scores remained closer to the HD range than to the normal range. Conclusions CBT is a promising treatment for HD, although there is significant room for improvement. Results are discussed in terms of treatment refinement for HD, and additional moderator variables are suggested for further study.

Hoarding Disorder (HD), new in DSM-5, is remarkably prevalent, affecting 2% to 5% of the population. Hoarding symptoms were long considered an aspect of OCD, but it has been increasingly recognized that they differ, phenomenologically and epidemiologically; the new DSM-5 diagnosis formalizes this recognition. HD is a complex disorder consisting of problems with attachments to possessions that lead to difficulty discarding and organizing them. Together, these features lead to severely cluttered living spaces that can pose serious health and safety threats. The vast majority of those with HD acquire excessively, mostly through buying or collecting things that others have discarded. Hoarding behaviors appear early in life and typically get progressively worse over the life span. Cognitive behavioral therapy specifically designed to treat hoarding has been shown to be effective, though many still suffer from symptoms after treatment. Several medications have shown promise, but no controlled clinical trials have been conducted.

Objective To explore the acceptability of currently available treatments and services for individuals who self-report hoarding behaviors. Method Between 10/2013 and 8/2014, participants were invited to complete an online survey that provided them descriptions of eleven treatments and services for hoarding behaviors and asked them to evaluate their acceptability using quantitative (0 [not at all acceptable]−10 [completely acceptable]) Likert scale ratings. The a priori definition of acceptability for a given resource was an average Likert scale score of six or greater. Two well-validated self-report measures assessed hoarding symptom severity: the Saving Inventory-Revised and the Clutter Image Rating Scale. Results Two hundred and seventy two participants who self-reported having hoarding behaviors completed the questionnaire. Analyses focused on the 73% of responders ( n =203) who reported clinically significant hoarding behaviors (i.e., Saving Inventory-Revised scores of ≥40). The three most acceptable treatments were individual cognitive behavioral therapy (6.2±3.1 on the Likert scale), professional organizing service (6.1±3.2), and use of a self-help book (6.0±3.0). Conclusion In this sample of individuals with self-reported clinically significant hoarding behaviors ( n =203), only 3 out of 11 treatments and services for hoarding were deemed acceptable using an a priori score. While needing replication, these findings indicate the need to design more acceptable treatments and services to engage clients and maximize treatment outcomes for hoarding disorder.

Background A cognitive-behavioral model of hoarding posits deficits in information processing, maladaptive beliefs about and attachments to possessions that provoke distress and avoidance, and positive emotional responses to saving and acquiring that reinforce these behaviors. A 26-session individual cognitive-behavioral therapy (CBT) based on this model showed significant reductions in hoarding symptoms and large effect sizes (Steketee et al.[1]). Methods The present study presents findings at follow-up (up to 12 months), as well as predictors of outcome at posttreatment (n = 37) and follow-up (n = 31). Results Significant improvements at post-treatment were sustained at follow-up with large effects, and Clinical Global Impression-Improvement (CGI-I) ratings by clinicians and patients at follow-up indicated that 62 and 79% of patients were rated “much improved” or “very much improved,” respectively. The most prevalent patterns of outcome were improvement followed by stable gains or little improvement across all time points. Pretreatment severity of hoarding, overall clinical status, gender, perfectionism, and social anxiety were all associated with worse outcome. Only perfectionism and gender emerged as significant predictors after controlling for initial hoarding severity. Conclusions The present findings suggest general stability of individual CBT outcomes for hoarding and indicated that gender, perfectionism, and social anxiety may affect outcomes. More research on larger samples is needed to direct efforts to improve treatment for hoarding.

Animal hoarding is an understudied phenomenon and a potentially severe behavioral disorder that has serious negative effects on the individuals and the hoarded animals. The present study assessed animal hoarding behaviors and their effects among a large sample of self-identified individuals who hoarded objects and also owned animals (n=550) and family/friends of people with hoarding (n=494). The sample was recruited from a database of over 10,000 individuals who requested information regarding hoarding. The study reports on demographics, possible differences in object versus animal hoarding, methods of acquiring animals, and level of insight regarding hoarding behaviors. Those with more animals were more likely to make sacrifices with regard to money, job, social life, as well as cleanliness of the home, but no difference between groups was found for the overall condition of the home. Family members of people owning several animals believed that their loved ones made significant sacrifices in the above mentioned areas, as well as in the overall condition of the home. Similarities and differences between those who hoard objects vs. animals are discussed with regard to insight and methods of acquisition.

Although much has been written about hoarding recently, excessive acquisition in hoarding has remained relatively unexplored. The present study examined the types and role of acquisition and acquisition avoidance in hoarding. Of the 852 people who identified themselves as having problems with hoarding and volunteered for an internet study, 526 completed principle study measures, and 369 of these met criteria for clinically significant hoarding. In addition, 469 family and friend informants completed measures about a hoarding loved one. Sixty percent of those who met criteria for hoarding also met criteria for excessive acquisition. Of the remainder, nearly 70% reported acquiring problems in the past. Overall, 88% of hoarding participants had problems with acquisition currently or in the past. Ninety-two percent of informants reported moderate or greater levels of acquisition on the part of their hoarding family member or friend. Comparisons of current, past, and non-acquirers indicated differences with respect to hoarding severity and associated features (e.g., cognitive failures, self-control, perfectionism). Further, a substantial number in all three groups reported avoidance of acquisition-related cues. Only a few cases reported stealing behavior. Inhibited self-control emerged as a significant predictor of excessive buying, while cognitive failures predicted both buying and free acquisition.

Three studies were performed to investigate the psychometric properties of the paper-and-pencil and online versions of the Italian Saving Inventory-Revised (SI-R) in nonclinical participants. In Study 1, the SI-R was administered to a community sample of 473 participants together with measures of obsessive-compulsive symptomatology, compulsive shopping, depression, and anxiety. In Study 2, temporal stability of the SI-R was investigated by administering the scale to 75 participants twice with a 4-week interval in between. In Study 3, 452 participants completed the SI-R through the internet. Evidence of internal consistency, test-retest reliability, construct validity, and replicability of the original three-correlated-factor structure was obtained. After ruling out the bias due to nonrandomized assignment to administration methods through propensity matching, multiple-group confirmatory factor analyses provided evidence of measurement invariance among the administration formats. However, higher latent and...

Background Hoarding disorder (HD) is currently being considered for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), yet remains poorly understood. Consensus is building that hoarding may constitute a separate disorder, although comorbidity remains high and complicates the diagnostic picture. The purpose of this investigation was to explore patterns of comorbidity among people who engage in hoarding behavior in order to better understand its clinical presentation and phenomenology. Methods Data were collected from a large internet sample (N = 363) of people who self-identified as having hoarding problems, met criteria for clinically significant hoarding, and completed all measures for this study. Participants self-reported their symptoms of disorders commonly co-occurring with hoarding (obsessive-compulsive disorder [OCD], depression, and attention deficit hyperactivity disorder [ADHD]), along with other clinical problems. Results Latent class analysis results indicated that the participants were grouped into three classes: “non-comorbid” hoarding (42%), hoarding with depression (42%), and hoarding with depression and inattention (16%). Conclusions Depression symptoms were the most commonly co-occurring symptom in this sample. Contrary to previous theory relating to hoarding etiology, OCD symptoms were not significantly co-occurring and a large percentage of the study participants were free from comorbid symptoms of OCD, depression, and ADHD. This suggests that HD is not primarily the consequence of other psychiatric conditions. Implications for DSM-5, clinical treatment, and future research directions are discussed.

An essential criterion for hoarding disorder (HD) is difficulty discarding or parting with possessions, yet few studies have examined reactions to actual discarding behaviors. The present study examined whether individuals with HD differed from non-hoarding community controls (CC) in discarding behavior and emotional reactions to discarding. A second purpose was to examine the course of experienced distress following discarding. A third purpose was to determine whether HD participants responded differently to a simple thought listing (TL) instruction or to a cognitive restructuring (CR) protocol. Participants were asked to decide whether to keep or discard (a) a personal possession and (b) a newly acquired object (magazine). HD participants anticipated more and longer distress and reported stronger attachment motives than community controls, but they did not differ significantly from community controls in actual discarding behavior. TL was somewhat more effective than CR in improving discarding behavior and reducing negative emotions and attachments to discarded objects among HD participants. Reductions in distress were observed for both HD-TL and HD-CR groups. Thought listing may have reduced avoidance of decision-making about discarding or perhaps CR, but not TL, provoked therapeutic reactance. Discarding was not related to reductions in distress or hoarding-related beliefs.

Trichotillomania (TTM) is still a scarcely known and often inadequately treated disorder in Italian clinical settings, despite growing evidence about its severe and disabling consequences. The current study investigated the phenomenology of TTM in Italian individuals; in addition, we sought to examine patterns of self-esteem, anxiety, depression, and OCD-related symptoms in individuals with TTM compared to healthy participants. The current study represents the first attempt to investigate the phenomenological and psychopathological features of TTM in Italian hair pullers. One hundred and twenty-two individuals with TTM were enrolled: 24 were assessed face-to-face (face-to-face group) and 98 were recruited online (online group). An additional group of 22 face-to-face assessed healthy controls (HC group) was included in the study. The overall female to male ratio was 14:1, which is slightly higher favoring female than findings reported in literature. Main results revealed that a higher percentage of individuals in the online group reported pulling from the pubic region than did face-to-face participants; furthermore, the former engaged in examining the bulb and running the hair across the lips and reported pulling while lying in bed at higher frequencies than the latter. Interestingly, the online TTM group showed greater functional and psychological impairment, as well as more severe psychopathological characteristics (self-esteem, physiological and social anxiety, perfectionism, overestimation of threat, and control of thoughts), than the face-to-face one. Differences between the two TTM groups may be explained by the anonymity nature of the online group, which may have led to successful recruitment of more serious TTM cases, or fostered more open answers to questions. Overall, results revealed that many of the phenomenological features of Italian TTM participants matched those found in U.S. clinical settings, even though some notable differences were observed; therefore, cross-cultural invariance might represent a characteristic of OCD-related disorders.

Hoarding is a serious form of psychopathology that has been associated with significant health and safety concerns, as well as the source of social and economic burden (Tolin, Frost, Steketee, & Fitch, 2008; Tolin, Frost, Steketee, Gray, & Fitch, 2008). Recent developments in the treatment of hoarding have met with some success for both individual and group treatments. Nevertheless, the cost and limited accessibility of these treatments leave many hoarding sufferers without options for help. One alternative is support groups that require relatively few resources. Frost, Pekareva-Kochergina, and Maxner (2011) reported significant declines in hoarding symptoms following a non-professionally run 13-week support group (The Buried in Treasures [BIT] Workshop). The BIT Workshop is a highly structured and short term support group. The present study extended these findings by reporting on the results of a waitlist control trial of the BIT Workshop. Significant declines in all hoarding symptom measures were observed compared to a waitlist control. The treatment response rate for the BIT Workshop was similar to that obtained by previous individual and group treatment studies, despite its shorter length and lack of a trained therapist. The BIT Workshop may be an effective adjunct to cognitive behavior therapy for hoarding disorder, or an alternative when cognitive behavior therapy is inaccessible.

The acquisition and saving of a large number of possessions that interfere with the use of living areas in the home are remarkably common behaviors that can pose serious threats to the health and safety of the affected person and those living nearby. Recent research on hoarding has led the DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Post-traumatic, and Dissociative Disorders Work Group to propose the addition of hoarding disorder to the list of disorders in the upcoming revision of the diagnostic manual. This review examines the research related to the diagnosis and assessment of hoarding and hoarding disorder. The proposed criteria appear to accurately define the disorder, and preliminary studies suggest they are reliable. Recent assessment strategies for hoarding have improved our understanding of the nature of this behavior. Areas in need of further research have been highlighted.

Elderly participants with clinically significant hoarding ( n =25) and a comparison sample without hoarding ( n =28) completed in-home interviews and questionnaires about saving behaviors and beliefs, daily activities, and depression. The hoarding sample had a bimodal onset age and scored significantly higher than non-hoarding participants on measures of clutter, difficulty discarding and acquiring, and on beliefs about responsibility and emotional attachment to possessions. They did not show significantly more depression or concern about memory but reported more problems with personal hygiene, although these were mild. Friends and family were rated significantly more concerned about the hoarding than were the participants. This somewhat less severe sample of older adults showed milder emotional, cognitive, and behavioral effects and limited problems with insight compared to prior studies.

Compulsive hoarding is characterized by the acquisition of, and failure to discard, a large number of possessions and clutter that prevents the use of living spaces as intended. Current successful treatments such as individual and group cognitive-behavioral therapy are lengthy and costly, requiring a time commitment ranging from four to twelve months, trained clinicians to administer treatment, and multiple home visits. Nonprofessional interventions may provide a cost-effective pre-treatment, adjunct, or alternative for individuals who want to work on hoarding problems but are unable or unwilling to engage in treatment. The purpose of the present study was to investigate the effectiveness of an innovative program consisting of a 13-session non-professionally facilitated biblio-based, action-oriented support group using Tolin, Frost, and Steketee's (2007b) self-help book. In study 1, seventeen self-identified hoarding participants experienced significant decreases in clutter, difficulty discarding, and excessive acquisition from pre-treatment to post-treatment, with reductions evident at mid-treatment. Study 2 replicated the findings of study 1 using interview and observational measures taken in participants' homes. These findings suggest that a facilitated biblio-based group may be a promising intervention for hoarding disorder.

Hoarding behavior and the problems associated with it have been the subject of an increasing amount of research. Early theorizing has suggested that problems with decision-making constitute a core feature, yet relatively few studies have examined this in depth. In the present study, indecisiveness was examined in large samples of adults who self-identified as having significant hoarding problems (n = 887), adult children of such individuals (n = 295), and spouses of such individuals (n = 120). People with hoarding problems reported more decision-making problems than children or spouses, and considerably more than community controls from other studies. Adult children of people with hoarding reported more indecisiveness than spouses, suggesting that this characteristic runs in families. Among the hoarding group, decision-making problems were correlated with all three core features of hoarding (excessive acquisition, difficulty discarding, clutter/disorganization), and the associations were independent of de...

Currently, case studies and media reports provide the only descriptive information available to understand what distinguishes hoarding of animals from nonhoarding animal ownership. This poorly understood problem appears to be associated with substantial mental health difficulties. The present study investigated characteristics and antecedents that might explain hoarding behaviors. Sixteen people who fit criteria for hoarding of animals and 11 nonhoarding controls who owned large numbers of animals participated in semistructured interviews that were analyzed using somewhat atypical qualitative and quantitative methods. The interviews focused on demographic information, history of animal contact, social history, insight into physical and mental health issues, collecting behaviors, and beliefs and emotions associated with animals. Descriptive statistics and qualitative analyses were used to examine differences between hoarding and nonhoarding groups and to capture distinguishing themes and patterns. Both groups were well matched in demographic variables and were mainly White women of middle age; the average number of animals owned was 31. Thematic content common to both groups was stressful life events (both childhood and adult), strong emotional reactions to animal death, strong caretaking roles and attitudes toward animals, a tendency to rescue animals, and intense feelings of closeness or attachment to animals. Themes found significantly more often among animal hoarding participants than controls included problems with early attachment, chaotic childhood environments, significant mental health concerns, attribution of human characteristics to animals, and the presence of more dysfunctional current relationships. These themes are elaborated and discussed with regard to potential models for understanding hoarding of animals.

Although empirically supported treatment for compulsive hoarding is in its preliminary stages, some information has emerged regarding ethical challenges experienced in treating this population. Our aims are twofold: (a) to inform the clinical community of ethical complications when conducting treatment for hoarding clients, and (b) to provide a decision-making model for ensuring quality and ethical care of hoarding clients. The ethical challenges (boundary crossings, dual roles, privacy/confidentiality, record keeping, fees, and cultural competence in treatment) were discovered through multiple roundtable discussions, supervision, and in the course of delivering empirically supported treatment protocols. A literature search was conducted to identify research that addressed ethical concerns. A decision-making model addressing ethical challenges in treatment of compulsive hoarding was developed.

Compulsive hoarding is a chronic and debilitating condition that has proven difficult to treat. The cognitive behavioral approaches that have otherwise been successful for people suffering from obsessive-compulsive disorder do not work very well for hoarding (Abramowitz, Franklin, Schwartz, & Furr, 2003). Many have suggested that this is due to the ego-syntonic nature of the symptoms and the accompanying lack of insight. This paper describes several challenges related to insight that limit the effectiveness of traditional cognitive behavioral approaches for compulsive hoarding. Problems with anosognosia, overvalued ideation, and defensiveness that characterize hoarding are described and suggestions offered for dealing with them.

Hoarding, the excessive collection and failure to discard objects of apparently little value, can represent a serious psychiatric problem and pose a threat to public health. Hoarding has traditionally been considered a symptom (or symptom dimension) of Obsessive-Compulsive Disorder (OCD), but its nosological status has recently been debated. Mounting evidence suggests that, once other primary causes are ruled out, hoarding may be a discrete diagnostic entity, recently named Hoarding Disorder. However, hoarding can sometimes be a genuine OCD symptom. This can be confusing and clinicians may sometimes struggle making the differential diagnosis. To illustrate this, we describe 10 OCD patients with severe hoarding behavior that is better conceptualized as a symptom of OCD. We focus on the motivations for hoarding and the overlapping of hoarding with other obsessive-compulsive symptom dimensions. We estimate that this clinical presentation is relatively rare and accounts for a minority of severe hoarding cases. We discuss the unique characteristics of hoarding as a symptom of OCD and the implications for DSM-V.

This study reports on the development and initial psychometric properties of the Children's Saving Inventory (CSI), a parent-rated measure designed to assess child hoarding behaviors. Subjects included 123 children and adolescents diagnosed with primary Obsessive-Compulsive Disorder (OCD) and their parents. Trained clinicians administered the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), items assessing Family Accommodation and the Clinical Global Impressions--Severity index. Parents completed the CSI, Child Obsessive-Compulsive Impact Scale (COIS)--Parent Version and Child Behavior Checklist. Youth completed the COIS--Child Version, Obsessive-Compulsive Inventory Child Version (OCI-CV), Multidimensional Anxiety Scale for Children, and Children's Depression Inventory--Short Form. A four factor solution was identified; factors were named Discarding, Clutter, Acquisition, and Distress/Impairment. Internal consistency for the CSI Total and factor scores were good. One-week test-retest reliability (n = 31) from a random subsample was excellent. Known groups validity was supported vis-à-vis higher CSI scores for those endorsing hoarding on the CY-BOCS Symptom Checklist. Convergent and discriminant validity was evidenced by weak relationships with OCI-CV Checking and Contamination factors but strong relationships with the OCI-CV Hoarding factor and with hoarding obsession/compulsions on the CY-BOCS. These findings provide initial support for the reliability and validity of the CSI for the assessment of hoarding behaviors among youth with OCD. Future studies are needed to extend these findings to non-OCD samples of youth.

In the past 5 years, hoarding has emerged as a serious, potentially debilitating and remarkably frequent form of psychopathology. Attempts to treat it have met with little success. Although the majority of studies using serotonin-reuptake inhibitors have shown a poor response among people with hoarding disorder, serious methodological problems limit the conclusions that can be drawn from these studies. The true efficacy of serotonin-reuptake inhibitors for hoarding is largely unknown. Cognitive-behavioral treatments for obsessive-compulsive disorder have also fared badly in the treatment of hoarding. However, therapy based on a cognitive-behavioral model of hoarding has shown considerable promise.

This study tested the effectiveness of an existing private online CBT-based group intervention designed to help people with hoarding. Web-group participants were hypothesized to show more improvement in hoarding symptoms over time compared to those placed on a naturalistic waitlist. This web-based self-help group (N = 106 members, N = 155 waitlisted) includes a formal application process and requires that participants post action steps and progress at least once monthly. Members have access to educational resources on hoarding, cognitive strategies, and a chat-group. Potential research participants were invited to complete an anonymous web-based survey about their hoarding behaviors and clinical improvement on five occasions (3 months apart). The sample was mainly middle-aged, female and White. Regression analyses show that Recent members reported greater improvement and less clutter at 6 months (than Waitlist). Long-term members reported milder hoarding symptoms than Recent ones, suggesting benefits from group participation over time. All members showed reductions in clutter and hoarding symptoms over 15 months. Less posting activity was associated with greater hoarding severity. Online CBT-based self-help for hoarding appears to be a promising intervention strategy that may extend access to treatment. Evaluating the benefits of internet self-help groups is critical given growing popularity of and demand for web-based interventions.

Hypersentimentality to possessions has been proposed to play an important role in the development and maintenance of compulsive hoarding. The current study prospectively examined the formation of attachment to a newly acquired object in an OCD sample (n = 62) to determine whether specific hoarding symptoms moderated the development of attachment to an object over time. Participants rated their level of attachment to a keychain immediately upon receipt (time 1) and one week later (time 2). We hypothesized that individuals with a tendency to hoard and strong beliefs about the value of possessions would exhibit greater attachment to the object over time. Hierarchical multiple regression analyses revealed that a person's initial attachment to the object was the best predictor of attachment one week later. Although emotional attachment increased similarly for all participants independent of their hoarding symptoms, specific hoarding-related beliefs and behaviors uniquely predicted initial attachment to the keychain.