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COGNITIVE BEHAVIORAL THERAPY FOR HOARDING DISORDER: A META-ANALYSIS
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.
Journal Article
Treatment for hoarding disorder : workbook
\"This second edition ... is the culmination of more than 20 years of research on understanding hoarding and building an effective intervention to address its myriad components. Thoroughly updated and reflective of changes made to the fifth edition of the Diagnostic and statistical manual for mental disorders (DSM-5), this second edition of the client workbook and accompanying therapist guide outlines an empirically supported and effective CBT program for HD\"--Page 4 of cover.
Book
Experience and the developing prefrontal cortex
The prefrontal cortex (PFC) receives input from all other cortical regions and functions to plan and direct motor, cognitive, affective, and social behavior across time. It has a prolonged development, which allows the acquisition of complex cognitive abilities through experience but makes it susceptible to factors that can lead to abnormal functioning, which is often manifested in neuropsychiatric disorders. When the PFC is exposed to different environmental events during development, such as sensory stimuli, stress, drugs, hormones, and social experiences (including both parental and peer interactions), the developing PFC may develop in different ways. The goal of the current review is to illustrate how the circuitry of the developing PFC can be sculpted by a wide range of pre- and postnatal factors. We begin with an overview of prefrontal functioning and development, and we conclude with a consideration of how early experiences influence prefrontal development and behavior.
Journal Article
Suicidal thoughts and behaviors in adults with hoarding disorder
Hoarding disorder (HD) is characterized by difficulty discarding possessions and clutter that impairs daily functioning. Previous research has demonstrated a high correlation between hoarding behaviors and suicidal thoughts and behaviors; however, there is limited research on suicidal thoughts and behaviors in individuals meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for HD. Our aim in this study was to report our findings about suicidal thoughts and behaviors in a HD sample.
We used existing data from participants meeting DSM-5 criteria for HD (n = 99). Data about suicidal thoughts and behaviors was collected using a structured instrument, the Columbia-Suicide Severity Rating Scale (C-SSRS).
Among the 99 participants, 49.5 % and 26.3 % had passive and active suicidal ideation (SI), respectively. Of those with active ideation, 11 participants endorsed thinking about overdose during their most severe SI. 13 participants reported attempting suicide at least once in their lifetime.
To our knowledge, this is the first study examining suicidal thoughts and behaviors in HD using the structured assessment C-SSRS. In this HD data set, participants reported suicidal thoughts and behaviors at higher rates than the general U.S. population. Our study highlights the importance of screening for suicidal thoughts and behaviors in individuals with HD.
Journal Article
Family Informants’ Perceptions of Insight in Compulsive Hoarding
Existing psychological and pharmacological interventions for obsessive-compulsive disorder have not been particularly successful for compulsive hoarding, perhaps due in part to poor insight on the part of sufferers. Individuals with compulsive hoarding problems commonly display lack of awareness of the severity of their behavior, sometimes denying that they have a problem and often resisting intervention attempts and failing to follow through with therapeutic assignments. Using an internet-based survey, family and friends of individuals with reported hoarding problems (
family/friend informants, N
= 584) provided ratings of the hoarder’s level of insight. They also made several ratings of the severity of the person’s hoarding behavior, then rated the same items again with regard to how they thought the hoarder would respond to the items. Family/friend informants described the hoarder on average as having fair to poor insight. More than half were described as having “poor insight” or “lacks insight/delusional,” substantially worse insight than found in samples of OCD clinic patients using the same measure. Family/friend informants’ ratings of hoarding severity were significantly greater than were their estimates of the hoarder’s ratings. Hoarders described as showing less distress about the hoarding were described as showing poorer insight. These results suggest that compulsive hoarding is characterized by poor insight into the severity of the problem. Treatment development might need to emphasize strategies to bolster awareness, insight, and motivation.
Journal Article
Cognitions in Compulsive Buying and Acquisition
Compulsive buying is a disabling condition associated with a chronic failure to control the urge to purchase objects. Compulsive buying is closely related to major depression, obsessive-compulsive disorder, and in particular, compulsive hoarding. Like compulsive hoarding, compulsive buying is thought to be influenced by a range of cognitive domains including deficits in decision-making, emotional attachments to objects and erroneous beliefs about possessions, and other maladaptive beliefs. This study examined cognitive factors related to compulsive buying among 189 participants, described by R. O. Frost, G. Steketee, and L. F. Williams (2002), of whom 75 were classified as \"compulsive buyers\" and 85 as \"controls.\" Beliefs associated with compulsive buying were assessed with the newly developed 43-item self-report Buying Cognitions Inventory (BCI). Other cognitive styles (i.e., perfectionism) and processing (i.e., decision-making) were also assessed. Overall, this study supported a theoretical model of compulsive buying addressing 5 main domains: (a) depressed mood; (b) compromised self-perceptions and perfectionistic expectations; (c) erroneous beliefs about the nature of objects, potential purchases, and purchasing opportunities; (d) erroneous beliefs about the psychological benefits of buying; and (e) decision-making difficulties.
Journal Article
Olanzapine Treatment of Adolescent Rats Causes Enduring Specific Memory Impairments and Alters Cortical Development and Function
Antipsychotic drugs are increasingly used in children and adolescents to treat a variety of psychiatric disorders. However, little is known about the long-term effects of early life antipsychotic drug treatment. Most antipsychotic drugs are potent antagonists or partial agonists of dopamine D2 receptors; atypical antipsychotic drugs also antagonize type 2A serotonin receptors. Dopamine and serotonin regulate many neurodevelopmental processes. Thus, early life antipsychotic drug treatment can, potentially, perturb these processes, causing long-term behavioral- and neurobiological impairments. Here, we treated adolescent, male rats with olanzapine on post-natal days 28-49. As adults, they exhibited impaired working memory, but normal spatial memory, as compared to vehicle-treated control rats. They also showed a deficit in extinction of fear conditioning. Measures of motor activity and skill, habituation to an open field, and affect were normal. In the orbital- and medial prefrontal cortices, parietal cortex, nucleus accumbens core and dentate gyrus, adolescent olanzapine treatment altered the developmental dynamics and mature values of dendritic spine density in a region-specific manner. Measures of motor activity and skill, habituation to an open field, and affect were normal. In the orbital- and medial prefrontal cortices, D1 binding was reduced and binding of GABA(A) receptors with open Cl(-) channels was increased. In medial prefrontal cortex, D2 binding was also increased. The persistence of these changes underscores the importance of improved understanding of the enduring sequelae of pediatric APD treatment as a basis for weighing the benefits and risks of adolescent antipsychotic drug therapy, especially prophylactic treatment in high risk, asymptomatic patients. The long-term changes in neurotransmitter receptor binding and neural circuitry induced by adolescent APD treatment may also cause enduring changes in behavioral- and neurobiological responses to other therapeutic- or illicit psychotropic drugs.
Journal Article
Cognitive Aspects of Compulsive Hoarding
Hoarding of possessions is thought to be influenced by deficits in information processing, emotional attachments, and erroneous beliefs about possessions. This study examined hypothesized beliefs about possessions using an instrument developed for this purpose, the Saving Cognitions Inventory (SCI). Participants were individuals with compulsive hoarding (n = 95), obsessive compulsive disorder without hoarding (n = 21), and community controls (n = 40). An exploratory factor analysis yielded 4 factors similar to those hypothesized, representing emotional attachment, concerns about memory, control over possessions, and responsibility toward possessions. Subscales created based on these factors were internally consistent, and showed known groups, convergent and discriminant validity. Regression analyses indicated that 3 of the 4 subscales (memory, control, and responsibility) significantly predicted hoarding severity after age, moodstate, OCD symptoms and other OCD-related cognitive variables were entered. Interestingly, difficulty with decision-making also proved to be an important predictor of hoarding behavior. Implications for understanding and treating hoarding are discussed and study limitations are noted.
Journal Article
Assessing Squalor in Hoarding: The Home Environment Index
The current study examined a new measure of squalor associated with hoarding, the Home Environment Index (HEI). Participants (
N
= 793) were recruited from a large database of individuals who sought information about hoarding following national media appearances and consented to an internet study. Participants completed measures of hoarding and related psychopathology, including the HEI. The HEI showed good internal consistency and construct validity and reflected a single factor of home squalor (15 items). The HEI correlated positively with measures of hoarding and mood psychopathology. Recommendations for future modifications and further study are provided.
Journal Article