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\"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.

ABSTRACTBackgroundThe Clutter Image Rating (CIR) was created to meet a gap in the research on compulsive hoarding: how to ascertain clutter level in an individual's home without a home visit, as not all clinicians have the ability to conduct a home visit. The CIR has proven itself to be both reliable and valid for use in adults with compulsive hoarding symptoms. However, there is currently a dearth of information on performance of the CIR in older adults diagnosed with hoarding disorder (HD). Because older adults have increased medical issues, including fall risks, evaluating the level of clutter in the house is especially critical in geriatric populations. MethodThe current study was an investigation of the reliability and validity of the CIR in assessing late life HD. The internal consistency, convergent and divergent validity, and norms of the CIR were investigated in a large geriatric HD sample and compared with a midlife sample of individuals with HD. Criterion validity of the CIR was investigated through the comparison of participant ratings conducted in the clinic and clinician ratings conducted in the home. ResultsThe current study found similar levels of reliability and validity in a late life sample as in previous studies conducted in mid-life adults. ConclusionsUnlike previous studies, the current study did not find a significant relationship between the CIR and the non-clutter related subscales of the Savings Inventory-Revised. The CIR appears to be both reliable and valid for assessing clutter levels in older adults diagnosed with HD.

IntroductionHoarding disorder can cause problems with work performance, personal hygiene, health and well-being. The disorder is a growing social problem in Japan. Having difficulty discarding rubbish, decluttering and organising can signal a future hoarding disorder, and early intervention is important. We developed an educational workshop on decluttering and organising for teens and adults with difficulty organising. The objective of this study is to evaluate the effectiveness of a workshop for reducing clutter and improving quality of life among younger people with difficulty decluttering and organising.Methods and analysisAn open-label, parallel-group, randomised controlled trial will be conducted among volunteers aged 12–55 years with mild difficulty decluttering and organising. Those in the intervention group will attend the workshop and receive a visit from a professional cleaning company to declutter their living space. The control group will have only the latter. The primary outcome will be the score on the Japanese version of the Saving Inventory-Revised. Secondary outcomes will be scores on the Clutter Image Rating Scale, the Japanese version of the Rosenberg Self-Esteem Scale and the Roles of Private Space Scale. The results will be examined for differences between the two groups in changes from baseline to 7 months. We will examine crude effects and adjust for gender and age using a general linear model for continuous variables and a logistic regression model for dichotomous variables. Sample size was calculated assuming a significance level of 5% (two tailed), a power of 80% and an effect size of 0.75. In total, 60 subjects (30 in each group) will be required.Ethics and disseminationThe study protocol has been approved by the Medical Ethical Committee of Teikyo University (No. 15-065). The findings will be disseminated widely through peer-reviewed publication and conference presentations.Trial registration numberUMIN000020568. Issue date: 16 January 2016.

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 is characterised by both the distress associated with discarding and the resulting accumulation of possessions that clutter the home environment, and represents a substantial public health and social problem, requiring an effective multi-agency response. Although a recognised psychiatric condition since 2013, hoarding disorder is under-recognised within mental health treatment provision, and evidence-based treatment pathways are lacking. This study aimed to explore multi-agency working in practice and similarities and differences in how hoarding support is perceived across a broad range of front-line professionals. 35 semi-structured interviews representing a wide range of services from health, social care, housing, and the voluntary sector were conducted and analysed thematically. Three overarching themes are reported: Unique challenges of supporting people who hoard, Conflicting needs of client vs. needs of the organisation, Managing role boundaries and psychological tensions. Findings consistently highlight the challenges specific to these cases. However, they also point to a lack of consensus between professional groups in terms of perceived problems and risks to be addressed. Collaborating effectively with others to meet the psychological needs of clients while ensuring risk mitigation and addressing broader organisational, environmental, and community concerns was found to be a key challenge and associated with often going beyond designated role boundaries to support the person. Our findings point to a need for greater support and training of a diverse set of professionals in psychological models of people who hoard to enhance knowledge, awareness, and confidence of the psychological dimensions of hoarding disorder, and to support them in feeling more emotionally and practically prepared. The results indicate a need for greater integration of mental health measures in the assessment of hoarding cases, and to ensure adequate care pathways with dedicated psychological support along with assignment of case workers/coordination.

Background Although hoarding disorder (HD) is commonly characterized as a chronic and progressive condition, relatively little is known about its longitudinal course and the factors that contribute to the progression, maintenance, or remission of hoarding symptoms. The current study, the first prospective investigation of hoarding symptom course, aims to identify and characterize patterns of hoarding symptom chronicity in a large sample of adults with clinically significant hoarding. Methods Participants who were enrolled in the internet-based Brain Health Registry completed online self-report measures of hoarding symptom severity at 6-month intervals over a period of 5 years. In a sample of 1,275 participants with clinically significant hoarding symptoms (79% with follow-up ≥ 4 years, n  = 1,004), latent class mixed modeling (LCMM) was used to identify subgroups of individuals with similar symptom trajectories. Data-driven trajectories were then compared to four previously described theory-driven trajectories, and the demographic and clinical characteristics associated with trajectory class membership were assessed. Results LCMM yielded three distinct hoarding symptom trajectories: (1) persistent clinically severe symptoms (“severe”: n  = 203, 15.9%), (2) persistent mild or subclinical symptoms (“mild”: n  = 955, 74.9%), and (3) rapidly improving symptoms (“improving”: n  = 117, 9.2%). Although this data-driven model characterized most participants as exhibiting a predominantly chronic course (90.8%), individuals in the “improving” class experienced sustained remission of hoarding symptoms within 18 months and were distinguished by later age of onset (median age = 47.5 years) and elevated prevalence of self-reported PTSD (20.2%). However, when integrated with the theory-driven framework, substantial heterogeneity in symptom progression emerged among those in the “mild” and “severe” classes, with 29% improving and 20% worsening over time. Individuals in the “severe” class with worsening symptoms ( n  = 41) were uniquely characterized by childhood-onset hoarding symptoms (median age = 13 years) and elevated prevalence of self-reported ADHD (35.0%). Conclusion Individuals with clinically relevant hoarding exhibit marked variability in longitudinal symptom course, including a distinct subgroup characterized by rapid improvement; these individuals had unique clinical and demographic characteristics compared to the other groups. These findings underscore the importance of monitoring intraindividual change and may inform early intervention and prevention strategies. Clinical trial number Not applicable.

This study aimed to investigate the relationships between hoarding behaviors, autism characteristics, and demographic factors in adults diagnosed with high-functioning ASD (Autism Spectrum Disorder). A total of 112 adults, aged 18–35, with high-functioning ASD completed self-reported assessments on hoarding (Savings Inventory-Revised; SI-R) and autism traits (Autism-Spectrum Quotient; AQ). Additionally, demographic data was gathered. Correlation and regression analyses were performed. The findings revealed positive correlations between hoarding and overall autism traits. Autism quotient scores accounted for 24% of the variance in hoarding inventory scores. Higher AQ scores were associated with increased SI-R scores. Specific AQ subscales were linked to particular SI-R subscales. Gender, age, education level, and employment status were connected to assessment scores. A multiple regression analysis revealed that demographic variables accounted for 19% of the variance in hoarding severity. Gender was found to moderate the impact of age on hoarding behaviors. Significant associations were identified between hoarding tendencies and autism traits in adults with ASD. Demographic variables also played a role in symptom presentation. These findings shed light on the relationship between autism characteristics and hoarding behaviors, as well as how external factors influence them. Further research is necessary to enhance understanding and guide interventions for hoarding in ASD populations.

Hoarding is a complex behavior associated with poor quality of life for both patients and caregivers. Although the link between hoarding behavior and comorbid disorders such as depression, anxiety and chronic pain have been suggested, these associations have been underexplored among individuals with neurological conditions. We aim to investigate the association between reported hoarding behavior and comorbidities in patients with neurocognitive conditions. We administered a single-item hoarding screen (SIHS) and Neuropsychiatric Inventory Questionnaire (NPIQ) to be filled by caregivers, as well as Patient Health Questionnaire (PHQ-9), Generalized Anxiety Questionnaire (GAD-7), and PROMIS-10 questionnaire including a 1-10 pain scale which were self-reported by clinic patients with neurocognitive conditions during their initial healthcare visit. We then investigated correlations between the SIHS and the additional measures in each assessment tool. A mixed effects analysis, accounting for repeated measures, revealed that positive hoarding screens were linked to significantly higher pain ratings with an estimated increase of approximately 3 points (β = 3.26, p =  0.004, CI [1.05, 5.47], R  = 0.13). This association remained after controlling for sex, age, and disease severity. Notably, no significant correlations were found between hoarding and measures of anxiety or negative mood symptoms on either patient or caregiver reported measures. Our findings indicate a relationship between hoarding behaviors and increased pain in patients with neurocognitive conditions, aligning with recent population-based literature showing increased chronic pain in hoarding disorder. An absence of correlation with negative mood symptoms or anxiety, commonly observed in studies with other populations, suggest a distinct mechanism in these neurocognitively impaired populations. Further studies should consider investigating shared neurobiological substrates in pain processing and executive function, particularly in the anterior cingulate cortex and insula to gain a better understanding of these associations.

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. 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. 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. 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. •A measure of material scrupulosity (MOMS) was reliable and correlated with hoarding symptoms and beliefs.•Material scrupulosity accounted for variance in hoarding symptoms independent of other variables.•Material scrupulosity and excessive responsibility for possessions were greater in men than women.•OCD-based scrupulosity was associated with hoarding in a nonclinical, but not a clinical sample.

Background The longitudinal course of hoarding behavior (HB) in children and adolescents, as well as the predictors of its outcome, remain unknown. This prospective longitudinal study aims to evaluate the four-year course of HB and identify predictors of progression to hoarding disorder (HD) and the persistence of hoarding symptoms. Methods Children and adolescents with HB underwent a clinical assessment after a four-year follow-up period. The assessment included a one-on-one psychiatric interview, an HD clinical interview based on DSM-5 diagnostic criteria, Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), a semi-structured diagnostic interview for comorbid diagnoses, and the Children’s Saving Inventory (CSI) to assess hoarding symptom severity. Results Over the 4-year follow-up period, 42.2% ( n  = 19) of participants progressed to HD, 20% ( n  = 9) persisted in HB, and 37.8% ( n  = 17) no longer displayed hoarding symptoms. Baseline hoarding symptom severity significantly predicted progression to HD and was also associated with persistence of hoarding symptoms. In exploratory models, current psychiatric comorbidity and female gender were associated with persistence but not progression. Conclusions These findings provide precious insights into the longitudinal course of HB and predictors. The results also suggest the importance of early identification and monitoring of HB.