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Aso Y, Suzuki A, Nojiri Y, Mochizuki Y, Shimozono M, Naganuma Y, Yamaoka K. Evaluation of an educational programme for people who have difficulty decluttering and organising: A randomised controlled trial in Japan. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2507-e2517. [PMID: 34939248 DOI: 10.1111/hsc.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/05/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Home clutter can adversely affect work performance, health and well-being. Clinical-level hoarding disorders usually manifest during early adolescence, so early detection and prevention of subclinical hoarding tendencies are essential. This study aimed to evaluate a community-based programme for individuals with poor organising and decluttering skills who volunteered to receive education on how to organise their homes. We conducted an open-label randomised controlled trial beginning in January 2016 in Tokyo. We enrolled 61 volunteers aged 12-55 years with problems with organising and decluttering. A workshop and home visit group (n = 30) attended four workshop sessions on organising skills and received a visit from a home organiser. The home visit only group (n = 31) only received the home organiser visit. The primary outcome was Saving Inventory-Revised (SI-R; Japanese version) scores. The secondary outcomes were Clutter Image Rating Scale and Rosenberg Self-Esteem Scale (Japanese version) scores. Between-group changes from baseline to 7 months were analysed using a general linear model. At follow-up, the SI-R scores of both groups had improved. The mean change from baseline in SI-R scores was -20.8 (standard deviation = 9.8) and -13.1 (standard deviation = 14.3) in the workshop and home visit and home visit only groups, respectively. The estimated between-group difference in SI-R score changes from baseline (adjusted for baseline SI-R score) was non-significant at -5.7 (95% confidence interval, -12.4 to 0.9; p = .089). However, the difference was significant in the univariate model: -7.2 (95% confidence interval, -13.7 to -0.8; p = .029). Although both groups improved, after adjusting for baseline values and participant characteristics, there was no significant difference between the groups. Our results suggest that a workshop-style educational intervention and assistance and advice from professional organisers may help to improve the living conditions of people with hoarding tendencies.
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Affiliation(s)
- Yasuko Aso
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
| | - Asuka Suzuki
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Yuka Nojiri
- International University of Health and Welfare Graduate School, Tokyo, Japan
| | - Yukiko Mochizuki
- Department of Public Health Nursing, Faculty of Nursing, Toho University, Tokyo, Japan
| | - Mihoko Shimozono
- Department of Nursing, Faculty of Allied Health Sciences, Yamato University, Osaka, Japan
| | - Yuki Naganuma
- DrPH student, Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kazue Yamaoka
- Teikyo University Graduate School of Public Health, Tokyo, Japan
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Tolin DF, Frost RO, Steketee G, Muroff J. Cognitive Behavioral Therapy For Hoarding Disorder: A Meta-Analysis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:468-476. [PMID: 35747301 PMCID: PMC9063573 DOI: 10.1176/appi.focus.19403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/24/2014] [Accepted: 09/27/2014] [Indexed: 06/15/2023]
Abstract
(Appeared originally in Depression and Anxiety 2015; 32:158-166).
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Affiliation(s)
- David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychology, Smith College, Northampton, Massachusetts; School of Social Work, Boston University, Boston, Massachusetts
| | - Randy O Frost
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychology, Smith College, Northampton, Massachusetts; School of Social Work, Boston University, Boston, Massachusetts
| | - Gail Steketee
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychology, Smith College, Northampton, Massachusetts; School of Social Work, Boston University, Boston, Massachusetts
| | - Jordana Muroff
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychology, Smith College, Northampton, Massachusetts; School of Social Work, Boston University, Boston, Massachusetts
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3
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David J, Crone C, Norberg MM. A critical review of cognitive behavioural therapy for hoarding disorder: How can we improve outcomes? Clin Psychol Psychother 2021; 29:469-488. [PMID: 34409679 DOI: 10.1002/cpp.2660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/08/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022]
Abstract
Psychological treatment for hoarding problems has historically been associated with poor outcomes. When treated as a subgroup of obsessive-compulsive disorder, individuals with hoarding beliefs were less likely to respond to treatment than individuals exhibiting other obsessive-compulsive beliefs and behaviours. When treated as its own disorder using cognitive behavioural therapy, individuals report approximately 25% improvement in symptoms on average. However, less than a third of people experience clinically meaningful change. Further, changes in functioning and quality of life are not routinely assessed. In this paper, we review the current conceptualization and treatment of hoarding problems to shed light on how treatment for hoarding disorder may be improved. Utilizing a harm reduction approach before administering treatment may be important to ensure the safety of individuals. Research should test whether treatment outcomes improve by including strategies that enhance a client's interpersonal functioning and ability to regulate emotions (i.e., based on dialectal behaviour therapy and mentalization-based treatments), especially while discarding and organizing belongings. We should also use modern learning theory to improve the delivery of exposure activities.
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Affiliation(s)
- Jonathan David
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Cassandra Crone
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Melissa M Norberg
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
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Rodgers N, McDonald S, Wootton BM. Cognitive behavioral therapy for hoarding disorder: An updated meta-analysis. J Affect Disord 2021; 290:128-135. [PMID: 33993079 DOI: 10.1016/j.jad.2021.04.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hoarding disorder (HD) is a new disorder in DSM-5. While cognitive-behavioral therapy (CBT) is seen as the gold standard approach to treatment, the literature in this field is still emerging. METHODS The aim of the present study is to synthesize the current treatment outcome literature on CBT for HD, as well as secondary depressive symptoms, using a meta-analytic approach. Due to a lack of controlled trials only within-group effect sizes were calculated. RESULTS Sixteen studies were included in the meta-analysis (n = 505; mean age = 56 years; mean percentage female participants = 72%). Large effect sizes were found from pre-treatment to post-treatment (g = 1.11; 95% CI: 0.92-1.29) and from pre-treatment to follow-up (g = 1.25; 95% CI: 0.94-1.56) on HD symptoms. The gender distribution of the sample moderated treatment outcome, with larger effects seen in studies that included a larger proportion of female patients. Treatment modality (individual vs group), therapist training, use of home visits, trial type (efficacy vs effectiveness), number of treatment weeks, participant age, and study quality did not moderate treatment outcome. Small effect sizes were found from pre-treatment to post-treatment (g = 0.45; 95% CI: 0.28-0.61) for depressive symptoms and baseline depression severity, treatment modality, use of home visits, and assessment tool used did not moderate outcome. LIMITATIONS The study is limited by the small number of studies available in this field. CONCLUSIONS This study demonstrates that CBT for HD is an effective treatment, however, controlled trials are needed, as are trials examining the long-term efficacy of CBT for HD.
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Affiliation(s)
- Natasha Rodgers
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW 2007, Australia
| | - Sarah McDonald
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW 2007, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW 2007, Australia.
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Timpano KR, Bainter SA, Goodman ZT, Tolin DF, Steketee G, Frost RO. A Network Analysis of Hoarding Symptoms, Saving and Acquiring Motives, and Comorbidity. J Obsessive Compuls Relat Disord 2020; 25:100520. [PMID: 36212770 PMCID: PMC9544394 DOI: 10.1016/j.jocrd.2020.100520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hoarding disorder is marked by strong attachments to everyday objects, extreme difficulties discarding, and impairing levels of clutter. We examined the associations between hoarding symptoms and associated clinical features using network analysis in a large sample of individuals with established hoarding disorder (n=217) and matched healthy controls (n=130). Network nodes included the three core features of hoarding (difficulties discarding, clutter, and acquiring), along with comorbid symptoms, impairment, and saving and acquiring motives. Models showed hoarding and comorbid symptoms as separate syndromes. Healthy and patient networks differed significantly in both global network strength and structure. For the hoarding patient network, the comorbidity and hoarding clusters were connected by acquiring and anxiety, which served as bridge symptoms. Clutter was the only hoarding node associated with impairment. Hoarding beliefs were not central to the model, and only difficulties discarding was associated with saving and acquiring motives, including emotional attachment and wastefulness beliefs. Our findings indicate that the network approach to mental disorders provides a new and complementary way to improve our understanding of the etiological model of hoarding, and may present novel hypotheses to examine in treatment development research.
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Affiliation(s)
| | | | | | - David F. Tolin
- Institute of Living and Yale University School of Medicine
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Spence C, Kellett S, Totterdell P, Parry G. Can cognitive analytic therapy treat hoarding disorder? An adjudicated hermeneutic single-case efficacy design evaluation. Clin Psychol Psychother 2019; 26:673-683. [PMID: 31343093 DOI: 10.1002/cpp.2390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 11/07/2022]
Abstract
This paper sought to assess whether cognitive analytic therapy (CAT) was effective with a male patient meeting diagnostic criteria for hoarding disorder (HD) who had been nonresponsive to two previous courses of cognitive behaviour therapy. An adjudicated hermeneutic single-case efficacy design (HSCED) evaluation was undertaken. A rich case record (i.e., a summary document containing the case details, formulations, and detailed qualitative and quantitative outcomes) was created. The rich case record was then debated by affirmative (N = 3) and sceptic (N = 3) research teams. Expert judges (N = 3) reviewed the debate and then delivered a final verdict as to whether treatment had worked. Judges unanimously returned a verdict in favour of the sceptic position, concluding that CAT had not enabled change. Lack of change on the primary nomothetic hoarding outcome measure was particularly influential in the final judgement. In this case of HD, CAT was therefore not effective as an intervention. More research is needed before any definitive conclusions can be drawn however as to the wider utility of CAT with HD. Methodological limitations are outlined, alongside considerations for future research.
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Affiliation(s)
| | - Stephen Kellett
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK.,Specialist Psychotherapy Service, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
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Nakao T, Kanba S. Pathophysiology and treatment of hoarding disorder. Psychiatry Clin Neurosci 2019; 73:370-375. [PMID: 31021515 DOI: 10.1111/pcn.12853] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/29/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
Hoarding disorder (HD) is a newly listed disease in the new category of Obsessive-Compulsive and Related Disorders in the DSM-5. Patients with HD find it difficult to discard possessions regardless of their actual value and to organize those things. As a result, the possessions overflow the living space and hinder living functions. Though the hoarding symptom had been regarded as a subtype of obsessive-compulsive disorder (OCD) to date, recent studies have revealed many differences in clinical characteristics, including onset, course, degree of insight, and treatment responses, between hoarding and other subtypes. Moreover, several neuroimaging studies have found specific changes of brain structure and function in OCD patients with hoarding symptoms compared to patients with non-hoarding OCD. Meanwhile, strategies for treatment of HD have not been standardized. At present, psychological treatment using cognitive behavioral therapy techniques has a certain effect. In this review, we outline the pathophysiology and treatment of HD.
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Affiliation(s)
- Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Bodryzlova Y, Audet JS, Bergeron K, O'Connor K. Group cognitive-behavioural therapy for hoarding disorder: Systematic review and meta-analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:517-530. [PMID: 30033635 DOI: 10.1111/hsc.12598] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
Previous meta-analysis has reported the rate of reliable and clinically significant changes in hoarding disorder (HD) after cognitive-behavioural therapy (CBT) based on the classical CBT model of HD, as between 42% and 25%. However, in this analysis, different types of therapy (group vs individual, G-CBT and I-CBT, respectively), different providers (psychologist vs nonpsychologist), and different diagnosis (HD vs hoarding behaviour) were analysed together. Hence, it remains unclear if reported rate of changes was due to limits of the CBT model of HD or due to the fact that different applications of the model were analysed together. The aim of this meta-analysis is to highlight shortcomings in the description of existing approaches in G-CBT in HD and provide an up-to-date review of the current state of efficacy. We searched references for treatment trials of G-CBT for HD in adults with object hoarding, where treatment was conducted by a professional in PubMed, PsychINFO and Web of Science databases, and ResearchGate (for grey literature). Data on participants, treatment modalities, and outcomes were extracted; treatment effect-size was meta-analysed. Five hundred and forty-three references were found; after title and abstract screening, eight articles (178 participants) were retained of which seven were included in the meta-analysis. G-CBT showed improvement of HD severity at posttreatment (Hedge's g = 0.96). The rate of clinically reliable changes across groups of treatment was 21%-68% (M = 36.7%; SD = 12.1%). The meta-analyses showed a statistically but not clinically significant impact of age on effect-size. No publication bias was found. There is strong evidence supporting the efficacy of G-CBT including modified or extended versions of classical G-CBT protocols. However, controlled trials with follow-up assessment are needed to evaluate long-term G-CBT efficacy for HD. As well, the rate of clinically significant changes is low; further research on the HD model could improve the efficacy of G-CBT.
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Affiliation(s)
- Yuliya Bodryzlova
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
| | - Jean-Sebastien Audet
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
| | - Karine Bergeron
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
| | - Kieron O'Connor
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- Psychiatry Department, University of Montreal, Montréal, QC, Canada
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9
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Presidential Address: Team Science Across Disciplines: Advancing CBT Research and Practice on Hoarding. Behav Ther 2018; 49:643-652. [PMID: 30146133 DOI: 10.1016/j.beth.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/24/2022]
Abstract
This presidential address focuses on the recent history of research and practice on hoarding disorder (HD) as a potential model for coordinating interdisciplinary teams of professionals within and outside mental health fields to advance scientific efforts to understand and resolve mental health problems. To identify, assess, and intervene with clients who have HD, psychologists, social workers, psychiatrists, and other service professionals are needed, including those in public health, housing, medicine, aging and protective services, fire, safety, and animal protection. Research findings and practice methods developed by many of my colleagues highlight the various skills of these diverse disciplines and fields. Of particular interest are multimethod assessments and CBT interventions that span individual, group, and family treatments, delivered in the office, at home and via the web by mental health and other professionals, as well as peers. Outcomes are positive, but there remains much work to do to improve understanding and intervention outcomes.
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Ayers CR, Pittman JO, Davidson EJ, Dozier ME, Mayes TL, Almklov E. Predictors of treatment outcome and attrition in adults with hoarding disorder. J Obsessive Compuls Relat Disord 2018; 23:10.1016/j.jocrd.2019.100465. [PMID: 32670783 PMCID: PMC7362989 DOI: 10.1016/j.jocrd.2019.100465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
While a number of hoarding disorder-specific therapeutic interventions have been developed over recent years, hoarding disorder (HD) remains difficult to treat. The purpose of this investigation is to inform HD treatment efforts by examining factors that influence treatment attrition and treatment response. Secondary data analysis of baseline and post-treatment data from two previously published psychotherapy treatment studies for hoarding were performed to identify predictors of hoarding symptom improvement and treatment attrition in 106 adults with HD. No demographic variables were associated with symptom improvement or treatment attrition. However, higher levels of avoidant coping (i.e., self-distraction combined with behavioral disengagement) significantly predicted symptom improvement. The maintenance stage of change along with high readiness for change also significantly predicted symptom improvement. Participants who dropped from treatment had significantly higher baseline levels of denial and clutter, both of which independently predicted treatment attrition. The findings from this study suggest that emotion-related constructs, such as managing stress and motivation for change, may play an important role in patients' response to and participation in HD treatment.
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Affiliation(s)
- Catherine R. Ayers
- Research Service, VA San Diego Healthcare System, USA
- Mental Healthcare Line, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
| | - James O.E. Pittman
- Mental Healthcare Line, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
| | - Eliza J. Davidson
- Research Service, VA San Diego Healthcare System, USA
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Mary E. Dozier
- Research Service, VA San Diego Healthcare System, USA
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
- Psychology Service, South Texas Veterans Health Care System, USA
- Department of Psychology, Mississippi State University, USA
| | - Tina L. Mayes
- Research Service, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
| | - Erin Almklov
- Research Service, VA San Diego Healthcare System, USA
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Ivanov VZ, Enander J, Mataix‐Cols D, Serlachius E, Månsson KN, Andersson G, Flygare O, Tolin D, Rück C. Enhancing group cognitive-behavioral therapy for hoarding disorder with between-session Internet-based clinician support: A feasibility study. J Clin Psychol 2018; 74:1092-1105. [PMID: 29411356 PMCID: PMC6686153 DOI: 10.1002/jclp.22589] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/27/2017] [Accepted: 12/06/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hoarding disorder (HD) is difficult to treat. In an effort to increase efficacy and engagement in cognitive-behavioral therapy (CBT), we developed and evaluated a novel intervention comprising group CBT combined with between-session Internet-based clinician support for people with HD. METHOD Twenty participants with HD received group CBT combined with an Internet-support system enabling therapist-participant communication between group sessions. RESULTS The treatment was associated with a significant reduction on the Saving Inventory-Revised (SI-R) and a large effect size (Cohen's d = 1.57) was found at posttreatment. Treatment gains were maintained at the 3-month follow-up. Group attendance was high and no participants dropped out from treatment prematurely. Between-session motivational support from the therapist was most frequently mentioned as the main strength of the system. CONCLUSION The results of this study support adding Internet-based clinician support to group CBT for HD to increase treatment adherence and, potentially, improve the overall efficacy of CBT.
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Affiliation(s)
- Volen Z. Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - David Mataix‐Cols
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Kristoffer N.T. Månsson
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Department of PsychologyStockholm UniversityStockholmSweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Department of Behavioural Sciences and LearningLinköping UniversityLinköpingSweden
| | - Oskar Flygare
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
| | - David Tolin
- The Institute of LivingYale University School of MedicineNew HavenCTUSA
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
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O'Connor K, Bodryzlova Y, Audet JS, Koszegi N, Bergeron K, Guitard A. Group cognitive-behavioural treatment with long-term follow-up and targeting self-identity for hoarding disorder: An open trial. Clin Psychol Psychother 2018; 25:701-709. [DOI: 10.1002/cpp.2304] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Kieron O'Connor
- Research Centre of the Montreal Institute of Mental Health; Montreal Canada
- University of Montreal; Montreal Canada
| | - Yuliya Bodryzlova
- Research Centre of the Montreal Institute of Mental Health; Montreal Canada
- University of Montreal; Montreal Canada
| | - Jean-Sébastien Audet
- Research Centre of the Montreal Institute of Mental Health; Montreal Canada
- University of Montreal; Montreal Canada
| | - Natalia Koszegi
- Research Centre of the Montreal Institute of Mental Health; Montreal Canada
| | - Karine Bergeron
- Research Centre of the Montreal Institute of Mental Health; Montreal Canada
| | - Annik Guitard
- Research Centre of the Montreal Institute of Mental Health; Montreal Canada
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Fitzpatrick M, Nedeljkovic M, Abbott JA, Kyrios M, Moulding R. "Blended" therapy: The development and pilot evaluation of an internet-facilitated cognitive behavioral intervention to supplement face-to-face therapy for hoarding disorder. Internet Interv 2018; 12:16-25. [PMID: 30135765 PMCID: PMC6096324 DOI: 10.1016/j.invent.2018.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 11/21/2022] Open
Abstract
Mixed findings regarding the long-term efficacy of cognitive behavior therapy (CBT) for the treatment of hoarding has led to the investigation of novel treatment approaches. "Blended" therapy, a combination of face-to-face (f2f) and online therapy, is a form of therapy that enables longer exposure to therapy in a cost-effective and accessible format. Blended therapy holds many benefits, including increased access to content, lower time commitment for clinicians, and lower costs. The aim of the present study was to develop and evaluate a "blended" treatment program for hoarding disorder (HoPE), involving 12-weeks of face-to-face group therapy, and an 8 week online therapist assisted program. A sample of 12 participants with hoarding symptomology were recruited from the Melbourne Metropolitan area, and were involved in one of two conditions; 12 weeks group therapy +8 weeks online therapy (bCBT) or 12 weeks group therapy +8 weeks waitlist +8 weeks online therapy. Questionnaires were completed at all time points. The 8-week online component consists of 8 CBT-based modules, addressing psychoeducation, goal setting, motivation, relapse prevention and other key components. No significant differences were found over time between the bCBT group and waitlist control group, however trends suggested continued improvement in overall hoarding scores for the bCBT group, when compared to the waitlist control group. There were significant differences in scores from pre-treatment to 28 weeks, suggesting that all participants who were involved in the online intervention showed continued improvement from pre-treatment to post-treatment. This study highlights the potential benefit of novel formats of treatment. Future research into the efficacy of blended therapy would prove beneficial.
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Affiliation(s)
- Molly Fitzpatrick
- Department of Psychological Sciences, Faculty of Arts, Health and Design, Swinburne University of Technology, Melbourne, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Jo-Anne Abbott
- Department of Psychological Sciences, Faculty of Arts, Health and Design, Swinburne University of Technology, Melbourne, Australia
| | - Michael Kyrios
- School of Psychology, Australian National University, Canberra, Australia
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Ong CW, Krafft J, Levin ME, Twohig MP. An Examination of the Role of Psychological Inflexibility in Hoarding Using Multiple Mediator Models. J Cogn Psychother 2018; 32:97-111. [PMID: 32746400 DOI: 10.1891/0889-8391.32.2.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hoarding is associated with functional impairment and impacts quality of life. One process that has been theorized to explain how hoarding develops and leads to impairment is psychological inflexibility, in which behavior is rigidly controlled by a perceived need to regulate internal experiences, at the expense of more effective, valued actions. The present study aimed to test the mediational role of psychological inflexibility in the development of hoarding and its impact on life satisfaction with a sample of 489 college students completing an online survey. Results indicated that multiple measures of psychological inflexibility (overall inflexibility, inattention, and values obstruction) mediated the relationship between distress and hoarding. Other measures of psychological inflexibility (overall inflexibility, cognitive fusion, and lack of values progress) mediated the link between hoarding severity and life satisfaction. These findings suggest that how one responds to distress and hoarding symptoms can influence symptom severity and life satisfaction, and that psychological flexibility may promote more adaptive outcomes. Thus, current interventions for problematic hoarding may be strengthened by targeting psychological inflexibility and related processes.
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Ayers CR, Dozier ME, Twamley EW, Saxena S, Granholm E, Mayes TL, Wetherell JL. Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder in Older Adults: A Randomized Clinical Trial. J Clin Psychiatry 2018; 79:16m11072. [PMID: 28541646 PMCID: PMC7295125 DOI: 10.4088/jcp.16m11072] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/13/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the efficacy of Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) with geriatric case management (CM) in a sample of older adults meeting DSM-5 diagnostic criteria for hoarding disorder (HD). METHODS Fifty-eight older adults with HD were enrolled in a randomized controlled trial between December 2011 and March 2014. Thirty-one participants received CREST, and 27 participants received CM. Both interventions consisted of 26 individual sessions over a period of 6 months and included several home visits by the study therapists (CREST) or nurses (CM). The Saving Inventory-Revised (SI-R) and the UCLA Hoarding Severity Scale (UHSS) were the main outcome measures. RESULTS Participants in the CREST condition had significantly greater improvement on the SI-R than participants in the CM group (group × time interaction: β = 3.95, SE = 1.81, P = .029), with participants who completed the CREST condition averaging a 38% decrease in symptoms and participants who completed the CM condition averaging a 25% decrease in symptoms. In contrast, there was not a significant group × time interaction effect on the UHSS (β = 1.23, SE = 0.84, P = .144), although participants did report greater improvement in symptoms in the CREST condition (35%) than in the CM condition (24%). Treatment gains were maintained at 6-month follow-up. CONCLUSIONS CREST appears to be an efficacious treatment compared to CM for older adults, but CM also showed meaningful benefits. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01227057.
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Affiliation(s)
- Catherine R. Ayers
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego School of Medicine, San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California,Corresponding author: Catherine R. Ayers, PhD, ABPP, 3350 La Jolla Village Drive, 116B, San Diego, CA92161 ()
| | - Mary E. Dozier
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California,Research Service, VA San Diego Healthcare System, San Diego, California
| | - Elizabeth W. Twamley
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California,Research Service, VA San Diego Healthcare System, San Diego, California,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California
| | - Sanjaya Saxena
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego
| | - Eric Granholm
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego School of Medicine, San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Tina L. Mayes
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Julie Loebach Wetherell
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego School of Medicine, San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
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16
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Thompson C, Fernández de la Cruz L, Mataix-Cols D, Onwumere J. A systematic review and quality assessment of psychological, pharmacological, and family-based interventions for hoarding disorder. Asian J Psychiatr 2017; 27:53-66. [PMID: 28558897 DOI: 10.1016/j.ajp.2017.02.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hoarding disorder (HD) affects at least 1.5% of the population and is considered to be hard to treat. The current study aimed to systematically review the treatments designed to improve HD symptoms and family impact. METHOD Searches of PsycINFO, MEDLINE, EMBASE, and Web of Science were undertaken. Studies were included if: (i) the study evaluated an intervention for hoarding problems; (ii) outcome measures were reported; and (iii) study results were published in an indexed journal or were a published abstract from a professional/research conference. The quality of the studies was assessed using the Clinical Trials Assessment Measure (CTAM). RESULTS Twenty studies, comprising 492 participants with clinically significant hoarding symptoms or HD and 21 relatives of individuals with HD, met inclusion criteria. Treatments reviewed included cognitive-behavior therapy, medication, cognitive remediation, and multi-component interventions for relatives. Most studies yielded statistically significant improvements in hoarding symptoms, although reductions were generally modest and many participants remained in the clinical range after treatment. According to the CTAM, most studies were judged to be of low methodological quality. CONCLUSIONS HD is a chronic and highly burdensome condition for which efficacious treatments are needed. The current evidence base is somewhat limited and of low quality. Further research is needed to improve treatments, identify mechanisms of change, and increase the availability of evidence-based interventions for this group.
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Affiliation(s)
- Claire Thompson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK.
| | - Lorena Fernández de la Cruz
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Juliana Onwumere
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
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17
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Rodriguez CI, Levinson A, Patel SR, Rottier K, Zwerling J, Essock S, Shuer L, Frost RO, Simpson HB. Acceptability of Treatments and Services for Individuals with Hoarding Behaviors. J Obsessive Compuls Relat Disord 2016; 11:1-8. [PMID: 28163996 PMCID: PMC5287410 DOI: 10.1016/j.jocrd.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the acceptability of currently available treatments and services for individuals who self-report hoarding behaviors. METHOD Between 10/2013 and 8/2014, participants were invited to complete an online survey that provided them descriptions of eleven treatments and services for hoarding behaviors and asked them to evaluate their acceptability using quantitative (0 [not at all acceptable] -10 [completely acceptable]) Likert scale ratings. The a priori definition of acceptability for a given resource was an average Likert scale score of six or greater. Two well-validated self-report measures assessed hoarding symptom severity: the Saving Inventory-Revised and the Clutter Image Rating Scale. RESULTS Two hundred and seventy two participants who self-reported having hoarding behaviors completed the questionnaire. Analyses focused on the 73% of responders (n=203) who reported clinically significant hoarding behaviors (i.e., Saving Inventory-Revised scores of ≥40). The three most acceptable treatments were individual cognitive behavioral therapy (6.2 ±3.1 on the Likert scale), professional organizing service (6.1 ±3.2), and use of a self-help book (6.0 ±3.0). CONCLUSION In this sample of individuals with self-reported clinically significant hoarding behaviors (n=203), only 3 out of 11 treatments and services for hoarding were deemed acceptable using an a priori score. While needing replication, these findings indicate the need to design more acceptable treatments and services to engage clients and maximize treatment outcomes for hoarding disorder.
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Affiliation(s)
- Carolyn I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Amanda Levinson
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Sapana R. Patel
- New York State Psychiatric Institute, New York, NY1 10032
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY 10032
| | - Kim Rottier
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Jordana Zwerling
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Susan Essock
- New York State Psychiatric Institute, New York, NY1 10032
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY 10032
| | - Lee Shuer
- Mutual Support Consulting, Easthampton, MA, 01027
| | - Randy O. Frost
- Smith College, Department of Psychology, Northampton, MA. 01063
| | - Helen Blair Simpson
- New York State Psychiatric Institute, New York, NY1 10032
- Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY 10032
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18
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Dozier ME, Porter B, Ayers CR. Age of onset and progression of hoarding symptoms in older adults with hoarding disorder. Aging Ment Health 2016; 20:736-42. [PMID: 25909628 PMCID: PMC5612663 DOI: 10.1080/13607863.2015.1033684] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We investigated (1) age of onset of hoarding disorder (HD) symptoms and diagnosis, (2) late-onset HD, (3) progression of HD symptoms, and (4) association between demographics and hoarding progression. METHOD Eighty-two older adults with HD provided retrospective ratings of their hoarding symptoms for each decade of life. Age of onset of symptoms (saving, difficulty discarding, and clutter) was operationalized as the first decade in which the participant reported at least minor symptom severity, and age of onset for possible HD diagnosis was operationalized as the first decade in which the participant reported all three symptoms. We used mixed effects modeling to examine the progression of HD symptoms. RESULTS The median age of onset for symptoms was between 10 and 20 years, and the median age of onset for possible HD diagnosis was between 20 and 30 years. Twenty-three percent of participants reported onset of possible HD diagnosis after the age of 40. All HD symptoms increased in severity over time. Men reported higher initial clutter and a slower increase in hoarding severity for all symptoms. Increased education was associated with slower increase in saving. Having at least one parent with hoarding tendencies was associated with higher initial hoarding symptoms. CONCLUSION Generally, symptoms of HD begin relatively early and worsen across the lifespan. However, approximately one fourth of older adults with HD reported a possible onset after the age of 40.
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Affiliation(s)
- Mary E. Dozier
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Catherine R. Ayers
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California, San Diego, CA, USA,Corresponding author:
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19
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Mathews CA, Uhm S, Chan J, Gause M, Franklin J, Plumadore J, Stark SJ, Yu W, Vigil O, Salazar M, Delucchi KL, Vega E. Treating Hoarding Disorder in a real-world setting: Results from the Mental Health Association of San Francisco. Psychiatry Res 2016; 237:331-8. [PMID: 26805562 PMCID: PMC6020681 DOI: 10.1016/j.psychres.2016.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 11/27/2022]
Abstract
Hoarding Disorder (HD) is associated with substantial distress, impairment, and individual and societal costs. Cognitive-behavioral therapy (CBT) tailored to HD is the best-studied form of treatment and can be led by mental health professionals or by non-professionals (peers) with specific training. No previous study has directly compared outcomes for therapist-led and peer-led groups, and none have examined the effectiveness of these groups in a real-world setting. We used retrospective data to compare psychologist-led CBT groups (G-CBT) to groups led by peer facilitators using the Buried in Treasures workbooks (G-BiT) in individuals who sought treatment for HD from the Mental Health Association of San Francisco. The primary outcome was change in Hoarding Severity Scale scores. Approximate costs per participant were also examined. Both G-CBT and G-BiT showed improvement consistent with previous reports (22% improvement overall). After controlling for baseline group characteristics, there were no significant differences in outcomes between G-CBT and G-BiT. For G-CBT, where additional outcome data were available, functional impairment and severity of hoarding symptoms improved to a similar degree as compared to previous G-CBT studies, while hoarding-related cognition improved to a lesser degree (also consistent with previous studies). G-BiT cost approximately $100 less per participant than did G-CBT.
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Affiliation(s)
- Carol A. Mathews
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA; aDepartment of Psychiatry, University of California, San Francisco, California, USA,Correspondence to Carol A Mathews, 100 S. Newell Dr, L4-100, Gainesville, FL 32610;
| | - Soo Uhm
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA; aDepartment of Psychiatry, University of California, San Francisco, California, USA
| | - Joanne Chan
- Mental Health Association of San Francisco, San Francisco, California, USA
| | - Michael Gause
- Mental Health Association of San Francisco, San Francisco, California, USA
| | - John Franklin
- Mental Health Association of San Francisco, San Francisco, California, USA
| | - Julian Plumadore
- Mental Health Association of San Francisco, San Francisco, California, USA
| | - Sandra J. Stark
- Mental Health Association of San Francisco, San Francisco, California, USA
| | - Wendy Yu
- Mental Health Association of San Francisco, San Francisco, California, USA
| | - Ofilio Vigil
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA; aDepartment of Psychiatry, University of California, San Francisco, California, USA
| | - Mark Salazar
- Mental Health Association of San Francisco, San Francisco, California, USA
| | - Kevin L. Delucchi
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA; aDepartment of Psychiatry, University of California, San Francisco, California, USA
| | - Eduardo Vega
- Mental Health Association of San Francisco, San Francisco, California, USA
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20
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Moulding R, Nedeljkovic M, Kyrios M, Osborne D, Mogan C. Short-Term Cognitive-Behavioural Group Treatment for Hoarding Disorder: A Naturalistic Treatment Outcome Study. Clin Psychol Psychother 2016; 24:235-244. [DOI: 10.1002/cpp.2001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | - Maja Nedeljkovic
- Brain and Psychological Science Research Centre; Swinburne University of Technology; Hawthorn Australia
- Department of Psychological Sciences; Swinburne University of Technology; Hawthorn Australia
| | - Michael Kyrios
- Research School of Psychology; Australian National University; Canberra Australia
| | - Debra Osborne
- Department of Psychological Sciences; Swinburne University of Technology; Hawthorn Australia
| | - Christopher Mogan
- The Anxiety Clinic; Melbourne Australia
- Department of Psychological Sciences; Swinburne University of Technology; Hawthorn Australia
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21
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Saxena S, Ayers CR, Dozier ME, Maidment KM. The UCLA Hoarding Severity Scale: development and validation. J Affect Disord 2015; 175:488-93. [PMID: 25681559 PMCID: PMC4352402 DOI: 10.1016/j.jad.2015.01.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 01/15/2015] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Sanjaya Saxena
- Department of Psychiatry, UC San Diego School of Medicine, United States.
| | - Catherine R Ayers
- Department of Psychiatry, UC San Diego School of Medicine, United States; Research Service, Veterans Affairs San Diego Healthcare System, United States
| | - Mary E Dozier
- Research Service, Veterans Affairs San Diego Healthcare System, United States
| | - Karron M Maidment
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, United States
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22
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Tolin DF, Frost RO, Steketee G, Muroff J. Cognitive behavioral therapy for hoarding disorder: a meta-analysis. Depress Anxiety 2015; 32:158-66. [PMID: 25639467 DOI: 10.1002/da.22327] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/24/2014] [Accepted: 09/27/2014] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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23
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Ayers CR, Dozier ME, Mayes TL, Espejo EP, Wilson A, Iqbal Y, Strickland K. Treatment Recruitment and Retention of Geriatric Participants With Hoarding Disorder. Clin Gerontol 2015; 38:235-250. [PMID: 29386745 PMCID: PMC5788454 DOI: 10.1080/07317115.2015.1032467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study describes the initial contact of 255 potential participants, recruitment of 63 participants, and retention of 57 participants from three geriatric Hoarding Disorder (HD) studies. Patients with HD were easily recruited from the community, primarily through the use of clinician referrals and posted flyers, as evidenced by steady patient flow despite lack of compensation for participation. Contrary to treatment outcomes of late life mood and anxiety disorders, geriatric HD patients are largely retained in clinical research treatment studies. Results demonstrate that older adults with HD can be engaged in treatment. Participants often needed the study staff to provide substantial support, including informal motivational interviewing and problem solving, in scheduling and attending the initial visit.
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Affiliation(s)
- Catherine R Ayers
- VA San Diego Healthcare System and University of California, San Diego School of Medicine, San Diego, California, USA
| | - Mary E Dozier
- VA San Diego Healthcare System and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Tina L Mayes
- VA San Diego Healthcare System, San Diego, California, USA
| | - Emmanuel P Espejo
- VA San Diego Healthcare System and University of California, San Diego School of Medicine, San Diego, California, USA
| | - Ariel Wilson
- VA San Diego Healthcare System, San Diego, California, USA
| | - Yasmeen Iqbal
- VA San Diego Healthcare System, San Diego, California, USA
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24
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Park JM, Lewin AB, Storch EA. Adult offspring perspectives on parental hoarding behaviors. Psychiatry Res 2014; 220:328-34. [PMID: 25129564 DOI: 10.1016/j.psychres.2014.07.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 07/25/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
Abstract
Hoarding disorder (HD) is characterized by difficulty discarding unneeded items and the accumulation of items within living spaces and is associated with significant functional impairment and distress. Along with the negative impact of hoarding on the individual, HD is substantially impairing for family members, and linked to disruptions in family functioning. The present study utilized a path model analysis to examine the associations between an array of hoarding variables hypothesized to impact family functioning and parent-offspring relationships in 150 adult-aged children of hoarders who responded to online requests to participate in a research study. It was hypothesized that increased hoarding severity, decreased insight, and increased family accommodation (i.e., act of family members facilitating or assisting in hoarding behaviors) would be associated with decreased family functioning, decreased quality of parent-offspring relationships, and increased offspring impairment. Results from the path model revealed that family functioning mediated the relationship between hoarding severity and parent-offspring relationship. Diminished insight in the hoarding parent (as reported by the offspring) was associated with increased familial conflict and family functioning partially mediated the relationship between insight and quality of parent-offspring relationship. Increased family accommodation was significantly associated with increased impairment (work, social, and family domains) in offspring of hoarders.
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Affiliation(s)
- Jennifer M Park
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Child CBT Program, 151 Merrimac Street, 3rd Floor, Boston, MA 02114-3117, United States.
| | - Adam B Lewin
- Departments of Psychology and Pediatrics, University of South Florida, United States; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, United States
| | - Eric A Storch
- Departments of Psychology and Pediatrics, University of South Florida, United States; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, United States
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Muroff J, Steketee G, Frost RO, Tolin DF. Cognitive behavior therapy for hoarding disorder: follow-up findings and predictors of outcome. Depress Anxiety 2014; 31:964-71. [PMID: 24277161 DOI: 10.1002/da.22222] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 10/10/2013] [Accepted: 11/02/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A cognitive-behavioral model of hoarding posits deficits in information processing, maladaptive beliefs about and attachments to possessions that provoke distress and avoidance, and positive emotional responses to saving and acquiring that reinforce these behaviors. A 26-session individual cognitive-behavioral therapy (CBT) based on this model showed significant reductions in hoarding symptoms and large effect sizes (Steketee et al.([1])). METHODS The present study presents findings at follow-up (up to 12 months), as well as predictors of outcome at posttreatment (n = 37) and follow-up (n = 31). RESULTS Significant improvements at post-treatment were sustained at follow-up with large effects, and Clinical Global Impression-Improvement (CGI-I) ratings by clinicians and patients at follow-up indicated that 62 and 79% of patients were rated "much improved" or "very much improved," respectively. The most prevalent patterns of outcome were improvement followed by stable gains or little improvement across all time points. Pretreatment severity of hoarding, overall clinical status, gender, perfectionism, and social anxiety were all associated with worse outcome. Only perfectionism and gender emerged as significant predictors after controlling for initial hoarding severity. CONCLUSIONS The present findings suggest general stability of individual CBT outcomes for hoarding and indicated that gender, perfectionism, and social anxiety may affect outcomes. More research on larger samples is needed to direct efforts to improve treatment for hoarding.
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Affiliation(s)
- Jordana Muroff
- Boston University School of Social Work, Boston, Massachusetts
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Abstract
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.
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Abstract
Cognitive behavior therapy (CBT) is considered a first-line intervention for obsessive-compulsive disorder (OCD) across the lifespan. Efficacy studies of CBT with exposure and response prevention suggest robust symptom reduction, often with sustained remission. Acceptability of CBT is high, and the treatment is devoid of adverse side effects. The primary mechanism of CBT is based on operant principles, specifically extinction learning. The efficacy of extinction-based treatments such as CBT is being shown for other obsessive-compulsive spectrum disorders. This article reviews the theoretic basis, clinical application, and relevant treatment outcome research for CBT and related therapies for several obsessive-compulsive spectrum disorders.
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López-Solà C, Gutiérrez F, Alonso P, Rosado S, Taberner J, Segalàs C, Real E, Menchón JM, Fullana MA. Spanish version of the Dimensional Obsessive-Compulsive Scale (DOCS): psychometric properties and relation to obsessive beliefs. Compr Psychiatry 2014; 55:206-14. [PMID: 24209609 DOI: 10.1016/j.comppsych.2013.08.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/31/2013] [Accepted: 08/08/2013] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Clara López-Solà
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
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Thiel N, Hertenstein E, Nissen C, Herbst N, Külz AK, Voderholzer U. The effect of personality disorders on treatment outcomes in patients with obsessive-compulsive disorders. J Pers Disord 2013; 27:697-715. [PMID: 23795757 DOI: 10.1521/pedi_2013_27_104] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Pollock L, Kellett S, Totterdell P. An intensive time-series evaluation of the effectiveness of cognitive behaviour therapy for hoarding disorder: a 2-year prospective study. Psychother Res 2013; 24:485-95. [PMID: 24219319 DOI: 10.1080/10503307.2013.843802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To intensively evaluate the effectiveness of cognitive-behavioural therapy (CBT) for Hoarding Disorder. METHOD An ABC with extended follow-up N=1 single-case experimental design (SCED) measured discard incidence/frequency/volume and associated cognitions, behaviours and emotions in a 644-day time series. Following a 4-week baseline (A), CBT was initially delivered via out-patient sessions (B) and then out-patient sessions plus domiciliary visits (C). Total treatment duration was 45 sessions (65 weeks) and follow-up was 4 sessions over 23 weeks. RESULTS There was a significant increase in frequency and volume of discard, with a reliable and clinically significant reduction in hoarding. The addition of domiciliary visits did not significantly improve discard ability. DISCUSSION The clinical utility of domiciliary visits whilst treating of hoarding is discussed and study limitations noted.
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Affiliation(s)
- Lisa Pollock
- a Adult ADHD Service , Belle Isle Health Park , Wakefield , UK
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Stasik SM, Naragon-Gainey K, Chmielewski M, Watson D. Core OCD symptoms: exploration of specificity and relations with psychopathology. J Anxiety Disord 2012; 26:859-70. [PMID: 23026094 PMCID: PMC3490030 DOI: 10.1016/j.janxdis.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Sara M. Stasik
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556
| | - Kristin Naragon-Gainey
- Center for Anxiety and Related Disorders, Boston University, 648 Beacon St., Boston, MA 02215
| | - Michael Chmielewski
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275
| | - David Watson
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556
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Frost RO, Ruby D, Shuer LJ. The Buried in Treasures Workshop: waitlist control trial of facilitated support groups for hoarding. Behav Res Ther 2012; 50:661-7. [PMID: 22982080 DOI: 10.1016/j.brat.2012.08.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 08/07/2012] [Accepted: 08/13/2012] [Indexed: 10/28/2022]
Abstract
Hoarding is a serious form of psychopathology that has been associated with significant health and safety concerns, as well as the source of social and economic burden (Tolin, Frost, Steketee, & Fitch, 2008; Tolin, Frost, Steketee, Gray, & Fitch, 2008). Recent developments in the treatment of hoarding have met with some success for both individual and group treatments. Nevertheless, the cost and limited accessibility of these treatments leave many hoarding sufferers without options for help. One alternative is support groups that require relatively few resources. Frost, Pekareva-Kochergina, and Maxner (2011) reported significant declines in hoarding symptoms following a non-professionally run 13-week support group (The Buried in Treasures [BIT] Workshop). The BIT Workshop is a highly structured and short term support group. The present study extended these findings by reporting on the results of a waitlist control trial of the BIT Workshop. Significant declines in all hoarding symptom measures were observed compared to a waitlist control. The treatment response rate for the BIT Workshop was similar to that obtained by previous individual and group treatment studies, despite its shorter length and lack of a trained therapist. The BIT Workshop may be an effective adjunct to cognitive behavior therapy for hoarding disorder, or an alternative when cognitive behavior therapy is inaccessible.
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Affiliation(s)
- Randy O Frost
- Department of Psychology, Smith College, Northampton, MA 01063, USA.
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Fleury G, Gaudette L, Moran P. Compulsive Hoarding: Overview and Implications for Community Health Nurses. J Community Health Nurs 2012; 29:154-62. [DOI: 10.1080/07370016.2012.697846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Muroff J, Steketee G, Bratiotis C, Ross A. Group cognitive and behavioral therapy and bibliotherapy for hoarding: a pilot trial. Depress Anxiety 2012; 29:597-604. [PMID: 22447579 DOI: 10.1002/da.21923] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/24/2012] [Accepted: 01/28/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Group cognitive behavioral treatments (GCBTs) for hoarding have produced modest benefits. The current study examined whether the outcomes of a specialized GCBT improve upon bibliotherapy (BIB) for hoarding, as part of a stepped care model. We also explored whether additional home assistance enhanced GCBT outcomes. METHODS Hoarding patients (n = 38) were randomized and completed one of three conditions: (1) GCBT with nonclinician home assistants (GCBT+HA; N = 11), (2) GCBT without HA (CGBT; N = 14), and (3) BIB (N = 13). All GCBT participants received 20 weekly group sessions and four home visits by a group co-therapist. GCBT+HA groups received four additional visits by a nonclinician coach. BIB participants were assigned a self-help book describing specific skills to reduce hoarding over the 20-week period. All participants were assessed by self-report at baseline, mid-treatment, and posttreatment. The sample averaged 57 years old and was mainly female, White, highly educated, employed, and living alone. RESULTS GCBT+HA and GCBT participants showed significant reductions on hoarding and depression symptoms, whereas BIB did not. GCBT+HA and GCBT benefited substantially and similarly on the saving inventory-revised (reductions of 29.9 and 23.3%, respectively) and SI-R (Saving Inventory-Revised) (reductions of 26.5 and 25.4%), whereas BIB participants showed very limited improvement (9% reduction) on both measures. CONCLUSION This study provides support for the efficacy of GCBT for hoarding. The effect of adding nonclinician home assistance was not significant in this small sample. BIB was not sufficient to improve hoarding symptoms. The findings have implications for a stepped care model for treating hoarding (e.g., the benefits of psycho-education via BIB, added benefits of extra in-home visits) and suggest the need to further examine the role of in-home hoarding coaches.
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Affiliation(s)
- Jordana Muroff
- Boston University School of Social Work, Boston, Massachusetts 02215, USA.
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Mataix-Cols D, Pertusa A. Annual research review: hoarding disorder: potential benefits and pitfalls of a new mental disorder. J Child Psychol Psychiatry 2012; 53:608-18. [PMID: 21895651 DOI: 10.1111/j.1469-7610.2011.02464.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The inclusion of a new mental disorder in the nomenclature is not a trivial matter. Many have highlighted the risks of an ever-increasing number of mental disorders and of overpathologizing human behaviour. Given the proposed inclusion of a new hoarding disorder (HD) in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), it is pertinent to discuss the potential benefits and pitfalls of such a development. METHOD In this article, we examine whether HD fits with the current DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and proposed DSM-5 definitions of 'mental disorder'. We next discuss the potential benefits and risks of the creation of this diagnosis. Finally, we address some additional considerations that may arise when proposing a new disorder for the nomenclature and identify some of the gaps in the knowledge base. CONCLUSION HD fits the current DSM-IV and proposed DSM-5 definitions for a mental disorder. On balance, the potential benefits of creating the new diagnosis (e.g. identification of the majority of cases who clearly suffer and need help but are currently missed out by the existing diagnostic categories) outweigh the potential harms (e.g. pathologizing normal behaviour). Whether the criteria will need modification for their use in children/adolescents is unclear and more research is needed to address this question.
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Affiliation(s)
- David Mataix-Cols
- Departments of Psychosis Studies and Psychology, King's College London, Institute of Psychiatry, London, UK.
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Nordsletten AE, Mataix-Cols D. Hoarding versus collecting: Where does pathology diverge from play? Clin Psychol Rev 2012; 32:165-76. [DOI: 10.1016/j.cpr.2011.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/13/2011] [Accepted: 12/13/2011] [Indexed: 10/14/2022]
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Gilliam CM, Norberg MM, Villavicencio A, Morrison S, Hannan SE, Tolin DF. Group cognitive-behavioral therapy for hoarding disorder: an open trial. Behav Res Ther 2011; 49:802-7. [PMID: 21925643 DOI: 10.1016/j.brat.2011.08.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/26/2011] [Accepted: 08/30/2011] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Christina M Gilliam
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, USA.
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Walsh KH, McDougle CJ. Psychotherapy and medication management strategies for obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2011; 7:485-94. [PMID: 21931490 PMCID: PMC3173031 DOI: 10.2147/ndt.s13205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder. While medication and psychotherapy advances have been very helpful to patients, many patients do not respond adequately to initial trials of serotonergic medication or cognitive-behavioral therapy (CBT) and require multiple treatment trials or combination therapies. Comorbidity may also influence treatment response. The role of streptococcal infections in pediatric OCD has become an area of intense scrutiny and controversy. In this article, current treatment methods for OCD will be reviewed, with special attention to strategies for treating OCD in children and in patients with comorbid tic disorders. Alternative psychotherapy strategies for patients who are highly anxious about starting CBT, such as cognitive therapy or augmentation with D-cycloserine, will be reviewed. Newer issues regarding use of antibiotics, neuroleptics, and glutamate modulators in OCD treatment will also be explored.
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Affiliation(s)
- Kelda H Walsh
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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41
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The effectiveness of a biblio-based support group for hoarding disorder. Behav Res Ther 2011; 49:628-34. [PMID: 21831357 DOI: 10.1016/j.brat.2011.06.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/17/2011] [Accepted: 06/25/2011] [Indexed: 11/22/2022]
Abstract
Compulsive hoarding is characterized by the acquisition of, and failure to discard, a large number of possessions and clutter that prevents the use of living spaces as intended. Current successful treatments such as individual and group cognitive-behavioral therapy are lengthy and costly, requiring a time commitment ranging from four to twelve months, trained clinicians to administer treatment, and multiple home visits. Nonprofessional interventions may provide a cost-effective pre-treatment, adjunct, or alternative for individuals who want to work on hoarding problems but are unable or unwilling to engage in treatment. The purpose of the present study was to investigate the effectiveness of an innovative program consisting of a 13-session non-professionally facilitated biblio-based, action-oriented support group using Tolin, Frost, and Steketee's (2007b) self-help book. In study 1, seventeen self-identified hoarding participants experienced significant decreases in clutter, difficulty discarding, and excessive acquisition from pre-treatment to post-treatment, with reductions evident at mid-treatment. Study 2 replicated the findings of study 1 using interview and observational measures taken in participants' homes. These findings suggest that a facilitated biblio-based group may be a promising intervention for hoarding disorder.
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Ayers CR, Wetherell JL, Golshan S, Saxena S. Cognitive-behavioral therapy for geriatric compulsive hoarding. Behav Res Ther 2011; 49:689-94. [PMID: 21784412 DOI: 10.1016/j.brat.2011.07.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 06/30/2011] [Accepted: 07/01/2011] [Indexed: 11/18/2022]
Abstract
This investigation examined response to a manualized cognitive-behavioral therapy (CBT) protocol for compulsive hoarding (Steketee & Frost, 2007) in a sample of 12 adults over age 65. All participants were cognitively intact, not engaging in any other psychotherapy, and had compulsive hoarding as their primary problem. All received 26 sessions of individual CBT over the course of 17 weeks. The primary outcome measures were the Savings Inventory-Revised and UCLA Hoarding Severity Scale, which were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up. Other outcomes included Clinical Global Impression (CGI) scores, depression, anxiety, disability, and clutter image ratings. Results demonstrated statistically significant changes on hoarding severity and depression. However, only three of the twelve participants were classified as treatment responders at post-treatment, and their gains were not maintained at 6-month follow-up. CGI, anxiety, disability, and clutter ratings were unchanged at post-treatment and follow-up. No participants dropped out, but homework compliance was variable and correlated with decreases in hoarding severity. Findings suggest that older adults with compulsive hoarding may require an enhanced or alternative treatment.
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Affiliation(s)
- Catherine R Ayers
- Research Service, VA San Diego Healthcare System, San Diego, CA 92161, USA.
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Abstract
This study reports on the development and initial psychometric properties of the Children's Saving Inventory (CSI), a parent-rated measure designed to assess child hoarding behaviors. Subjects included 123 children and adolescents diagnosed with primary Obsessive-Compulsive Disorder (OCD) and their parents. Trained clinicians administered the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), items assessing Family Accommodation and the Clinical Global Impressions--Severity index. Parents completed the CSI, Child Obsessive-Compulsive Impact Scale (COIS)--Parent Version and Child Behavior Checklist. Youth completed the COIS--Child Version, Obsessive-Compulsive Inventory Child Version (OCI-CV), Multidimensional Anxiety Scale for Children, and Children's Depression Inventory--Short Form. A four factor solution was identified; factors were named Discarding, Clutter, Acquisition, and Distress/Impairment. Internal consistency for the CSI Total and factor scores were good. One-week test-retest reliability (n = 31) from a random subsample was excellent. Known groups validity was supported vis-à-vis higher CSI scores for those endorsing hoarding on the CY-BOCS Symptom Checklist. Convergent and discriminant validity was evidenced by weak relationships with OCI-CV Checking and Contamination factors but strong relationships with the OCI-CV Hoarding factor and with hoarding obsession/compulsions on the CY-BOCS. These findings provide initial support for the reliability and validity of the CSI for the assessment of hoarding behaviors among youth with OCD. Future studies are needed to extend these findings to non-OCD samples of youth.
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Schmalisch CS, Bratiotis C, Muroff J. Processes in Group Cognitive and Behavioral Treatment for Hoarding. COGNITIVE AND BEHAVIORAL PRACTICE 2010. [DOI: 10.1016/j.cbpra.2009.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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O'Sullivan SS, Djamshidian A, Evans AH, Loane CM, Lees AJ, Lawrence AD. Excessive hoarding in Parkinson's disease. Mov Disord 2010; 25:1026-33. [PMID: 20131391 DOI: 10.1002/mds.23016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Hoarding is seen in several psychiatric conditions, but has not been specifically assessed in Parkinson's disease (PD). This study investigates hoarding tendency amongst patients with PD, and its association with impulsive-compulsive spectrum behaviors (ICBs). We compare clinical features, measures of hoarding, impulse buying, self-control, obsessive-compulsive symptoms, depression, and anxiety in 39 patients with PD with ICBs (PD + ICB), 61 patients with PD without ICBs (PD - ICB), and 50 healthy controls. A much higher proportion of PD + ICB (27.8%) than PD - ICB (3.5%) were hoarders (P = 0.001). 6% of healthy controls were hoarders. Compulsive shoppers scored higher than other varieties of ICB on excessive acquisition measures. Hoarding correlated positively with impulsive buying, obsessive-compulsive symptoms, PD duration, and negatively with self-control measures. Using multivariate regression analyzes, the presence of ICBs and measures of impulsive buying were the only variables independently associated with hoarding in PD. The association of hoarding with other ICBs and low trait impulse control suggests that excessive hoarding is related to the spectrum of impulsive behaviors in PD.
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Affiliation(s)
- Sean S O'Sullivan
- Reta Lila Weston Institute of Neurological Studies, University College London, United Kingdom.
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Grisham JR, Norberg MM. Compulsive hoarding: current controversies and new directions. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20623927 PMCID: PMC3181962 DOI: 10.31887/dcns.2010.12.2/jgrisham] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Compulsive hoarding is a disabling psychological disorder characterized by excessive collecting and saving behavior. This article reviews four key areas of recent advances in hoarding research. First, we provide an overview of the evolving controversy regarding the diagnostic status of hoarding, highlighting accumulating evidence that it may be best conceptualized as a separate syndrome. Second, we describe advances in our understanding of the epidemiology, course, and demographic features of compulsive hoarding. Third, we review the latest findings regarding possible neuropsychological correlates of the disorder. Finally, we discuss ongoing progress and future directions related to the clinical management of compulsive hoarding.
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Affiliation(s)
- Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia.
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Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman JF, Stein DJ, Matsunaga H, Wilhelm S. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety 2010; 27:556-72. [PMID: 20336805 DOI: 10.1002/da.20693] [Citation(s) in RCA: 347] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This article provides a focused review of the literature on compulsive hoarding and presents a number of options and preliminary recommendations to be considered for DSM-V. In DSM-IV-TR, hoarding is listed as one of the diagnostic criteria for obsessive-compulsive personality disorder (OCPD). According to DSM-IV-TR, when hoarding is extreme, clinicians should consider a diagnosis of obsessive-compulsive disorder (OCD) and may diagnose both OCPD and OCD if the criteria for both are met. However, compulsive hoarding seems to frequently be independent from other neurological and psychiatric disorders, including OCD and OCPD. In this review, we first address whether hoarding should be considered a symptom of OCD and/or a criterion of OCPD. Second, we address whether compulsive hoarding should be classified as a separate disorder in DSM-V, weighing the advantages and disadvantages of doing so. Finally, we discuss where compulsive hoarding should be classified in DSM-V if included as a separate disorder. We conclude that there is sufficient evidence to recommend the creation of a new disorder, provisionally called hoarding disorder. Given the historical link between hoarding and OCD/OCPD, and the conservative approach adopted by DSM-V, it may make sense to provisionally list it as an obsessive-compulsive spectrum disorder. An alternative to our recommendation would be to include it in an Appendix of Criteria Sets Provided for Further Study. The creation of a new diagnosis in DSM-V would likely increase public awareness, improve identification of cases, and stimulate both research and the development of specific treatments for hoarding disorder.
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Affiliation(s)
- David Mataix-Cols
- King's College London, Institute of Psychiatry, London, United Kingdom.
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Pertusa A, Frost RO, Fullana MA, Samuels J, Steketee G, Tolin D, Saxena S, Leckman JF, Mataix-Cols D. Refining the diagnostic boundaries of compulsive hoarding: A critical review. Clin Psychol Rev 2010; 30:371-86. [DOI: 10.1016/j.cpr.2010.01.007] [Citation(s) in RCA: 229] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 01/20/2010] [Accepted: 01/28/2010] [Indexed: 11/12/2022]
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50
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Phillips KA, Stein DJ, Rauch SL, Hollander E, Fallon BA, Barsky A, Fineberg N, Mataix-Cols D, Ferrão YA, Saxena S, Wilhelm S, Kelly MM, Clark LA, Pinto A, Bienvenu OJ, Farrow J, Leckman J. Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depress Anxiety 2010; 27:528-55. [PMID: 20533367 PMCID: PMC3985410 DOI: 10.1002/da.20705] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The obsessive-compulsive (OC) spectrum has been discussed in the literature for two decades. Proponents of this concept propose that certain disorders characterized by repetitive thoughts and/or behaviors are related to obsessive-compulsive disorder (OCD), and suggest that such disorders be grouped together in the same category (i.e. grouping, or "chapter") in DSM. This article addresses this topic and presents options and preliminary recommendations to be considered for DSM-V. The article builds upon and extends prior reviews of this topic that were prepared for and discussed at a DSM-V Research Planning Conference on Obsessive-Compulsive Spectrum Disorders held in 2006. Our preliminary recommendation is that an OC-spectrum grouping of disorders be included in DSM-V. Furthermore, we preliminarily recommend that consideration be given to including this group of disorders within a larger supraordinate category of "Anxiety and Obsessive-Compulsive Spectrum Disorders." These preliminary recommendations must be evaluated in light of recommendations for, and constraints upon, the overall structure of DSM-V.
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