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"Hoarding disorder"
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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
“In an ideal world that would be a multiagency service because you need everybody’s expertise.” Managing hoarding disorder: A qualitative investigation of existing procedures and practices
Hoarding disorder is characterised by the acquisition of, and failure to discard large numbers of items regardless of their actual value, a perceived need to save the items and distress associated with discarding them, significant clutter in living spaces that render the activities associated with those spaces very difficult causing significant distress or impairment in functioning. To aid development of an intervention for hoarding disorder we aimed to identify current practice by investigating key stakeholders existing practice regarding identification, assessment and intervention associated with people with hoarding disorder. Two focus groups with a purposive sample of 17 (eight male, nine female) stakeholders representing a range of services from housing, health, and social care were audio recorded, transcribed verbatim and analysed thematically. There was a lack of consensus regarding how hoarding disorder was understood and of the number of cases of hoarding disorder however all stakeholders agreed hoarding disorder appeared to be increasing. The clutter image rating scale was most used to identify people who needed help for hoarding disorder, in addition to other assessments relevant to the stakeholder. People with hoarding disorder were commonly identified in social housing where regular access to property was required. Stakeholders reported that symptoms of hoarding disorder were often tackled by enforced cleaning, eviction, or other legal action however these approaches were extremely traumatic for the person with hoarding disorder and failed to address the root cause of the disorder. While stakeholders reported there was no established services or treatment pathways specifically for people with hoarding disorder, stakeholders were unanimous in their support for a multi-agency approach. The absence of an established multiagency service that would offer an appropriate and effective pathway when working with a hoarding disorder presentation led stakeholders to work together to suggest a psychology led multiagency model for people who present with hoarding disorder. There is currently a need to examine the acceptability of such a model.
Journal Article
Family game night and other catastrophes
Seventh-grader Annabelle's mother is a hoarder, and their whole house is full of canned goods, broken toys, fabric, and old newspapers--and when a pile of newspapers (organized by weather reports) falls on Annabelle's younger sister Leslie and their mother is more concerned about the newspapers, it sets off a chain of events that brings their fix-it-all grandmother in, and Annabelle realizes that if there's any hope for change she can't isolate herself and keep her family's problems secret.
Book
To hoard or not to hoard purchased items - does it matter? A clinical cross-sectional study on compulsive buying-shopping disorder
Research with individuals with compulsive buying-shopping disorder (CBSD) indicated that comorbid hoarding disorder (HD), as determined by questionnaire cutoffs, is associated with more severe CBSD. This study investigated a clinical sample with CBSD and determined the prevalence of HD by clinical interview, explored whether hoarding refers to consumer goods and/or non-purchased, free items, and compared patients with (HD+) and without (HD-) comorbid HD regarding materialism, impulsiveness, general psychopathology, CBSD and HD symptoms. Additionally, the relationship between CBSD symptoms and other study variables was explored in the total sample.
All patients (N = 81) underwent a clinical interview and answered the Pathological Buying Screener (PBS), the German Saving Inventory-Revised (GSI-R), and measures for materialism, impulsiveness, depression and anxiety.
Seventeen patients had comorbid HD, of which 82 % hoarded predominantly purchased items. The HD+ group scored higher than the HD- group on the clutter and difficulty discarding GSI-R subscales, but not on the excessive acquisition GSI-R subscale or the PBS. There were no group differences in materialism, impulsiveness, and general psychopathology. The correlation between the PBS and the GSI-R in the total sample was driven by the high correlation between the PBS and the excessive acquisition GSI-R subscale. Higher PBS/GSI-R excessive acquisition scores were related to higher materialism and more psychopathology.
The findings indicate that hoarding in CBSD is mostly related to purchased consumer goods and not associated with a higher symptom severity of CBSD. Further investigation into the specifics of hoarding in the context of CBSD is necessary.
•In this sample of patients with CBSD, a comorbid HD diagnosis was not related to a higher symptom severity of CBSD.•A comorbid HD in patients with CBSD showed no influence on materialism, impulsiveness and general psychopathology.•Most patients with CBSD and comorbid HD reported hoarding only purchased consumer goods and not non-purchased, free items.•The GSI-R excessive acquisition subscale contributed the most to the correlation between the PBS and the GSI-R total scores.•The results question the accuracy of HD prevalences measured with GSI-R total score cutoffs in samples of patients with CBSD.
Journal Article
Scrupulosity and hoarding
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.
Journal Article
“Falling between the cracks”: Investigating the competing challenges experienced by professionals working with people who hoard
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.
Journal Article
An examination of the role of intolerance of distress and uncertainty in hoarding symptoms
Hoarding disorder (HD) is a common and debilitating disorder characterized by an accumulation of and failure to discard one's possessions. The identification and examination of underlying factors that may contribute to hoarding symptoms are needed to elucidate the nature of the disorder and refine existing treatments. Two transdiagnostic vulnerability factors that have been associated with hoarding symptoms are distress intolerance (DI) and intolerance of uncertainty (IU).
This study examined the relationships between DI, IU, and symptoms of hoarding in two samples consisting of outpatients and individuals recruited from Amazon's Mechanical Turk. We hypothesized that DI and IU would show unique and interactive associations with hoarding symptoms.
Across both samples, DI and IU were significantly associated with hoarding symptoms. However, DI and IU did not interact in their prediction of symptoms, and only IU remained a significant predictor, when accounting for relevant covariates.
Results suggest that IU is a robust predictor of hoarding symptoms and may be a promising and novel treatment target for HD.
Journal Article
Clinical Manifestations
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.
Journal Article