Cognition |
Thoughts related to hoarding are not archetypal obsessions as
those typically found in OCD patients. (For a review, see
Mataix-Cols et al.2626 . Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman
JF, et al. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety.
2010;27:556-72.) |
Thoughts related to symmetry and ordering are not typical
obsessions either,3535 . Radomsky AS, Rachman S. Symmetry, ordering and arranging
compulsive behaviour. Behav Res Ther. 2004;42:893-913. thus
suggesting that this is actually a weak argument. |
Thoughts related to hoarding are different from other
obsessive-compulsive thoughts, as the former involve the
emotional significance, instrumental characteristics, or
intrinsic values of hoarded items.2828 . Steketee G, Frost R, Kyrios M. Cognitive aspects of compulsive
hoarding. Cogn Ther Res. 2003;27:463-79.,3636 . Frost RO, Hartl TL, Christian R, Williams N. The value of
possessions in compulsive hoarding: patterns of use and attachment. Behav Res
Ther. 1995;33:897-902.
|
Insight |
Thoughts related to hoarding typically lack insight, while most
OCD patients have insight toward their symptoms.2727 . Tolin DF, Fitch KE, Frost RO, Steketee G. Family informants'
perceptions of insight in compulsive hoarding. Cogn Ther Res.
2010;34:69-81.
|
Thoughts related to other OC dimensions may also lack
insight,3737 . Tolin DF, Abramowitz JS, Kozak MJ, Foa EB. Fixity of belief,
perceptual aberration, and magical ideation in obsessive-compulsive disorder. J
Anxiety Disord. 2001;15:501-10.
38 . De Berardis D, Campanella D, Gambi F, Sepede G, Salini G, Carano
A, et al. Insight and alexithymia in adult outpatients with obsessive-compulsive
disorder. Eur Arch Psychiatry Clin Neurosci. 2005;255:350-8.-3939 . Marazziti D, Dell'Osso L, Di Nasso E, Pfanner C, Presta S,
Mungai F, et al. Insight in obsessive-compulsive disorder: a study of an Italian
sample. Eur Psychiatry. 2002;17:407-10. which seems to depend on
the severity of OC symptoms.4040 . Fontenelle JM, Harrison BJ, Santana L, Conceicao do Rosario M,
Versiani M, Fontenelle LF. Correlates of insight into different symptom
dimensions in obsessive-compulsive disorder. Ann Clin Psychiatry.
2013;25:11-6. In a field trial, most individuals who hoarded
(> 85%) were rated as having good or fair insight.4141 . Mataix-Cols D, Billotti D, Fernandez de la Cruz L, Nordsletten AE.
The London field trial for hoarding disorder. Psychol Med.
2013;43:837-47.
|
Hoarding patients may be particularly prone to lack of insight
into the consequences of hoarding behaviors,4141 . Mataix-Cols D, Billotti D, Fernandez de la Cruz L, Nordsletten AE.
The London field trial for hoarding disorder. Psychol Med.
2013;43:837-47.,4242 . Frost RO, Tolin DF, Maltby N. Insight-related challenges in the
treatment of hoarding. Cogn Behav Pract. 2010;17:404-13. rather than just into their
hoarding-related thoughts, as reported in other OC dimensions.
Furthermore, in the study reporting a high rate of good or fair
insight in hoarding, most subjects were self-identified
individuals attending a local support group.4141 . Mataix-Cols D, Billotti D, Fernandez de la Cruz L, Nordsletten AE.
The London field trial for hoarding disorder. Psychol Med.
2013;43:837-47.
|
Affective states |
Thoughts related to hoarding may result in feelings of grief and
anger, whereas OCD-related thoughts result in anxiety.2626 . Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman
JF, et al. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety.
2010;27:556-72.
|
Thoughts related to symmetry and contamination may also result
in anger or other non-anxiety emotions (e.g., disgust).4343 . Whiteside SP, Abramowitz JS. The expression of anger and its
relationship to symptoms and cognitions in obsessive-compulsive disorder.
Depress Anxiety. 2005;21:106-11.
44 . Mancini F, Gragnani A, D'Olimpio F. The connection between
disgust and obsessions and compulsions in a non-clinical sample. Pers Individ
Dif. 2001;31:1173-80.
45 . Tolin DF, Woods CM, Abramowitz JS. Disgust sensitivity and
obsessive-compulsive symptoms in a non-clinical sample. J Behav Ther Exp
Psychiatry. 2006;37:30-40.-4646 . Olatunji BO, Ebesutani C, David B, Fan Q, McGrath PB. Disgust
proneness and obsessive-compulsive symptoms in a clinical sample: structural
differentiation from negative affect. J Anxiety Disord.
2011;25:932-8.
|
Thoughts related to hoarding are distinct from those related to
other OC dimensions insofar as they are associated with grief
and with the experience of other pro-social emotions, such as
pity and regret. |
Reward |
Hoarding behaviors are associated with pleasure and reward,
whereas in OCD, they lead to anxiety relief.2828 . Steketee G, Frost R, Kyrios M. Cognitive aspects of compulsive
hoarding. Cogn Ther Res. 2003;27:463-79.
|
Symmetry and ordering behaviors may also be associated with
pleasure and reward (e.g., in so-called “house-proud
homemakers”).4747 . Cooper J. The Leyton obsessional inventory. Psychol Med.
1970;1:48-64.
|
While the experience of reward in hoarding is frequently
associated with shame, reward-related symmetry is probably
ascribed more to social reinforcement and pride. |
Course |
Hoarding behaviors worsen over each decade of life,2929 . Ayers CR, Saxena S, Golshan S, Wetherell JL. Age at onset and
clinical features of late life compulsive hoarding. Int J Geriatr Psychiatry.
2010;25:142-9.,3030 . Grisham JR, Frost RO, Steketee G, Kim HJ, Hood S. Age of onset of
compulsive hoarding. J Anxiety Disord. 2006;20:675-86. while OCD tends to wax and wane over
time. |
One could argue that it is actually clutter, a mere byproduct of
hoarding, that worsens over each decade of life. |
Clutter is a key and intrinsic feature of clinically significant
hoarding behaviors2222 . Frost RO, Steketee G, Grisham J. Measurement of compulsive
hoarding: saving inventory-revised. Behav Res Ther.
2004;42:1163-82. and,
therefore, cannot be considered a simple byproduct of the
condition. |
Co-occurrence with OCD |
Hoarding is a significant problem in only a minority of patients
with OCD.3131 . Foa EB, Kozak MJ, Goodman WK, Hollander E, Jenike MA, Rasmussen
SA. DSM-IV field trial: obsessive-compulsive disorder. Am J Psychiatry.
1995;152:90-6.
|
Hoarding is present in the majority of patients with OCD.1818 . Torres AR, Fontenelle LF, Ferrao YA, do Rosário MC, Torresan
RC, Miguel EC, et al. Clinical features of obsessive-compulsive disorder with
hoarding symptoms: a multicenter study. J Psychiatr Res.
2012;46:724-32.
|
Hoarding is a common phenomenon in other anxiety disorders4848 . Tolin DF, Meunier SA, Frost RO, Steketee G. Hoarding among
patients seeking treatment for anxiety disorders. J Anxiety Disord.
2011;25:43-8.; therefore, it is not
surprising that it is also frequently reported in OCD. |
Functional relationships |
Hoarding is not frequently related to other non-hoarding OCD
dimensions.3232 . Pertusa A, Fullana MA, Singh S, Alonso P, Menchon JM, Mataix-Cols
D. Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both?
Am J Psychiatry. 2008;165:1289-98.
|
Other OC symptoms (e.g., washing) are also infrequently related
to other OC symptom dimensions (e.g., sexual/religious).1616 . Rosario-Campos MC, Miguel EC, Quatrano S, Chacon P, Ferrao Y,
Findley D, et al. The Dimensional Yale-Brown Obsessive-Compulsive Scale
(DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions.
Mol Psychiatry. 2006;11:495-504.
|
It is presently unclear whether hoarding unrelated to OCD is
more or less frequent than other “hybrid symptoms”
in OCD because there is an absence of studies reporting this
“crossover” between different OC dimensions. |
Correlations |
Hoarding is infrequently associated with other OCD symptoms;
correlations between hoarding and other OCD symptoms are
moderate.3434 . Wu KD, Watson D. Hoarding and its relation to obsessive-compulsive
disorder. Behav Res Ther. 2005;43:897-921.
|
Correlations between hoarding and other OCD symptoms were
sometimes reported to be high in clinical samples of patients
with OCD.2424 . Fontenelle IS, Prazeres AM, Borges MC, Range BP, Versiani M,
Fontenelle LF. The Brazilian Portuguese version of the Saving Inventory-Revised:
internal consistency, test-retest reliability, and validity of a questionnaire
to assess hoarding. Psychol Rep. 2010;106:279-96.
|
OCD patients may display hoarding secondary to OCD, thus
artificially increasing correlations between both conditions.
However, hoarding and OCD symptoms are much less correlated in
non-OCD (e.g., epidemiological) samples. |
Treatment response |
Patients with hoarding symptoms show poor adherence4949 . Santana L, Fontenelle JM, Yucel M, Fontenelle LF. Rates and
correlates of nonadherence to treatment in obsessive-compulsive disorder. J
Psychiatr Pract. 2013;19:42-53. and poor response to
treatment.5050 . Mataix-Cols D, Marks IM, Greist JH, Kobak KA, Baer L.
Obsessive-compulsive symptom dimensions as predictors of compliance with and
response to behaviour therapy: results from a controlled trial. Psychother
Psychosom. 2002;71:255-62.
|
Studies suggest that patients with sexual/religious symptoms may
also show a poor therapeutic outcome.5151 . Ferrao YA, Shavitt RG, Bedin NR, de Mathis ME, Carlos Lopes A, et
al. Clinical features associated to refractory obsessive-compulsive disorder. J
Affect Disord. 2006;94:199-209.
|
Although non-hoarding OCD symptoms were found to predict poor
response to OCD treatment, studies reporting these findings
failed to characterize hoarding unrelated to OCD in their
samples. |
Biological correlates |
Individuals with hoarding show a certain pattern of genetic,
cognitive, and neuroimaging findings, thus suggesting that they
have a putatively different disorder.2626 . Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman
JF, et al. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety.
2010;27:556-72.
|
However, it is also possible to interpret these specificities as
indicating a different and more clear-cut type of OCD
dimension.2626 . Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman
JF, et al. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety.
2010;27:556-72.,5252 . Mataix-Cols D, Pertusa A. Annual research review: hoarding
disorder: potential benefits and pitfalls of a new mental disorder. J Child
Psychol Psychiatry. 2012;53:608-18.
|
Since no study has ever compared the neurobiology of individuals
with hoarding to that of individuals with OCD, it is still
unknown whether these conditions share most or just a few
neurobiological features, findings that would support hoarding
as an OCD subtype or as an OCD-related disorder,
respectively. |