Hoarding in obsessive compulsive disorder: results from a case-control study

Understanding DSM-5 Hoarding Disorder: A Triple Vulnerability Model

OBJECTIVE

Whereas a triple vulnerability model has been used to evaluate several anxiety- and mood-related conditions, no research has purposefully examined hoarding from this perspective.

METHOD

Using a multivariate approach, the current study evaluated the unique relations between hoarding and a general biological (e.g., neuroticism), psychological (e.g., anxiety sensitivity), and hoarding-specific vulnerability (e.g., saving cognitions) within 526 individuals.

RESULTS

A structural equation model (SEM) including all three vulnerabilities as well as hoarding symptoms provided good fit to the data. Consistent with the model, the vulnerabilities accounted for a substantial percentage (66%) of the variance in hoarding severity.

CONCLUSIONS

These findings suggest that, similar to other emotional distress disorders, risk for hoarding can be conveyed through a constellation of general and specific vulnerabilities. Future research should continue to examine this model, particularly utilizing a prospective design and clinical sample.

Is late-onset OCD a distinct phenotype? Findings from a comparative analysis of "age at onset" groups

OBJECTIVE

Significant differences in clinical profile and comorbidity patterns have been observed between "juvenile-onset" and "adult-onset" obsessive-compulsive disorder (OCD). There is little systematic research on onset of OCD after the fourth decade. The current study aims to compare the demographic, clinical, and comorbidity patterns of patients with "juvenile-onset" (<18 years), "adult-onset" (18-39 years), and "late-onset" (≥40 years) OCD.

METHOD

Eight hundred two consecutive patients who consulted a specialty OCD clinic at a tertiary care hospital in India were evaluated with the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive-Compulsive Scale, and the Clinical Global Impression scale.

RESULTS

37.4%, 57.4%, and 5.2% of patients had juvenile-, adult-, and late-onset OCD, respectively. Late-onset OCD was associated with female gender (χ2=42, p<0.001); negative family history of OCD in first-degree relatives (χ2=20.4, p<0.001); and less aggressive obsessions (χ2=18.16, p<0.001), sexual obsessions (χ2=26.68, p<0.001), pathological doubts (χ2=19.41; p<0.001), and repeating rituals (χ2=44.28; p<0.001). On multinomial logistic regression, late-onset OCD was significantly associated with female gender, collecting compulsions, and less aggressive obsessions, in comparison with adult-onset OCD. In comparison with juvenile-onset, late-onset OCD was significantly associated with female gender, presence of precipitating factors, and less aggressive obsessions, sexual obsessions, and repeating compulsions.

CONCLUSION

Late-onset OCD is characterized by female gender, lesser familial loading for OCD, and presence of precipitating factors, suggesting that it may have a distinct pathophysiology compared to juvenile- and adult-onset OCD. Systematic research is required to understand the family-genetic, neuropsychological, and neurobiological correlates of late-onset OCD.

FAMILIAL PATTERNS OF HOARDING SYMPTOMS

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.

The UCLA Hoarding Severity Scale: development and validation

BACKGROUND

Effective management of Hoarding Disorder (HD) must begin with assessment of the severity of hoarding symptoms and functional impairment. We sought to validate the UCLA Hoarding Severity Scale (UHSS), a semi-structured, clinician-administered rating scale that measures the severity of both the core symptoms of HD and the associated features of indecisiveness, perfectionism, task prolongation, and procrastination, which are significantly associated with the diagnosis and impairment of HD.

METHODS

Hoarding symptom severity was measured in 62 patients who met DSM-5 diagnostic criteria for HD and 65 normal controls, using the UHSS and the Saving Inventory-Revised (SI-R), a well validated self-report measure of hoarding symptoms.

RESULTS

The UHSS showed significant internal consistency (Cronbach׳s α=.70). Principal components analysis revealed three factors that accounted for 58% of the variance: 1) associated features and functional impairment, 2) clutter volume and social impairment, and 3) difficulty discarding, urges to save, and excessive acquisition. UHSS and SI-R scores were significantly correlated. UHSS and SI-R total and factor scores of HD patients were all significantly different from those of controls.

LIMITATIONS

Inter-rater and test-retest reliability were not assessed. The initial version of the UHSS did not contain rater instructions, so it lacked quantifiable anchor points for ratings.

CONCLUSIONS

The UHSS showed internal consistency, construct validity, convergent validity, and known groups discriminant validity. The UHSS validly measures the core symptoms, associated features, and functional impairment of patients with HD. Utilizing a valid clinician-administered scale will provide a more comprehensive and accurate clinical assessment of patients with HD.

An Initial Investigation of the Relationship Between Insomnia and Hoarding

OBJECTIVE

Insomnia has been shown to have profound negative consequences on multiple aspects of daily functioning. Despite increased interest in the association between insomnia and psychopathology, no research has examined the relationships between insomnia and hoarding. The aim of the current investigation was to examine the associations between insomnia and hoarding severity.

METHODS

Participants consisted of patients with hoarding disorder (n = 24).

RESULTS

Results revealed that insomnia was a significant predictor of increased hoarding severity. In addition, when examining the relationships among insomnia and specific hoarding symptoms, sleep difficulties were associated with increased acquiring and difficulty discarding behaviors.

CONCLUSIONS

These findings add to a growing body of literature on insomnia and various forms of psychopathology, as well as research on symptoms related to hoarding. Reducing insomnia symptoms among hoarders may help to reduce hoarding-related behaviors and increase treatment efficacy.

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.

Neuropsychological and neurophysiological insights into hoarding disorder

Hoarding disorder (HD) is associated with significant personal impairment in function and constitutes a severe public health burden. Individuals who hoard experience intense distress in discarding a large number of objects, which results in extreme clutter. Research and theory suggest that hoarding may be associated with specific deficits in information processing, particularly in the areas of attention, memory, and executive functioning. There is also growing interest in the neural underpinnings of hoarding behavior. Thus, the primary aim of this review is to summarize the current state of evidence regarding neuropsychological deficits associated with hoarding and review research on its neurophysiological underpinnings. We also outline the prominent theoretical model of hoarding and provide an up-to-date description of empirically based psychological and medical treatment approaches for HD. Finally, we discuss important future avenues for elaborating our model of HD and improving treatment access and outcomes for this disabling disorder.

Hoarding in an Asian Population: Prevalence, Correlates, Disability and Quality of Life

Introduction: Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value. The objectives of the study were to establish the prevalence of hoarding behaviour among the general population and among individuals with obsessive-compulsive disorder (OCD) in a cross-sectional study conducted in Singapore. Materials and Methods: The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older, living in households. The diagnoses of mental disorders were established using Version 3.0 of Composite International Diagnostic Interview (CIDI 3.0). Differences between 3 groups i.e. those diagnosed with lifetime/12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) OCD with hoarding, those diagnosed with lifetime/12-month DSM-IV OCD without hoarding and those with lifetime hoarding behaviour without diagnosis of DSM-IV OCD were determined. Results: The weighted prevalence of lifetime hoarding behaviour was 2% and that of hoarding among those with OCD was 22.6%. Those who met the criteria for hoarding behaviour alone were associated with lower odds of having obsessions of contamination, harming, ordering as well as compulsions of ordering and other compulsions than those who met criteria for both OCD and hoarding. Conclusion: Hoarders without OCD were less impaired, in terms of comorbid psychopathology, than those with OCD with and without hoarding, and had a higher quality of life versus those with both OCD and hoarding, though still lower than that of the general population. Keywords: Obsessive-compulsive disorder, Singapore, Survey

Hoarding in Children and Adolescents with Obsessive-Compulsive Disorder

Compared to studies in adults, there have been few studies of hoarding in children and adolescents with obsessive-compulsive disorder (OCD). In the current study, we evaluated OCD clinical features, Axis I disorders, and social reciprocity scores in 641 children and adolescents with OCD, of whom 163 (25%) had hoarding compulsions and 478 did not. We found that, as a group, youth with hoarding had an earlier age at onset and more severe lifetime OCD symptoms, poorer insight, more difficulty making decisions and completing tasks, and more overall impairment. The hoarding group also had a greater lifetime prevalence of panic disorder, specific phobia, Tourette disorder, and tics. As measured with the Social Reciprocity Scale, the hoarding group had more severe deficits in parent-rated domains of social communication, social motivation, and restricted interests and repetitive behavior. In a multivariable model, the overall social reciprocity score, age at onset of OCD symptoms, symmetry obsessions, and indecision were independently related to hoarding in these children and adolescents with OCD. These features should be considered as candidate risk factors for the development of hoarding behavior in pediatric OCD.

Partitioning the etiology of hoarding and obsessive-compulsive symptoms

BACKGROUND

Until recently, hoarding was considered an obsessive-compulsive symptom (OCS). However, current evidence suggests that these two phenotypes may be clinically, and perhaps etiologically, distinct. Both hoarding and OCS have a genetic etiology, but the degree of unique and shared genetic contributions to these phenotypes has not been well studied.

METHOD

Prevalence rates were assessed for hoarding and OCS in a sample of adult twin pairs (n = 7906 twins) and their family members from The Netherlands Twin Register (total sample = 15,914). Using Mplus, genetic analyses using liability threshold models were conducted for both phenotypes, for their co-morbidity, and for specific hoarding symptoms (cluttering, discarding and acquiring).

RESULTS

Of the total sample, 6.7% met criteria for clinically significant hoarding; endorsement of all three hoarding symptoms was > or = 79%. Men had slightly higher rates than women. Also, 5.7% met criteria for clinically significant OCS; rates were similar in males and females. Genetic factors accounted for 36% of the variance for hoarding and 40% of the variance for OCS. The genetic correlation between hoarding and OCS was 0.10. There was no evidence of sex-specific genetic contributions for hoarding or OCS. There was evidence for a genetic contribution to all hoarding symptom subtypes. Only cluttering showed evidence of a contribution from the shared environment.

CONCLUSIONS

OCS and hoarding are common in this population-based sample, have prevalence rates similar to those previously reported, and show significant heritability. Genetic factors contributed to the co-morbidity of both traits, although the genetic correlation between them was low.

Effects of clutter on information processing deficits in individuals with hoarding disorder

BACKGROUND

Current cognitive behavioral models of hoarding view hoarding as a multifaceted problem stemming from various information processing deficits. However, there is also reason to suspect that the consequences of hoarding may in turn impact or modulate deficits in information processing. The current study sought to expand upon the existing literature by manipulating clutter to examine whether the presence of a cluttered environment affects information processing.

METHODS

Participants included 34 individuals with hoarding disorder. Participants were randomized into a clutter or non-clutter condition and asked to complete various neuropsychological tasks of memory and attention.

RESULTS

Results revealed that hoarding severity was associated with difficulties in sustained attention. However, individuals in the clutter condition relative to the non-clutter condition did not experience greater deficits in information processing.

LIMITATIONS

Limitations include the cross-sectional design and small sample size.

CONCLUSIONS

The current findings add considerably to a growing body of literature on the relationships between information processing deficits and hoarding behaviors. Research of this type is integral to understanding the etiology and maintenance of hoarding.

Venlafaxine extended-release treatment of hoarding disorder

Hoarding disorder, classified as a separate disorder in Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), is a common, chronic, and potentially disabling syndrome that can be difficult to treat. Only one previous study prospectively measured response to pharmacotherapy in compulsive hoarders, finding that hoarders responded as well to paroxetine as did nonhoarding obsessive-compulsive disorder patients. However, paroxetine was not tolerated well in that study, and the overall response was moderate. Therefore, we conducted an open-label trial of venlafaxine extended-release for hoarding disorder. Twenty-four patients fulfilling the DSM-5 criteria for hoarding disorder were treated with venlafaxine extended-release for 12 weeks. All patients were free of psychotropic medications for at least 6 weeks before the study. No other psychotropic medications, cognitive-behavioral therapy, organizers, or cleaning crews were permitted during the study. To measure the severity of hoarding, the Saving Inventory-Revised (SI-R) and the UCLA Hoarding Severity Scale (UHSS) were administered before and after treatment. Twenty-three of the 24 patients completed treatment. Hoarding symptoms improved significantly, with a mean 36% decrease in UHSS scores and a mean 32% decrease in SI-R scores. Sixteen of the 23 completers (70%) were classified as responders to venlafaxine extended-release. These results suggest that venlafaxine extended-release may be effective for the treatment of hoarding disorder.

Panic attacks and hoarding disorder: an initial investigation

Panic attacks (PAs) defined as a discrete period of intense fear or discomfort, occur in the context of numerous anxiety and mood related disorders. Research has suggested that PAs serve as a significant indicator and prognostic factor for overall symptom severity, course, and comorbidity within various conditions. Consequently, a PA specifier is now applicable to all DSM-5 disorders. Despite these clinical and nosological implications, no research to date has examined associations between PAs and hoarding disorder. The current investigation evaluated relationships between PA endorsement and hoarding severity within a sample of 32 patients with hoarding disorder. Findings suggested a high rate of panic history among those with hoarding disorder (56%). Hoarders with co-occurring PAs, compared to those without PAs, evidenced significantly higher symptom severity. Moreover, PAs continued to significantly predict hoarding severity even after controlling for relevant covariates. When examining the specific relationships among PAs and hoarding symptoms (i.e., acquiring, difficulty discarding, and clutter), the endorsement of PAs was associated with increased acquiring and difficulty discarding symptoms. These findings add considerably to a growing body of literature on hoarding disorder. Implications for the assessment and treatment of PAs that co-occur with hoarding disorder are discussed.

An initial investigation of the relationships between hoarding and smoking

Cigarette smokers have increased rates of mood and anxiety-related conditions. Hoarding is another anxiety-related condition that has yet to be examined in relation to smoking behavior. The current investigation sought to examine smoking rates among a sample of individuals with hoarding disorder and individuals with non-hoarding obsessive-compulsive disorder (OCD). Additionally, we examined the relationship between hoarding symptoms and reasons for smoking. Participants in Study 1 consisted of 57 individuals with non-hoarding OCD or hoarding disorder. Participants in Study 2 consisted of 661 adult daily smokers. Results revealed that a significantly greater proportion of individuals diagnosed with hoarding were current smokers compared to the non-hoarding OCD group. Additionally, hoarding severity was associated with negative affect reduction expectancies. These results provide important information regarding smoking behaviors within hoarding disorder. Given the poor treatment outcomes and negative health risks associated with hoarding, this information could inform future research and treatment programs.

Hoarding behavior among young children with obsessive-compulsive disorder

Previous research has shown that among the various subtypes of obsessive-compulsive disorder (OCD), adults (e.g. Frost, Krause & Steketee, 1996) and older children and adolescents (Bloch et al., 2009; Storch et al., 2007) with problematic hoarding have distinct features and a poor treatment prognosis. However, there is limited information on the phenomenology and prevalence of hoarding behaviors in young children. The present study characterizes children ages 10 and under who present with OCD and hoarding behaviors. Sixty-eight children received a structured interview-determined diagnosis of OCD. Clinician administered, parent-report, and child-report measures on demographic, symptomatic, and diagnostic variables were completed. Clinician ratings of hoarding symptoms and parent and child endorsement of the hoarding item on the CY-BOCS checklist (Scahill, Riddle, McSwiggin-Hardin, & Ort, 1997) determined inclusion in the hoarding group (n=33). Compared to children without hoarding symptoms (n=35), the presence of hoarding symptoms was associated with an earlier age of primary diagnosis onset and a higher proportion of ADHD and provisional anxiety diagnoses. These results are partially consistent with the adult literature and with findings in older children (Storch et al., 2007). Additional data on clinical presentation and phenomenology of hoarding are needed to form a developmentally appropriate definition of the behavior.

Spanish version of the Dimensional Obsessive-Compulsive Scale (DOCS): psychometric properties and relation to obsessive beliefs

OBJECTIVES

Our main goal was to provide the psychometric properties of the Spanish version of the Dimensional Obsessive-Compulsive Scale (DOCS) in a non-clinical sample (n = 237) and in adult patients with Obsessive-Compulsive Disorder (OCD) (n = 110). We also examined the association between OC symptom dimensions and obsessive beliefs.

METHODS

The psychometric properties involved four steps: reliability, structural validity, convergent and discriminant validity and diagnostic sensitivity. Linear regression analyses were used to assess the associations between OC symptoms and obsessive beliefs.

RESULTS

Exploratory and confirmatory factor analyses replicated the original four-factor structure in both samples. The DOCS showed good performance in terms of internal consistency, test-retest reliability and convergent validity in both samples. The DOCS showed better diagnostic sensitivity than another self-report instrument of OC symptoms, the Obsessive-Compulsive Inventory Revised. Findings of the relationship between obsessive beliefs and OC symptoms revealed that certain obsessive beliefs predicted specific OC symptom dimensions.

CONCLUSIONS

The Spanish version of the DOCS has similar psychometric properties than the original English instrument, although its performance is somewhat better in OCD patients than in students. It will be important to ascertain its ability to discriminate OCD from other associated disorders.

The effect of personality disorders on treatment outcomes in patients with obsessive-compulsive disorders

The effect of comorbid personality disorders (PD) on treatment outcomes in obsessive-compulsive disorder (OCD) is unclear. The authors systematically review results from investigations of therapy outcomes in adult patients with OCD and a comorbid PD. PsycINFO and MEDLINE were searched for original articles. Twenty-three studies assessing PDs through interviews were selected. Cluster A PDs, particularly schizotypal PD, narcissistic PD, and the presence of two or more comorbid PDs, were associated with poorer treatment outcomes in patients with OCD. With regard to other PDs and clusters, the results are inconsistent or the sample sizes are too small to reach a conclusion. OCD patients with different comorbid PDs differ in their therapeutic response to treatment. To optimize the treatment of OCD, the predictive value of PDs on the treatment outcome should be further investigated, and treatment of Axis I and II comorbidity requires more attention.

Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder

The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18-77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and "compulsive" buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups.

Prevalence and correlates of difficulty discarding: results from a national sample of the US population

This study presents nationally representative data on the prevalence and the correlates of difficulty discarding, a behavior described in many psychiatric disorders, including a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, called hoarding disorder. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a national sample of the US population (N=43,093). Difficulty discarding worn-out/worthless items (assessed by a single item) and diagnoses of psychiatric disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule. The prevalence of difficulty discarding worn-out/worthless items in the general population was 20.6%. Difficulty discarding strongly correlated with axis I and axis II disorders, level of impairment, and use of mental health services. Difficulty discarding worn-out/worthless items is a common behavior that can be associated with various forms of psychopathology. When reported in a clinical setting, it may signal that careful assessment is needed to clarify diagnosis and inform treatment strategies.

"Do they think I am a pack rat?"

This case study presents details of the life of one older man who lived in seclusion and squalor, surrounded by hoarded possessions. This man was one participant of a focused ethnography of eight older adults who received home care. All participants in the original ethnography were identified by their community care coordinators as exhibiting hoarding behaviors. The case study presented here provides rich narrative and photographic detail in order to add strength to what has already been presented in previous research articles about compulsive acquisition. The narratives reveal examples of debilitating dysfunction, distress associated with decision making, broad acquisition of free things, compulsive buying, and ritualistic discarding. Quotes included in the case study stem from the original ethnography.

The use of psychotropic agents for the symptoms of obsessive-compulsive disorder

OBJECTIVE

To describe the use of psychotropic agents in a sample of subjects with obsessive-compulsive disorder (OCD), and in particular the differences associated with different OCD symptoms.

METHOD

A total of 154 subjects participated in a study assessing OCD symptom subtypes, called the Nepean OCD Study. In addition to a comprehensive evaluation of the subjects' OCD symptoms using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Vancouver Obsessive-Compulsive Inventory (VOCI), and the Sheehan Disability Scale (SDS), the subjects' medication history was recorded. The association between symptom severity, disability, OCD symptom subtypes and the use of psychotropic agents was examined.

RESULTS

Psychotropic medication was taken by 93 (60.4%) participants. In the majority of cases (n=55, 59.1%), selective serotonin reuptake inhibitors (SSRIs) were taken, and of the SSRIs, the most commonly used agent was escitalopram (n=21, 22.6%). Psychotropic agents were more likely to be taken by subjects with higher Y-BOCS and SDS scores. Hoarding was associated with a lower likelihood of psychotropic use, whereas unacceptable/taboo thoughts were associated with an increased likelihood of psychotropic and antipsychotic use.

CONCLUSION

Patients with OCD are more likely to be taking psychotropic agents if they have a more severe illness, greater disability and more prominent unacceptable/taboo thoughts.

Beliefs and experiences in hoarding

Recent research suggests that hoarding problems may be relatively heterogeneous, with the suggestion that three belief dimensions may underpin hoarding experiences, namely harm avoidance, fear of material deprivation, and heightened "sentimentality" in relation to possessions. The role of these hypothesised belief dimensions in hoarding was evaluated in this study, together with the association between compulsive hoarding and OCD on several clinically relevant variables. As hypothesised, individuals with hoarding and co-existing OCD reported greater harm avoidance beliefs in relation to possessions compared with a group of hoarders without OCD. Contrary to expectation, however, the hoarding group without OCD did not report significantly stronger beliefs associated with material deprivation and attachment disturbance relative to the hoarding with OCD group. The comparison of the clinical presentation of participants across groups lends further support to the notion that hoarding should be considered a distinct clinical syndrome from OCD.

Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive-compulsive disorder as an example of overlapping clinical and genetic heterogeneity

Individuals with obsessive-compulsive disorder (OCD) have also been shown to have comorbid lifetime diagnoses of major depressive disorder (MDD; rates greater than 70%), bipolar disorder (rates greater than 10%) and other anxiety disorders (e.g. panic disorder, post-traumatic stress disorder (PTSD)). In addition, overlap exists in some common genetic variants (e.g. the serotonin transporter gene (SLC6A4), the brain-derived neurotrophic factor (BDNF) gene), and rare variants in genes/chromosomal abnormalities (e.g. the 22q11 microdeletion syndrome) found across the affective/anxiety disorder spectrums. OCD has been proposed as a possible independent entity for DSM-5, but by others thought best retained as an anxiety disorder subtype (its current designation in DSM-IV), and yet by others considered best in the affective disorder spectrum. This review focuses on OCD, a well-studied but still puzzling heterogeneous disorder, regarding alterations in serotonergic, dopaminergic and glutamatergic neurotransmission in addition to other systems involved, and how related genes may be involved in the comorbidity of anxiety and affective disorders. OCD resembles disorders such as depression, in which gene × gene interactions, gene × environment interactions and stress elements coalesce to yield OC symptoms and, in some individuals, full-blown OCD with multiple comorbid disorders.

Intolerance of uncertainty as a vulnerability factor for hoarding behaviors

BACKGROUND

Intolerance of uncertainty (IU) has been identified as a key vulnerability factor among numerous anxiety related conditions. It has been suggested that individuals engage in uncertainty-motivated behaviors such as avoidance, as a way to cope with ambiguous and potentially distressing situations. Patterns of behavioral avoidance have also been observed in a substantial number of hoarding patients and are thought to directly contribute to the avoidance of discarding. However, no studies to date have examined the potential relationship between IU and hoarding. The primary aim of the current investigation was to examine the association between IU and hoarding behaviors.

METHOD

Participants consisted of 279 college students from a large southern university.

RESULTS

Results revealed that IU was a significant predictor of hoarding severity after controlling for relevant covariates. Moreover, when looking at the relationships among IU subfactors and hoarding, results indicated that Factor 1 was significantly associated with hoarding severity whereas Factor 2 was not.

LIMITATIONS

Future research should attempt to replicate the findings within clinical populations. Additionally, due to the cross sectional nature of the study, future work should utilize a longitudinal design.

CONCLUSIONS

The current study provides additional evidence that IU is an important individual difference variable associated with various anxiety related conditions. Moreover, our findings revealed that IU is a unique and robust predictor of hoarding behaviors. Increasing our knowledge of vulnerability factors in compulsive hoarding has important implications for the classification of this disorder within DSM-V. Additionally, this information could inform future research and treatment programs.

Hoarding behaviour in an Italian non-clinical sample

BACKGROUND

Hoarding is associated with significant impairment. Although traditionally considered as a symptom of obsessive-compulsive disorder (OCD), some authors have proposed that pathological hoarding could be considered as a stand alone condition. The prevalence of pathological hoarding behaviour has been shown to be high in some countries, but little is known about the prevalence and correlates of hoarding in the non-clinical population in Italy.

METHOD

We studied the prevalence of self-reported hoarding behaviour using the Italian version of the Saving Inventory-Revised, as well as the association between hoarding and various clinical correlates, including obsessive-compulsive symptoms, compulsive buying, anxiety, and depression.

RESULTS

The prevalence of pathological hoarding behaviour in two studies was between 3.7 and 6.0%. No differences were found between hoarding and non-hoarding participants with regard to gender, age, marital status, level of education, and employment status. Significant correlations were found between compulsive hoarding and obsessive-compulsive symptoms and also between hoarding and a measure of compulsive buying, even after controlling for anxiety and depressive symptoms.

CONCLUSIONS

These results indicate that pathological hoarding may also be prevalent in Italy and highlight the need for further epidemiological studies using validated instruments to assess hoarding disorder.

An exploration of comorbid symptoms and clinical correlates of clinically significant hoarding symptoms

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.

Social phobia in obsessive-compulsive disorder: prevalence and correlates

BACKGROUND

Social Phobia (SP) is an anxiety disorder that frequently co-occurs with obsessive-compulsive disorder (OCD); however, studies that evaluate clinical factors associated with this specific comorbidity are rare. The aim was to estimate the prevalence of SP in a large multicenter sample of OCD patients and compare the characteristics of individuals with and without SP.

METHOD

A cross-sectional study with 1001 patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders using several assessment instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Structured Clinical Interview for DSM-IV Axis I Disorders. Univariate analyses were followed by logistic regression.

RESULTS

Lifetime prevalence of SP was 34.6% (N=346). The following variables remained associated with SP comorbidity after logistic regression: male sex, lower socioeconomic status, body dysmorphic disorder, specific phobia, dysthymia, generalized anxiety disorder, agoraphobia, Tourette syndrome and binge eating disorder.

LIMITATIONS

The cross-sectional design does not permit the inference of causal relationships; some retrospective information may have been subject to recall bias; all patients were being treated in tertiary services, therefore generalization of the results to other samples of OCD sufferers should be cautious. Despite the large sample size, some hypotheses may not have been confirmed due to the small number of cases with these characteristics (type 2 error).

CONCLUSION

SP is frequent among OCD patients and co-occurs with other disorders that have common phenomenological features. These findings have important implications for clinical practice, indicating the need for broader treatment approaches for individuals with this profile.

Core OCD symptoms: exploration of specificity and relations with psychopathology

Obsessive-compulsive disorder (OCD) is a heterogeneous condition, comprised of multiple symptom domains. This study used aggregate composite scales representing three core OCD dimensions (Checking, Cleaning, and Rituals), as well as Hoarding, to examine the discriminant validity, diagnostic specificity, and predictive ability of OCD symptom scales. The core OCD scales demonstrated strong patterns of convergent and discriminant validity - suggesting that these dimensions are distinct from other self-reported symptoms - whereas hoarding symptoms correlated just as strongly with OCD and non-OCD symptoms in most analyses. Across analyses, our results indicated that Checking is a particularly strong, specific marker of OCD diagnosis, whereas the specificity of Cleaning and Hoarding to OCD was less strong. Finally, the OCD Checking scale was the only significant predictor of OCD diagnosis in logistic regression analyses. Results are discussed with regard to the importance of assessing OCD symptom dimensions separately and implications for classification.

Clinically significant hoarding in obsessive-compulsive disorder: results from an Indian study

BACKGROUND

Hoarding is frequently conceptualized as a symptom of obsessive-compulsive disorder (OCD), but recent evidence indicates that, in most cases, hoarding may be better conceptualized as a distinct disorder that can coexist with OCD. Most of the research on hoarding is from the Western countries. This study aimed to provide data on the prevalence and correlates of clinically significant hoarding in a large sample of patients with OCD from the Indian subcontinent.

METHODS

We examined 200 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition OCD for clinically significant hoarding using the Saving Inventory-Revised, followed by a clinical interview.

RESULTS

Twenty patients (10%) had clinically significant hoarding. In all cases, hoarding did not appear to be related or secondary to other OCD symptoms. None of the cases consulted for their hoarding problems. Compared with nonhoarders, hoarders hailed exclusively from an urban background and had a significantly higher frequency of certain obsessions and compulsions, bipolar disorder, generalized anxiety disorder, cluster C personality disorders, and a higher number of lifetime suicidal attempts. They also had a more severe OCD along with poorer global functioning and somewhat poorer insight into obsessive-compulsive symptoms.

CONCLUSIONS

The results suggest that clinically significant hoarding is relatively prevalent in Indian patients with OCD and that it appears to be largely unrelated to the OCD phenotype. However, the presence of comorbid hoarding is associated with more severe OCD, high comorbidity, more suicidal attempts, and a lower level of functioning. The results contribute to the current nosologic debate around hoarding disorder and provide a unique transcultural perspective.

Gender differences in obsessive-compulsive disorder: a literature review

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a heterogeneous condition, in which subtypes have been proposed. Previous studies suggested that gender plays a relevant role in OCD phenotypic expression. This study aimed to review the literature on gender differences in clinical, genetic or familial aspects of OCD.

METHOD

A conventional review was conducted, including all papers that investigated demographic, clinical, and genetic aspects of OCD according to gender. The search was based on data available in Medline and PsycINFO databases in the last 20 years, using as keywords: obsessive-compulsive disorder; and: gender, sex, male, female, demographic characteristics, clinical features, clinical characteristics, genetic, genes, genetics gender OCD, genes OCD, genes OCD males, genes OCD females.

RESULTS

Sixty three of 487 phenotypical and genetics studies were selected. Most studies indicate that male patients are more likely than females to be single, present early onset of symptoms and chronic course of the disorder, greater social impairment, more sexual-religious and aggressive symptoms, and greater comorbidity with tic and substance use disorders. Female patients present more contamination/cleaning symptoms and greater comorbidity with eating and impulse-control disorders. Genetic and family studies are inconclusive, but suggest that gender may play a role in the disease expression.

CONCLUSIONS

Gender is a relevant factor that should be taken into account when evaluating OCD patients. More studies are necessary to determine whether in fact it defines a homogeneous and particular group in OCD.

Clinical correlates of social adjustment in patients with obsessive-compulsive disorder

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) frequently show poor social adjustment, which has been associated with OCD severity. Little is known about the effects that age at symptom onset, specific OCD symptoms, and psychiatric comorbidities have on social adjustment. The objective of this study was to investigate the clinical correlates of social functioning in OCD patients.

METHODS

Cross-sectional study involving 815 adults with a primary DSM-IV diagnosis of OCD participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were assessed with the Social Adjustment Scale, the Medical Outcomes Study 36-item Short-Form Health Survey, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Clinical correlates of social adjustment were assessed with generalized linear models with gamma distribution.

RESULTS

Poor overall social functioning was associated with greater OCD severity (p = 0.02); hoarding symptoms (p = 0.004); sexual/religious obsessions (p = 0.005); current major depressive disorder (p = 0.004); current post-traumatic stress disorder (p = 0.002); and current eating disorders (p = 0.02). Poor social adjustment was also associated with impaired quality of life.

CONCLUSIONS

Patients with OCD have poor social functioning in domains related to personal relationships and professional performance. Hoarding symptoms and sexual/religious obsessions seem to have the strongest negative effects on social functioning. Early age at OCD symptom onset seems to be associated with professional and academic underachievement and impairment within the family unit, whereas current psychiatric comorbidity worsen overall social functioning. In comparison with quality of life, social adjustment measures seem to provide a more comprehensive overview of the OCD-related burden.

Clinical features of obsessive-compulsive disorder with hoarding symptoms: a multicenter study

BACKGROUND

Factor analyses indicate that hoarding symptoms constitute a distinctive dimension of obsessive-compulsive disorder (OCD), usually associated with higher severity and limited insight. The aim was to compare demographic and clinical features of OCD patients with and without hoarding symptoms.

METHOD

A cross sectional study was conducted with 1001 DSM-IV OCD patients from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (CTOC), using several instruments. The presence and severity of hoarding symptoms were determined using the Dimensional Yale-Brown Obsessive-Compulsive Scale. Statistical univariate analyses comparing factors possibly associated with hoarding symptoms were conducted, followed by logistic regression to adjust the results for possible confounders.

RESULTS

Approximately half of the sample (52.7%, n = 528) presented hoarding symptoms, but only four patients presented solely the hoarding dimension. Hoarding was the least severe dimension in the total sample (mean score: 3.89). The most common lifetime hoarding symptom was the obsessive thought of needing to collect and keep things for the future (44.0%, n = 440). After logistic regression, the following variables remained independently associated with hoarding symptoms: being older, living alone, earlier age of symptoms onset, insidious onset of obsessions, higher anxiety scores, poorer insight and higher frequency of the symmetry-ordering symptom dimension. Concerning comorbidities, major depressive, posttraumatic stress and attention deficit/hyperactivity disorders, compulsive buying and tic disorders remained associated with the hoarding dimension.

CONCLUSION

OCD hoarding patients are more likely to present certain clinical features, but further studies are needed to determine whether OCD patients with hoarding symptoms constitute an etiologically discrete subgroup.

Does insight have specific correlation with symptom dimensions in OCD?

OBJECTIVE

To study relationship between insight and clinical characteristics in subjects with obsessive-compulsive disorder (OCD).

METHOD

Sample included 545 consecutive patients with a primary diagnosis of DSM-IV OCD who consulted a specialty OCD Clinic at a tertiary psychiatric hospital in India between January 2004 and December 2009. They had been evaluated with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) symptom checklist, severity rating scale and the item 11 for insight, the Mini International Neuropsychiatric Interview (MINI) and the Clinical Global Impression scale (CGI). Regression analyses were performed to identify predictors of insight.

RESULTS

The sample had 498 (91%) subjects with good insight (score≤2) and 47 (9%) subjects with poor insight (score>2) as per the Y-BOCS item11. Poor insight group had a significantly higher score on the Y-BOCS compulsions (p<0.001) and total score (p=0.001), the CGI-Severity (p=0.001) and a higher rate of contamination fears (p<0.001) and washing compulsions (p<0.001). Good insight group had a significantly higher frequency of aggressive obsessions (p<0.001). In linear regression, contamination dimension (p=0.007) and Y-BOCS total score (p<0.001) predicted poorer insight and presence of forbidden thoughts (p=0.006) predicted better insight.

LIMITATIONS

Study sample is from a specialty OCD clinic of a major psychiatric hospital in India and therefore, generalizability to other clinical settings may be limited.

CONCLUSION

Poor insight is associated with severe form of OCD, and is associated with contamination dimension. That degree of insight has specific correlation with certain symptom dimensions adds to the growing knowledge on the dimensional aspect of OCD. Insight has to be systematically assessed in all OCD subjects particularly in those with contamination fears. Failure to systematically assess insight may have treatment implications.

Translational approaches to obsessive-compulsive disorder: from animal models to clinical treatment

Obsessive-compulsive disorder (OCD) is characterized by obsessions (intrusive thoughts) and compulsions (repetitive ritualistic behaviours) leading to functional impairment. Accumulating evidence links these conditions with underlying dysregulation of fronto-striatal circuitry and monoamine systems. These abnormalities represent key targets for existing and novel treatment interventions. However, the brain bases of these conditions and treatment mechanisms are still not fully elucidated. Animal models simulating the behavioural and clinical manifestations of the disorder show great potential for augmenting our understanding of the pathophysiology and treatment of OCD. This paper provides an overview of what is known about OCD from several perspectives. We begin by describing the clinical features of OCD and the criteria used to assess the validity of animal models of symptomatology; namely, face validity (phenomenological similarity between inducing conditions and specific symptoms of the human phenomenon), predictive validity (similarity in response to treatment) and construct validity (similarity in underlying physiological or psychological mechanisms). We then survey animal models of OC spectrum conditions within this framework, focusing on (i) ethological models; (ii) genetic and pharmacological models; and (iii) neurobehavioural models. We also discuss their advantages and shortcomings in relation to their capacity to identify potentially efficacious new compounds. It is of interest that there has been rather little evidence of 'false alarms' for therapeutic drug effects in OCD models which actually fail in the clinic. While it is more difficult to model obsessive cognition than compulsive behaviour in experimental animals, it is feasible to infer cognitive inflexibility in certain animal paradigms. Finally, key future neurobiological and treatment research areas are highlighted.

Therapist and patient perspectives on cognitive-behavioral therapy for older adults with hoarding disorder: a collective case study

Utilizing a qualitative approach, the current study explored therapist and patient perspectives on a specialized cognitive-behavioral therapy (CBT) protocol for clinically significant hoarding in older adult patients. Data were derived from the following sources: (1) therapist observation; (2) CBT consultant observation; (3) clinical treatment notes; (4) participant feedback, including a focus group; and (5) participant in-session notes and completed homework assignments. Our findings showed that the value of homework, treatment session compliance, and deficits in executive functioning (prospective memory, planning, problem solving, and cognitive flexibility) were common themes among participants as viewed by the therapist. Patients reported that exposure exercises and the therapeutic relationship were the most helpful aspects of their treatment, while cognitive strategies had limited success. Our results suggest that treatment for hoarding in older adults may be improved by focusing on exposure therapy elements, remediating executive function deficits, providing simplified homework assignments, and decreasing the emphasis or modifying cognitive restructuring techniques.

Cognitive functioning in compulsive hoarding

The aim of this study is to determine whether neurocognitive performance distinguishes individuals with compulsive hoarding (CH) from those with obsessive-compulsive disorder (OCD). Compared to control subjects, OCD patients and CHs scored significantly worse on the Serial Reaction Time Task suggesting disturbed implicit memory in both patient groups. On the Iowa Gambling Task, an overall learning progression difference over time was found between the CHs, OCD group, and control subjects, suggesting differences in decision-making between the groups. The groups did not differ in performance on the Stop Signal Reaction Time Task (motor inhibition). This study found evidence for impaired implicit memory in CHs, but also in OCD patients, albeit less severe. There was evidence that OCD patients learned more slowly on a decision-making task than CHs and control subjects. This latter finding provides some evidence to suggest that CH and OCD have, at least on this one measure, differing cognitive substrates.

An exploration of economic reasoning in hoarding disorder patients

Current models of hoarding disorder (HD) emphasize problems of decision-making. Evidence for neuropsychological impairment in HD, however, has been mixed. The present study examined whether HD patients show problems of economic reasoning that could be associated with decision-making problems. Forty-two HD patients, 29 obsessive-compulsive disorder (OCD) patients, and 36 healthy control participants completed the Iowa gambling task (IGT), a computerized card playing game that assesses participants' ability to learn and utilize a rule of sacrificing short-term gain for long-term gain, and a cognitive dissonance reduction task that measured changes in preference for items (art prints) after selecting or rejecting them. Results showed no deficits on the IGT for HD participants, and no difference in dissonance reduction results after selecting or rejecting items on the dissonance reduction task. Furthermore, performance on these two tasks was unrelated to hoarding symptom severity or self-reported indecisiveness. It is suggested that the problems of cognitive processing in HD patients may be largely related to as-yet understudied processes, including idiosyncratic categorization problems for personally-owned items as well as other aspects of economic reasoning.

Neuropsychological functioning in hoarding disorder

Hoarding disorder (HD) is increasingly viewed as distinct from obsessive-compulsive disorder (OCD). In particular, some researchers have suggested that HD is characterized by substantial problems of neurocognitive function; however, HD patients have not yet been compared to OCD patients in this respect. The aim of the present study was to compare neuropsychological test performance in HD patients (n=27), OCD patients (n=12), and healthy controls (n=26). Consistent with previous research, HD patients showed an attenuated ability to sustain attention and poorer employment of adaptive memory strategies compared to healthy controls. HD and OCD patients did not differ significantly on these measures, although moderate effect sizes suggested that hoarders showed somewhat greater attenuation of attentional capacity. Rates of true impairment on any particular neuropsychological test were fairly low across all three groups, although 67% of HD patients (compared to 58% of OCD patients and 42% of healthy controls) scored in the impaired range on at least one measure (odds ratio=2.22). Results are discussed in terms of emerging conceptualizations of HD as a distinct illness.

Comorbidity in hoarding disorder

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.

Comparison of object and animal hoarding

Recent research has highlighted the prevalence and harmful consequences of hoarding, and investigators have proposed inclusion of hoarding disorder in DSM-5. An unanswered question about the proposed disorder is whether people who hoard animals would meet diagnostic criteria for it. This article discusses the similarities and differences between object and animal hoarding. People who hoard animals appear to meet the basic diagnostic criteria for hoarding disorder. Their homes are cluttered, disorganized, and dysfunctional. They have great difficulty relinquishing animals to people who can more adequately care for them, and they form intense attachments (urges to save) that result in significant impairment. However, they differ from people who hoard objects in several ways. These differences are significant enough to warrant comment in the text description accompanying the diagnostic criteria and consideration as a subtype of hoarding disorder. More research is necessary to determine the exact relationship between object and animal hoarding.

Group cognitive-behavioral therapy for hoarding disorder: an open trial

Although cognitive-behavioral therapy (CBT) appears to be a promising treatment approach for hoarding disorder, treatment to date has been quite labor intensive. The goal of this study, therefore, was to assess the potential effectiveness of group CBT for hoarding, without home visits by the clinician. Forty-five individuals with hoarding disorder enrolled in either a 16 or 20 session program of group CBT; 30 (67%) completed treatment. Using mixed-effects models to account for missing data, we report data from 35 (78%) participants who provided enough data for analysis. Participants demonstrated significant improvements in hoarding symptoms, as well as symptoms of depression and anxiety, and quality of life. Improvements in hoarding symptoms were comparable to two published clinical trials on individual CBT for hoarding disorder. Results of this study suggest that group CBT for hoarding, without home discarding sessions by the clinician, may be an effective treatment option with the potential advantage of increasing treatment access by reducing clinician burden and cost of treatment.