Prevalence and correlates of hoarding behavior in a community-based sample

To hoard or not to hoard purchased items - does it matter? A clinical cross-sectional study on compulsive buying-shopping disorder

BACKGROUND

Research with individuals with compulsive buying-shopping disorder (CBSD) indicated that comorbid hoarding disorder (HD), as determined by questionnaire cutoffs, is associated with more severe CBSD. This study investigated a clinical sample with CBSD and determined the prevalence of HD by clinical interview, explored whether hoarding refers to consumer goods and/or non-purchased, free items, and compared patients with (HD+) and without (HD-) comorbid HD regarding materialism, impulsiveness, general psychopathology, CBSD and HD symptoms. Additionally, the relationship between CBSD symptoms and other study variables was explored in the total sample.

METHOD

All patients (N = 81) underwent a clinical interview and answered the Pathological Buying Screener (PBS), the German Saving Inventory-Revised (GSI-R), and measures for materialism, impulsiveness, depression and anxiety.

RESULTS

Seventeen patients had comorbid HD, of which 82 % hoarded predominantly purchased items. The HD+ group scored higher than the HD- group on the clutter and difficulty discarding GSI-R subscales, but not on the excessive acquisition GSI-R subscale or the PBS. There were no group differences in materialism, impulsiveness, and general psychopathology. The correlation between the PBS and the GSI-R in the total sample was driven by the high correlation between the PBS and the excessive acquisition GSI-R subscale. Higher PBS/GSI-R excessive acquisition scores were related to higher materialism and more psychopathology.

CONCLUSION

The findings indicate that hoarding in CBSD is mostly related to purchased consumer goods and not associated with a higher symptom severity of CBSD. Further investigation into the specifics of hoarding in the context of CBSD is necessary.

Functional Analysis and Treatment of Hoarding in a Child with Autism Spectrum Disorder

Excessive collecting is frequently reported in children with autism spectrum disorder, but few studies have used behavior analytic interventions based on functional analysis to treat it. In the current study, functional analysis results informed the creation of a multicomponent treatment package involving parent training for a 12-year-old girl with autism spectrum disorder who engaged in interfering hoarding that was significantly limiting quality of life for both her and her family. Based on the results of the functional analysis, which suggested automatic and potential attention functions, we evaluated differential reinforcement, rules, and acceptability criteria across the two hoarding topographies. Using a multiple baseline across behaviors design, results showed that the multicomponent treatment package successfully reduced hoarding. Social validity measures indicated a reduction in symptom severity, improvements in family quality of life, and high consumer satisfaction. In addition, outcomes were maintained over 2 months. This study shows the utility of functional analysis-based treatments for hoarding in children with autism spectrum disorder.

Rates of diagnosis and service utilization in veterans with hoarding disorder

Hoarding Disorder (HD) is a prominent and disabling neuropsychiatric condition defined by the inability to discard objects resulting in impairing levels of clutter. The prevalence rate is 2-6 % and increases with age. The aging Veteran population is a high risk group for impairment associated with HD. Medical and psychiatric comorbidities as well as associated rates of disability and poor quality of life are very common in both HD and the related disorder of OCD. We examined rates of HD and OCD diagnoses at the VA San Diego Healthcare System. Data were obtained from medical records for all Veterans with these diagnoses over 8-years and included information on medical and psychiatric care, homelessness services, and Care Assessment Needs (CAN) scores. Rates of diagnosis for both HD and OCD were well below epidemiological estimates. Veterans with HD were older, had higher rates of medical hospital admissions with longer stays; had more cardiac, neurological, and acquired medical conditions; had more psychiatric comorbidities; had more interactions with the suicide prevent team and homelessness services; and had higher CAN scores than Veterans with OCD. The low rate of diagnosis and high services utilization of Veterans with HD demonstrates an area of unmet need.

Relationship of Hoarding and Depression Symptoms in Older Adults

Hoarding disorder (HD) is a debilitating neuropsychiatric condition that affects 2%-6% of the population and increases in incidence with age. Major depressive disorder (MDD) co-occurs with HD in approximately 50% of cases and leads to increased functional impairment and disability. However, only one study to date has examined the rate and trajectory of hoarding symptoms in older individuals with a lifetime history of MDD, including those with current active depression (late-life depression; LLD). We therefore sought to characterize this potentially distinct phenotype. We determined the incidence of HD in two separate cohorts of participants with LLD (n = 73) or lifetime history of MDD (n = 580) and examined the reliability and stability of hoarding symptoms using the Saving Inventory-Revised (SI-R) and Hoarding Rating Scale-Self Report (HRS), as well as the co-variance of hoarding and depression scores over time. HD was present in 12% to 33% of participants with MDD, with higher rates found in those with active depressive symptoms. Hoarding severity was stable across timepoints in both samples (all correlations >0.75), and fewer than 30% of participants in each sample experienced significant changes in severity between any two timepoints. Change in depression symptoms over time did not co-vary with change in hoarding symptoms. These findings indicate that hoarding is a more common comorbidity in LLD than previously suggested, and should be considered in screening and management of LLD. Future studies should further characterize the interaction of these conditions and their impact on outcomes, particularly functional impairment in this vulnerable population.

Hard to let it go: repetitive negative thinking and hoarding in later life in Japan

Objectives: Hoarding in older adults can have a detrimental effect on daily life. Repetitive negative thinking (RNT) could result in a greater avoidance of discarding and increased saving behaviors; yet, the unique role of RNT on hoarding in older adults remains understudied. This study aimed to investigate whether the intensity of RNT contributes to hoarding in older adults. Methods: Two hundred and sixty-four older adults in Japan (ages 65-86 years, 132 males and 132 females) participated in an online survey. Hierarchical regression analyses were conducted to examine whether RNT could significantly explain the variance of hoarding after controlling for age, sex, years of education, self-reported cognitive impairment, and depression. Results: As we expected, RNT was significantly associated with greater hoarding behaviors, such as excessive acquisition (β = .27, p = .005) and difficulty in discarding (β = .27, p = .003). On the other hand, reflection, repetitive thinking without negative emotional valence, was significantly associated with higher scores on clutter (β = .36 p < .001). Conclusion: Our findings highlight the importance of addressing RNT in the prevention and treatment of hoarding symptoms among older adults, potentially leading to more effective interventions and improved outcomes in managing hoarding behaviors in this population.

Hoarding behaviour: special features and complications in real-world clinical practice

OBJECTIVE

Hoarding behaviour is a common but poorly characterised problem in real-world clinical practice. Although hoarding behaviour is the key component of Hoarding Disorder (HD), there are people who exhibit hoarding behaviour but do not suffer from HD. The aim of the present study was to characterise a clinical sample of patients with clinically relevant hoarding behaviour and evaluate the differential characteristics between patients with and without HD.

METHODS

This study included patients who received treatment at the home visitation program in Barcelona (Spain) from January 2013 through December 2020, and scored ≥ 4 on the Clutter Image Rating scale. Sociodemographic, DSM-5 diagnosis, clinical data and differences between patients with and without an HD diagnosis were assessed.

RESULTS

A total of 243 subjects were included. Hoarding behaviour had been unnoticed in its early stages and the median length in the sample was 10 years (IQR 15). 100% of the cases had hoarding-related complications. HD was the most common diagnosis in 117 patients (48.1%).

CONCLUSIONS

The study found several differential characteristics between patients with and without HD diagnosis. Alcohol use disorder could play an important role among those without HD diagnosis. Home visitation programs could improve earlier detection, preventing hoarding-related complications.

The Prader-Willi syndrome Profile: validation of a new measure of behavioral and emotional problems in Prader-Willi syndrome

BACKGROUND

Prader-Willi syndrome (PWS) is a rare, neurodevelopmental disorder caused by the lack of expression of paternally imprinted genes on chromosome 15q11-13. PWS features a complex behavioral phenotype, including hyperphagia, anxiety, compulsivity, rigidity, repetitive speech, temper outbursts, aggressivity, and skin-picking. Questionnaires exist for measuring hyperphagia, but not for the aggregation of other problems that are distinctive to PWS. A PWS-specific tool is needed for phenotypic research, and to help evaluate treatment efficacy in future clinical trials aimed at attenuating PWS's hyperphagia and related problems. In this 4-phase study, we leveraged our expertise in PWS with feedback from families and specialists to validate the PWS Profile, a novel, informant-based measure of behavioral and emotional problems in this syndrome.

RESULTS

The authors developed a bank of 73 items that tapped both common and less frequent but clinically significant problems in PWS (Phase 1). An iterative feedback process with families and stakeholders was used to ensure content and construct validity (Phase 2). After adding, omitting, or revising items, in Phase 3, we pilot tested the measure in 112 participants. Results were reviewed by an international team of PWS specialists and revised again (Phase 3). The final, 57-item Profile was then administered to 761 participants (Phase 4). Principal component factor analyses (n = 873) revealed eight conceptually meaningful factors, accounting for 60.52% of test variance, and were readily interpretated as: Rigidity, Insistence; Aggressive Behaviors; Repetitive Questioning, Speech; Compulsive Behaviors; Depression, Anxiety; Hoarding; Negative Distorted Thinking; and Magical Distorted Thinking. Factors were internally consistent and showed good test-retest reliability and convergent validity with existent measures of behavioral problems. Profile factors were not related to IQ, BMI, or parental SES. Three Profile factors differed across PWS genetic subtypes. Age and gender differences were found in only one Profile factor, Hoarding.

CONCLUSIONS

The PWS Profile is a valid, psychometrically-sound questionnaire that already has shown responsivity to treatment in a previous clinical trial. The Profile can extend the reach of future clinical trials by evaluating the impact of novel agents not only on hyperphagia, but also on the emotional and behavioral problems that characterize PWS.

Household factors and prevalence of squalor: meta-analysis and meta-regression

BACKGROUND

Severe domestic squalor occurs when a person lives in a dwelling that is significantly unclean, disorganised and unhygienic. The limited previous research has primarily focused on the characteristics of those who live in squalor and the associated risk factors. Robust and reliable studies of squalor prevalence have not been conducted. This study sought to produce a reliable estimate of the point prevalence of squalor.

METHODS

Using data from 13-years of the English Housing Survey, N = 85,681 households were included in a prevalence meta-analysis. Squalor prevalence over time, subgroup analysis and logistic regression investigated the role played by household and community characteristics.

RESULTS

The point prevalence of squalor was estimated to be 0.85% and squalor was seen to decrease significantly over time. More significant community deprivation, a rented dwelling, lower income and high numbers of people in the home was associated with a greater risk of squalor.

CONCLUSIONS

Squalor prevalence was higher than previous estimates and supports community care services in associated service planning. The results regarding household characteristics help to inform which households and individuals may be at a higher risk of living in squalid conditions.

'A more human approach … I haven't found that really': experiences of hoarding difficulties and seeking help

BACKGROUND AND AIMS

People with hoarding behaviours often struggle to engage in treatment. This study aimed to explore the experiences of a sample of people who identify as engaging in hoarding behaviours and who are seeking support. Exploring motivation to seek help, the barriers those who hoard face in accessing support and what facilitates accepting help, can aid understanding of how best to intervene.

METHOD

Eight individuals who self-identified as seeking help in relation to hoarding behaviours were recruited via social media and support groups. Interviews were conducted by telephone or video call, before being transcribed and analysed using interpretative phenomenological analysis.

RESULTS

Participants described complex help-seeking narratives and reported continued ambivalence about addressing their hoarding behaviours. The four group experiential themes identified were Wrestling with identity; Who can I trust?; Services don't fit; and Being overlooked: 'they're too busy looking at the thing, not the person'. Difficulties trusting others and services were identified; services were experienced as rejecting and many participants sought help for problems other than their hoarding. Problems accessing appropriate help for hoarding were predominant in the narratives, although participants who had accessed peer support described this as valuable.

CONCLUSIONS

There are both internal (e.g. fear of judgement; feeling overwhelmed) and external (e.g. service gaps) barriers that make finding useful help for hoarding behaviours very difficult. Services may facilitate those seeking help by taking a compassionate and person-centred approach to hoarding problems.

Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults

Hoarding disorder is common and debilitating, especially in older adults, and novel treatment approaches are needed. Many current treatments emphasize skills related to discarding and decision-making about possessions, which can be practiced in the patient's home. However in many cases, in-home visits are unfeasible, or real-life discarding is too difficult. Virtual reality (VR) offers the ability to create a virtual "home" including 3D scans of the patient's actual possessions that can be moved or discarded. VR discarding is an alternative to in-home visits and an approach that provides a stepping stone to real-life discarding. VR has been successfully utilized to treat many disorders but tested minimally in hoarding disorder. In nine older adults with hoarding disorder, we tested an 8-week VR intervention administered to augment a 16-week Buried in Treasures group treatment. Individualized VR rooms were uniquely modeled after each patient's home. During clinician-administered VR sessions, patients practiced sorting and discarding their virtual possessions. The intervention was feasible to administer. Open-ended participant responses, examined by two independent evaluators, indicated that VR sessions were well-tolerated and that participants found them useful, with nearly all participants noting that VR helped them increase real-life discarding. Self-reported hoarding symptoms decreased from baseline to close, with seven of the nine participants showing reliable improvement in this timeframe and none showing deterioration. Results from this exploratory pilot study suggest that VR is a feasible way to simulate an at-home sorting and discarding experience in a manner that may augment skills acquisition. It remains an open question whether VR discarding practice yields greater improvement than existing treatments. VR for this population merits further clinical investigation.

"Dying alone and being eaten": dog scavenging on the remains of an elderly animal hoarder-a case report

Animal hoarding and human consumption by dogs have been important but often understudied aspects of the human-animal bond that can be addressed within a One Health framework. No scientific report has focused on dog scavenging on animal hoarders to date, despite isolated reports of dog scavenging on human remains, mostly due to starvation. The phenomenon has been approached as a confounding factor for human forensics. In 2014, the Animal Protection Department of Curitiba City was called to rescue and handle ten small dogs which had scavenged for a week on the human remains of their elderly owner, a potential animal hoarder. At inspection, three dead dogs in early putrefaction were also found in the household. Human autopsy revealed body putrefaction and lack of soft organs. Along with the dental arch, DNA testing was performed on the remains for official deceased identification. Due to the potential public health risks of aggression toward frail human beings and for the control of zoonotic diseases, all ten dogs were euthanized. Subsequent investigations by the crime scene police, homicide police, and autopsy services were unable to establish or rule out natural death, criminal or suicidal poisoning, zoonotic disease (rabies), fatal dog attack, or fatal accidental trauma. A general protocol has been proposed for future approaches to dog scavenging and suspicious killing of animal hoarders, as well an assessment for the potential adoption or euthanasia of animals owned by hoarders in these circumstances.

Glutamatergic neurons and GABAergic neurons of medial prefrontal cortex control hoarding-like behavior

Hoarding disorder (HD) is a chronic disease that begins early in life and does not remission unless timely treated. A large number of factors affect the presentation of HD symptoms, including a strong possessive psychology of objects and neurocognitive functioning. However, the underlying neural mechanisms of the excessive hoarding behavior in HD are still unknown. Using viral infections and brain slice electrophysiology recordings, we found that increased glutamatergic neuronal activity and decreased GABAergic neuronal activity in medial prefrontal cortex (mPFC) accelerated the hoarding-like behavior in mice. Respectively, chemogenetic manipulation to reduce glutamatergic neuronal activity or enhance GABAergic neuronal activity could improve the hoarding-like behavioral response. These results reveal a critical role played by alterations in the activity of specific types of neurons in hoarding-like behavior, and that targeted therapies for HD may be possible by precisely modulating these types of neurons.

Changes in neural activity following a randomized trial of cognitive behavioral therapy for hoarding disorder

OBJECTIVE

Cognitive behavioral therapy (CBT) is efficacious for hoarding disorder (HD), though results are modest. HD patients show an increase in activity in the dorsal anterior cingulate cortex (dACC) when making decisions. The aim of this study is to determine whether CBT's benefits follow improvements in dACC dysfunction or abnormalities previously identified in other brain regions.

METHOD

In this randomized clinical trial of 64 treatment-seeking HD patients, patients received group CBT, delivered weekly for 16 weeks, versus wait list. Functional magnetic resonance imaging was used to examine neural activity during simulated decisions about whether to acquire and discard objects.

RESULTS

During acquiring decisions, activity decreased in several regions, including right dorsolateral prefrontal, right anterior intraparietal area, both right and left medial intraparietal areas, left and right amygdala, and left accumbens. During discarding decisions, activity decreased in right and left dorsolateral prefrontal, right and left rostral cingulate, left anterior ventral insular cortex, and right medial intraparietal areas. None of the a priori brain parcels of interest significantly mediated symptom reduction. Moderation effects were found for left rostral cingulate, right and left caudal cingulate, and left medial intraparietal parcels.

CONCLUSIONS

Therapeutic benefits of CBT for HD do not appear to be mediated by changes in dACC activation. However, pretreatment dACC activation predicts outcome. Findings suggest the need to re-evaluate emerging neurobiological models of HD and our understanding of how CBT affects the brain in HD, and perhaps shift focuses to new neural target discovery and target engagement trials. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hoarding Disorder: The Current Evidence in Conceptualization, Intervention, and Evaluation

Hoarding disorder is characterized by difficulty parting with possessions due to strong urges to save the items, leading to the excessive accumulation of items. High clutter levels result in varied personal, social, and legal consequences. Specialized treatments, including individual, virtual, and group cognitive and behavioral therapies, community-based interventions, and peer support approaches have shown preliminary effectiveness. Animal, attachment, and neurobiological models are expanding our understanding of the etiological bases of the disorder. Specialized populations such as children, older adults, and involuntary patients are highlighted as requiring special consideration for intervention and risk mitigation. Directions for future research are identified.

Self-reported memory and executive function in adult non-clinical hoarders

Hoarding is the excessive acquisition of, and failure to discard of, large numbers of items, leading to personal distress. Impairments on memory and executive functions have been systematically associated with hoarding behavior, predominantly focusing upon clinical (mainly middle-aged-elderly) patients with hoarding and/or PTSD. We were interested in hoarding-related memory and executive problems in younger non-clinical hoarders or non-hoarders, based on their Saving Inventory-Revised scores. In total, 113 young adults (aged 18-35 years) were assigned to either a hoarder group (N = 40) or non-hoarder group (N = 73) determined by their scores on the Saving Inventory-Revised (SI-R). Working memory (WM) and inhibition control (IC) were measured using the Adult Executive Functioning Inventory (ADEXI) and the Dysexecutive Questionnaire Revised (DEX-R) measured general executive function (EF). The Hospital Anxiety and Depression Scale measured anxiety and depression. After controlling for gender and anxiety, the analysis revealed that the hoarders reported significantly more problems than the non-hoarders on both the IC and general EF. There was no significant between-group difference on the WM sub-scale ADEXI. Self-reported deficits in IC and EF are associated with hoarding behavior. The IC deficits cold explain hoarders' inability to resist urges to buy, and general EF deficits suggest other domains are involved.

The experience of leaving a valuable object: An investigation of emotional processes related to Hoarding disorder features

One of the core features of hoarding is a significant resistance to discarding objects, which is fueled by dysfunctional beliefs and unwarranted negative emotions that hoarders tend to feel when disposing of their possessions. To our knowledge, longitudinal studies investigating the psychological effects that people who hoard experience after separating from their valuable possessions have yet to be conducted. Our study's principal aim was to explore psychological processes that individuals with high hoarding features (n = 53; 49.1%) and individuals with low hoarding features (n = 55; 50.9%) experienced when they had to separate from a valuable possession. To do this, we evaluated participants' thoughts and feelings at several time points after they had to leave a valuable object at the University laboratory (evaluations were specifically conducted at baseline, during the week, and at the end of the week). To investigate hoarding and anxiety, as well as depressive, obsessive-compulsive, and emotional processes-related features, a mixed-method approach was employed involving self-report questionnaires, ad hoc surveys, and a daily self-monitoring schedule. Our findings showed that compared to participants with low hoarding features, participants with high hoarding traits: 1) scored higher for anxiety sensitivity, distress tolerance, and emotional dysregulation; 2) reported having more negative emotions when leaving their object; 3) had more intrusive object-related beliefs; and 4) experienced a higher frequency of negative emotions as well as a higher level of distress during the week. Both groups experienced more negative emotions in the first part of the week, which decreased as the time at which participants could receive their object back drew closer. Finally, dysfunctional beliefs about leaving a personal object (Saving Cognitions Inventory), sensitivity to anxiety (Anxiety Sensitivity Index-3), and distress tolerance (Distress Tolerance Scale) contributed to the level of discomfort that participants with higher hoarding scores reported when they had to leave their possession. These results highlight the relevance of emotional processes in the hoarding disorder framework as well as underscore the importance of assessing and treating them in clinical settings.

"In an ideal world that would be a multiagency service because you need everybody's expertise." Managing hoarding disorder: A qualitative investigation of existing procedures and practices

Hoarding disorder is characterised by the acquisition of, and failure to discard large numbers of items regardless of their actual value, a perceived need to save the items and distress associated with discarding them, significant clutter in living spaces that render the activities associated with those spaces very difficult causing significant distress or impairment in functioning. To aid development of an intervention for hoarding disorder we aimed to identify current practice by investigating key stakeholders existing practice regarding identification, assessment and intervention associated with people with hoarding disorder. Two focus groups with a purposive sample of 17 (eight male, nine female) stakeholders representing a range of services from housing, health, and social care were audio recorded, transcribed verbatim and analysed thematically. There was a lack of consensus regarding how hoarding disorder was understood and of the number of cases of hoarding disorder however all stakeholders agreed hoarding disorder appeared to be increasing. The clutter image rating scale was most used to identify people who needed help for hoarding disorder, in addition to other assessments relevant to the stakeholder. People with hoarding disorder were commonly identified in social housing where regular access to property was required. Stakeholders reported that symptoms of hoarding disorder were often tackled by enforced cleaning, eviction, or other legal action however these approaches were extremely traumatic for the person with hoarding disorder and failed to address the root cause of the disorder. While stakeholders reported there was no established services or treatment pathways specifically for people with hoarding disorder, stakeholders were unanimous in their support for a multi-agency approach. The absence of an established multiagency service that would offer an appropriate and effective pathway when working with a hoarding disorder presentation led stakeholders to work together to suggest a psychology led multiagency model for people who present with hoarding disorder. There is currently a need to examine the acceptability of such a model.

Council tenancies and hoarding behaviours: A study with a large social landlord in England

Hoarding behaviours are highly stigmatised and often hidden. People with problematic hoarding behaviours have a higher rate of mental health and other healthcare and social services utilisation. Hoarding is a community health problem, one factor being housing insecurity. Hoarding behaviours represent significant burden to housing providers, impact the community and dealing with it involves multiple community agencies. This study with a city council in England with a large housing stock (over 14,000 properties) in summer 2021 sought to understand the nature, circumstances and extent that hoarding presents. We developed a reporting system and conducted 11 interviews with housing officers in which they described a case to explain their involvement. Our report details the nature of 38 people who hoard: 47% had a known disability or vulnerability, 34% presented a fire and environmental risk, 87% lived alone and 60% were resident in flats. Our qualitative themes are: Working with others, Balancing an enforcement approach, Feeling conflicted, Complex needs of people who hoard and Staff needs. The cases described by the housing officers are combined into six case studies and illustrate the complex, multi-agency circumstances around decision making and risk stratification. Our findings point to housing officers as frontline professionals dealing with a public health and social care issue which is often the manifestation of complex life histories and mental health conditions. We suggest a greater focus on risk stratification and a more holistic approach to hoarding cases to effectively deal with this most complex of community health and social care issues.

Historical Portrayal of Hoarding Disorder in European Literature and Its Relationship to the Economic and Personal Circumstances of the Authors

In 2013, hoarding disorder was officially recognized as a separate Diagnostic and Statistical Manual psychiatric diagnosis after years of debate. Prior to 2013, hoarding disorder was generally considered a subset of obsessive-compulsive disorder. Though modern medicine has only recently deepened the analysis of hoarding disorder, hoarding was regularly featured as a character trait in numerous European literary works dating back over 700 years. Several prominent European writers incorporated hoarding behavior in the fictional characters they created. Each author's individual social and economic experiences may have been motivators for perpetuating hoarding-like behavior. It can be postulated that specific historical events and economic circumstances in the country at the time of each author's life likely impacted their interpretation of hoarding behaviors, and the authors carried these influences into their portrayal of their fictional characters. This analysis discusses the various portrayals of hoarding in key pieces of literature and seeks to explain the rationale for these authors' inclusion of hoarding traits in their characters.

Prevalence and correlates of hoarding behavior and hoarding disorder in children and adolescents

Although hoarding symptoms are reported to begin in childhood and adolescence, the true prevalence of the disorder in this age group is unknown. This study aims to estimate the prevalence of hoarding disorder (HD) in children and adolescents. The present study was planned as a two-stage epidemiological research. In the first stage, the Children's Saving Inventory (CSI) and informed consent forms were delivered to a group of students' parents. In the second stage, one-on-one psychiatric interviews with a physician were planned with the families and children who had hoarding behavior (HB), as described by their parents. The DSM-5-based HD interview and the Development and Well-Being Assessment (DAWBA) diagnostic tool were used to detect prevalence of HD and comorbid psychiatric disorders. A total of 3249 children were included in the study, and 318 children and their parents were evaluated in the second stage. As a result of the second assessment, 32 out of 318 children met the HD diagnostic criteria. The estimated prevalence of HD was 0.98% (95% CI 0.7-1.4). Hoarding disorder was found more frequently in females (F/M = 3/1). After a logistic regression analysis, variables such as female sex and the presence of any psychopathology were identified as independent correlates of HD. More than half (56.2%) of the children diagnosed as having HD also had a comorbid psychiatric disorder. In the present study, the two-stage evaluation method was used in a large pediatric sample to determine the estimated prevalence of HD, as well as the factors associated with the disorder and comorbid psychiatric disorders.

Evaluation of an educational programme for people who have difficulty decluttering and organising: A randomised controlled trial in Japan

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.

Exploring the relationship between dispositional mindfulness and hoarding behavior: A moderated multi-mediation model

Hoarding behavior may not only interfere with hoarders’ daily lives but may also endanger the community. However, few studies have investigated the role of personality characteristics in hoarding behavior. We hypothesized that dispositional mindfulness would be negatively associated with hoarding behavior, and tested mechanisms and gender differences in this association. An online survey was conducted in a sample of 533 Chinese adults (262 women, Mage = 26.82; SD = 6.30). Regression-based analyses showed that mindfulness was associated with less hoarding behavior through higher self-esteem and lower emotion dysregulation. Moreover, gender moderated the mediating effect of emotion dysregulation in the association between mindfulness and hoarding behavior. Specifically, the indirect association was only significant for women. These findings provide a deeper understanding of how, why, and for whom dispositional mindfulness is negatively associated with hoarding behavior, they provide support for self-completion theory and the cognitive-behavioral model of hoarding, and they have heuristic value for future research.

What is underneath all that stuff? A Q-methodological exploration of profiles of beliefs and vulnerabilities in hoarding disorder

BACKGROUND

Hoarding disorder (HD) can be understood through the cognitive behavioural model in the context of vulnerability factors (for example, personality traits, co-morbidities, traumatic life events) and beliefs about possessions (for example, identity, emotional attachment, memory, utility). Less is known about the strength of these hypothesised beliefs, or how they interact within the hoarding population, with researchers suggesting that specifying beliefs would improve treatment outcomes.

AIM

The current study explored beliefs in HD, utilising Q-methodology to explore both categories of beliefs and the interactions between these. Moreover, Q-methodology allowed for comparison of the individuals endorsing specific categories of beliefs.

METHOD

A comprehensive list of beliefs about possessions was developed. Thirty-two adults with clinically significant levels of HD completed a Q-sort task, alongside measures of proposed vulnerabilities, including co-morbidity, trauma and attachment style.

RESULTS

Q-factor analysis produced four profiles consisting of groups of participants who endorsed the same beliefs and had shared characteristics: (1) 'Expression of identity', (2) 'Responsibility and morality', (3) 'Stability and predictability', and (4) 'Objects as emotional and meaningful beings'.

DISCUSSION

The profiles were distinguished by different categories of beliefs and co-morbid symptoms, suggesting that more targeted assessment tools and interventions would be beneficial to account for this heterogeneity within the clinical population. In particular, beliefs about identity and self-concept formed the largest profile, and beliefs about stability and predictability introduce a novel category of beliefs.

A remote cognitive behavioural therapy approach to treating hoarding disorder in an older adult

Hoarding disorder (HD) is characterised by excessive acquisition and distress associated with discarding objects, resulting in significant clutter. At present, cognitive behavioural therapy (CBT) represents the strongest evidence base for treating HD, although some limitations exist. Little research has examined the effectiveness of remote-CBT interventions for HD in older adults. This case study focuses on Mary, an older female adult presenting with clinically significant hoarding behaviours which severely impact her daily functioning and quality of life. Assessment and intervention followed a structured CBT approach. Despite the complicating factor of COVID-19, Mary responded well to a remote-CBT intervention, with progress indicators suggesting modest improvements in personal, social and occupational functioning. These findings support the use of remote-CBT for HD in both reducing frequency and intensity of hoarding behaviours and improving wellbeing.

Key learning aims

(1)

Characteristics of Deaths With Evidence of Pathological Hoarding in Cook County 2017 to 2018

ABSTRACT

Hoarding disorder was recently recognized as an independent diagnosis; it is characterized by the accumulation of objects causing a functional impairment and is commonly associated with increased risk of injury or death. Limited data exist about deaths of persons found in hoarding environments. This study investigated the characteristics and circumstances surrounding deaths found in "hoarding" environments. Using the electronic record management system, a search for the term "hoard" from 2017 to 2018 identified 138 cases. The mean age was 67 years, 56% were male, 76% were White, and 86% of decedents lived alone. Decomposition was noted in 61% of cases. A full autopsy was performed in 36 cases (26%); natural was the most common manner of death (80%), followed by accident (14%). Cases in which hoarding was thought to be contributory to the cause of death occurred in 5 cases. A qualitative hoard evaluation was done on 29 cases (21%) with available photographs. A hoarding level was assigned using the Clutter Hoarding Scale with an average of 3.39/5. Overall, the analysis showed deaths in pathological hoarding environments appeared to impact all socioeconomic groups and was associated with increased risk of accidental death and being found in a state of decomposition.

Sociodemographic, income, and environmental characteristics of individuals displaying animal and object hoarding behavior in a major city in South Brazil: A cross-sectional study

Background and Aim: Hoarding cases have not been researched in depth in developing countries, such as Brazil. This study aimed to describe the characteristics of people with hoarding behavior in Curitiba, Brazil. Materials and Methods: A cross-sectional study was conducted based on complaints about hoarding situations received by the City Hall. The data on sociodemographic, income, and environmental characteristics of individuals displaying animal and object hoarding behavior were obtained and analyzed using descriptive statistics and multiple correspondence analyses. Results: Out of the 113 hoarding cases reported, 69 (61.06%) were fully assessed. Most of the participants (43; 62.32%) were women, and it was observed that most of the animal hoarding cases were women (p=0.02). The average age was 62.47 years old, and most of them (44; 63.76%) had studied up to the middle school level. People associated with object hoarding belonged to the lower income category (p=0.031). In most cases, the homes had an unpleasant odor (45; 65.21%), and this was prevalent in cases involving women (p=0.004) and animals (p=0.001). The risk of fire (24 [34.78%]) and landslip (9 [13.04%]) was more frequent in the case of object hoarding (p=0.018 and 0.021, respectively). Conclusion: The description of characteristics of individuals with hoarding behavior may assist in understanding the magnitude of this public health problem in Brazil and shed light on the need to develop studies on the health conditions of people and animals that live in these situations.

The Relationship Between Compulsive Buying and Hoarding in China: A Multicenter Study

There is no previous research that has explored the correlation between compulsive buying and hoarding in the Chinese population. This study aims to determine the relationship between compulsive buying and hoarding in a sample of the Chinese population comprising participants from mainland China (emerging economy) and Hong Kong (developed economy). Self-reported measures consisting of demographic questions, the Chinese version of the Hoarding Rating Scale (CHRS), and Richmond Compulsive Buying Scale-Traditional Chinese (RCBS-TC) were administered to participants. After data collection, common method biases were precluded. The RCBS-TC and CHRS were validated by confirmatory factor analysis and found correlated by Pearson correlation coefficient. The RCBS-TC and CHRS demonstrated satisfactory levels of internal consistency (Cronbach’s α = 0.872 and 0.828, respectively). A three-factor model, including hoarding, obsessive-compulsive, and impulse control disorders, was obtained through Confirmatory Factor Analysis (CFA) with the satisfactory fit for the total sample from Hong Kong and mainland China. A significant correlation was found between RCBS-TC and CHRS (r = 0.473). Findings also showed that 14% of the participants exhibited compulsive buying behavior. This study provides sufficient proof of the reliability and validity of RCBS-TC and CHRS. Their relationship was explored based on two sets of samples from different regions in Asia, which contributes more applicability in a cross-cultural context.

Interpersonal attachment, early family environment, and trauma in hoarding: A systematic review

The formation of intense emotional attachments to objects, difficulty parting with possessions, and the extreme accumulation of clutter are key features of Hoarding Disorder (HD). Although substantial literature implicates processes such as dysfunctional beliefs and maladaptive emotional cycles in HD, little is known about the vulnerability factors that lead to their development and hoarding symptomatology. The current review sought to systematically collate and integrate findings from studies investigating the relationship between hoarding symptoms and three proposed vulnerability factors: i) interpersonal attachment, ii) early family environment, and iii) traumatic or adverse life events. A comprehensive search of the databases PsycInfo, PubMed, and Scopus identified a total of 39 studies for inclusion. The results presented a complex pattern that supported the presence of relationships between insecure attachment, cold and controlling family experiences, and exposure to adverse life events with increased hoarding severity. However, the specificity of these factors to HD over other clinical groups remains unclear and findings are limited by the heterogenous and small number of studies. We conclude by discussing the clinical implications and limitations of these findings and propose new directions for future research.

Cognitive Behavioral Therapy For Hoarding Disorder: A Meta-Analysis

(Appeared originally in Depression and Anxiety 2015; 32:158-166).

Investigating associations between hoarding symptoms and affective and cognitive empathy

OBJECTIVES

Hoarding is associated with poor interpersonal functioning, such as social isolation and difficulties in forming relationships, but the reasons for these social problems are not well understood. Previous studies have identified empathy as an important precursor to social functioning, particularly for clinical disorders characterized by social deficits. The aim of the current study was therefore to investigate associations between measures of cognitive and emotional empathy and hoarding symptoms.

METHOD

A total of 278 participants recruited via MTurk completed online self-report questionnaires on hoarding, empathy (including cognitive and affective components), and depression. All participants subsequently completed The Awareness of Social Inference Test-Short version (TASIT-S), a behavioural measure of theory of mind, a concept used interchangeably with cognitive empathy.

RESULTS

Hoarding symptoms were associated with greater self-reported emotional empathy, specifically emotional contagion, and less self-reported cognitive empathy. Emotional empathy predicted hoarding even after controlling for depression symptoms. Hoarding symptoms were also associated with poorer performance on the TASIT-S with respect to both emotion recognition and theory of mind, with theory of mind remaining a unique predictor of hoarding symptoms after controlling for depression. Participants who reported clinically significant hoarding symptoms were impaired in emotion recognition and theory of mind according to TASIT-S norms.

CONCLUSIONS

Hoarding symptoms are associated with increased emotional contagion and decreased cognitive empathy. Empathy may be an avenue for understanding and treating interpersonal difficulties in hoarding disorder.

PRACTITIONER POINTS

As hoarding increased, self-reported emotional contagion increased As hoarding increased, self-reported and behavioural cognitive empathy decreased Self-reported emotional empathy and behavioural cognitive empathy predicted hoarding even after controlling for depression Empathy may be an avenue for understanding social difficulties in hoarding disorder.

Traumatic and stressful life events in hoarding: the role of loss and deprivation

BACKGROUND

Although past research shows hoarding to be associated with stressful life events involving loss and/or deprivation, the temporal relationship between the onset of symptoms and these events is not completely clear.

OBJECTIVES

In a cross-sectional online study, we examined the relationship between the number of events involving loss or deprivation before/simultaneously vs. after the onset of hoarding and various hoarding-related beliefs, such as emotional attachment to possessions, and symptom severity. Further, we examined whether perceived social support moderated the influence of these events on emotional attachment to objects.

METHODS

One hundred seventeen subjects with hoarding problems responded to a series of instruments to assess the history and timing of traumatic and stressful loss and/or deprivation in relation to the onset of hoarding, and self-report tools evaluating the severity of hoarding, beliefs/motivations, depression, anxiety, general distress, and perceived social support.

RESULTS

The number of events involving loss or deprivation occurring before hoarding was related to increased emotional attachment to possessions, whereas events happening after the onset of hoarding were related to increased concerns about memory as drivers of hoarding symptoms. Events happening before hoarding did not interact with perceived social support to influence emotional attachment to objects.

CONCLUSIONS

The timing of traumatic and stressful life events related to loss and deprivation is associated with different hoarding phenotypes, including beliefs/motivations for hoarding. If confirmed by longitudinal studies, these findings may be relevant for therapeutic and preventive measures.

Investigating executive functions in youth with OCD and hoarding symptoms

Executive functions (EF) deficits are hypothesized to be a core contributor to hoarding symptoms. EF have been studied in adult hoarding populations, but studies in youth are lacking. The current study compared multiple EF subdomains between youth with obsessive-compulsive disorder (OCD) and youth with OCD and hoarding symptoms. Forty youth (8-18 years old) with a primary diagnosis of OCD were recruited. Participants were divided by hoarding severity on the Child Saving Inventory (CSI) into either the "hoarding group" (upper 33.3%) or the "low-hoarding group" (lower 66.7%). Groups were compared on EF tasks of cognitive flexibility, decision-making, and inhibitory control. Youth in the hoarding group exhibited significantly higher cognitive flexibility and lowered perseveration than the low-hoarding group. Hoarding and low-hoarding groups did not differ in any other EF subdomain. Hoarding symptoms in youth with OCD were not associated with deficits in EF subdomains; instead, youth who hoard exhibited higher cognitive flexibility compared to youth with low hoarding symptoms.

Internet-based hoarding assessment: The reliability and predictive validity of the internet-based Hoarding Rating Scale, Self-Report

The Hoarding Rating Scale, Self Report (HRS-SR) is a 5-item assessment developed to ascertain the presence and severity of hoarding symptoms. This study aimed to evaluate the validity of an online adaptation of the HRS-SR in a remote, unsupervised internet sample of 23,214 members of the Brain Health Registry (BHR), an online research registry that evaluates and longitudinally monitors cognition, medical and psychiatric health status. Convergent validity was assessed among a sub-sample of 1,183 participants who completed additional, remote measures of self-reported hoarding behaviors. Structured clinical interviews conducted in-clinic and via video conferencing tools were conducted among 230 BHR participants; ROC curves were plotted to assess the diagnostic performance of the internet-based HRS-SR using best estimate hoarding disorder (HD) diagnoses as the gold standard. The area under the curve indicated near-perfect model accuracy, and was confirmed with 10-fold cross validation. Sensitivity and specificity for distinguishing clinically relevant hoarding were optimized using an HRS-SR total score cut-off of 5. Longitudinal analyses indicated stability of HRS-SR scores over time. Findings indicate that the internet-based HRS-SR is a useful and valid assessment of hoarding symptoms, though additional research using samples with more diverse hoarding behavior is needed to validate optimal cut-off values.

The Association Between Sleep and Late Life Hoarding

Sleep problems are associated with many different forms of psychopathology in late life; however, there is currently a gap in the literature on the association between sleep quality and hoarding in older adults. This secondary data analysis of 40 older adults with hoarding disorder examined the association between sleep and hoarding, change in sleep disturbance following treatment, and the impact of sleep on treatment response. Sleep disturbance was correlated with hoarding severity, and this association remained significant when controlling for inability to sleep in a bed due to clutter in a multiple regression analysis. Following treatment, there was no change in sleep disturbance using a paired t-test, and baseline sleep disturbance was not correlated with change in hoarding severity. Future studies on the potential impact of sleep disturbance on hoarding treatment in older adults should examine if targeting sleep issues adjunctively could lead to improved sleep and improved treatment adherence/efficacy.

Personality traits in adults with hoarding disorder

BACKGROUND

Prior research has demonstrated a link between compulsive hoarding symptoms and personality traits; however, no studies have investigated the link between hoarding and personality traits utilizing a sample of individuals diagnosed with hoarding disorder (HD) using formal diagnostic criteria. The aim of the current study was to evaluate the frequency and type of personality traits in adults diagnosed with HD and to explore the associations among hoarding severity and personality disorder traits within this sample.

METHODS

Seventy-two veterans enrolled in an ongoing treatment trial for HD completed a battery of self-report measures during their initial assessment. Linear regression analyses were used to determine the unique variance accounted for by hoarding severity in predicting scores on the personality disorder scales from the Millon Clinical Multiaxial Inventory-III (MCMI-III).

RESULTS

The majority of participants had an elevated score on at least one of the MCMI-III Personality scales. The most frequently elevated scores were for the Avoidant, Dependent, Depressive, and Schizoid scales. Hoarding severity was a significant predictor of personality traits in 10 out of 14 MCMI-III scales.

LIMITATIONS

Given the exploratory nature of the investigation, we did not control for multiple comparisons or the presence of mood or anxiety disorders.

CONCLUSIONS

The elevated prevalence of co-occurring personality pathology in adults with HD indicates the importance of considering underlying personality structure when developing individualized treatment plans.

Prevalence of Hoarding Behavior Among Formerly Homeless Persons Living in Supported Housing

Hoarding disorder has become an official disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Hoarding disorder affects approximately 1.5% to 5% of the general population, and there is no known literature that has examined the prevalence of hoarding disorder among homeless populations or those living in supported housing, although hoarding problems can jeopardize their housing situation. This study used the Clutter Image Rating to estimate the prevalence of possible hoarding behavior among 660 adults living in supported housing. The results indicate that 18.5% of supported housing residents had hoarding behavior, which is more than three times the prevalence reported in the general population. These results suggest that hoarding behavior and possibly hoarding disorder may be more prevalent among those with histories of homelessness and housing instability, which may be of concern because it may affect both housing and health statuses.

Prevalence of hoarding disorder among primary care patients

Objectives:

Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India.

Methods:

To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers.

Results:

The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals.

Conclusion:

Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

An Ecological Momentary Assessment Study Investigating the Function of Hoarding

This study examined the function of hoarding behaviors and the relations between hoarding and a series of cognitive and affective processes in the moment using ecological momentary assessment. A matched-groups design was used to compare college students with higher hoarding symptoms (n = 31) and matched controls (n = 29). The two groups did not differ in what function they reported acquiring served, and positive automatic reinforcement was the most commonly reported function in both groups. Engaging in hoarding-relevant behaviors did not predict change in positive or negative affect when controlling for previous affect. Emotional reactivity and experiential avoidance in the moment were both elevated in the higher hoarding group compared to controls, while momentary mindfulness and negative affect differentiation were lower. Overall, these findings support the importance of emotion regulation processes in hoarding. They also suggest individuals may not be successfully regulating affect in the moment with hoarding behaviors, despite efforts to do so. It may be useful to evaluate processes such as striving for positive affect in hoarding disorder in the future.

Psychopathological Comorbid Symptoms in Animal Hoarding Disorder

The main goal of this research is to describe the psychopathological symptoms comorbid to animal hoarding disorder. This is a cross-sectional study with a sample of a 33 individuals sample diagnosed with animal hoarding disorder. For data collection, a Sociodemographic Data questionnaire and a Semi-Structured Clinical Interview were used, based on the DSM-5 Level 1 Cross-Cutting Symptom Measure. The sample consisted of 24 women (72.7%) and 9 men (27.30%), with a prevalence of 64% of the elderly. The mean number of self-reported animals per residence was 41.12 (DP = 24.41), totaling 1357 animals: 915 (68%) dogs, 382 (28%) cats, and 50 (4%) ducks. The results indicated animal hoarding disorder the comorbid psychopathological symptoms of depression (36%), anxiety (36%), memory deficits (27%), mania (21%) and obsessive-compulsive disorder (18%). The analyses revealed a higher occurrence of these symptoms among participants who had hoarded animals for over 20 years.

Serotonin system genes and hoarding with and without other obsessive-compulsive traits in a population-based, pediatric sample: A genetic association study

BACKGROUND

Hoarding, originally only considered a symptom of obsessive-compulsive disorder (OCD), is now categorized as a separate disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We studied candidate serotonergic genes and the distinctness of hoarding in children and adolescents and hypothesized that unique gene variants would be associated with hoarding alone.

METHODS

We examined obsessive-compulsive (OC) traits, including hoarding, in a total of 5,213 pediatric participants in the community. We genotyped candidate serotonin genes (5-HTTLPR polymorphism in SLC6A4 for 2,018 individuals and single nucleotide polymorphisms [SNPs] across genes SLC6A4, HTR2A, and HTR1B for 4,711 individuals). In a previous study conducted by our group in the same sample, we identified a significant association between 5-HTTLPR and hoarding in males. In this study, we examined hoarding more closely by testing the association between serotonin gene variants and hoarding traits with and without other accompanying OC traits.

RESULTS

The [L_G +S] variant in 5-HTTLPR was significantly associated with hoarding alone in males (p-value of 0.009). There were no significant findings for 5-HTTLPR in females. There were no significant findings after correction for multiple comparisons using SNP array data, but top SNP findings suggested that variation downstream of HTR1B may be implicated in hoarding alone in females.

CONCLUSIONS

Our results suggest specific serotonin gene variants are associated with hoarding traits alone, differing between sexes. Top findings are in line with our former study, suggesting that individuals with hoarding alone were driving previous results. Our paper supports hoarding disorder's new designation.

Treatment outcomes in older adults with hoarding disorder: The impact of self-control, boredom and social support

OBJECTIVES

Hoarding disorder in older adults often develops in the context of co-occurring psychosocial maladies, and treatment response tends to be suboptimal. This preliminary investigation explored several ageing-related factors and their relationship to hoarding symptom severity (HSS), and examined treatment response to 15 sessions of cognitive behavioural therapy (CBT) with in-home support.

METHODS

Twenty-nine participants (Mage = 67) completed self-report questionnaires measuring HSS, self-control, indecisiveness, depression, loneliness, social support and boredom, before (T1) and after (T2) treatment.

RESULTS

At T1, HSS was associated marginally with loneliness and significantly with all other variables, except social support. At T2, HSS and depression decreased significantly and only boredom and self-control remained associated with HSS. Attrition rates were high, and those with low social support were more likely to discontinue treatment prematurely.

CONCLUSIONS

Increasing social support may improve treatment retention, and pre-emptively reducing sources of boredom and increasing self-control during treatment might improve outcomes for older adults with hoarding disorder.

Adaptation and psychometric testing of the hoarding rating scale (HRS): a self-administered screening scale for epidemiological study in Chinese population

BACKGROUND

Hoarding disorder is a chronic and debilitating illness associated with restrictions on activities of daily living, compromised social and occupational functioning, and adverse health outcomes. However, researchers lack a brief and self-administered screening measurement to assess compulsive hoarding in the Chinese speaking population. This study aimed to adapt and validate the Hoarding Rating Scale-Interview (HRS-I) to as a tool for screening compulsive hoarding behavior in Chinese population.

METHODS

This study comprised two phases. During Phase 1, the English-language HRS-I was translated into Chinese (CHRS) (comprehensible for most Chinese speaking population, e.g., Cantonese & Mandarin) and subjected to an equivalence check. In Phase 2, the CHRS was validated by examining internal consistency, stability, and construct validity. Different samples were used appropriately to verify the items and reflect the psychometric properties.

RESULTS

In Phase 1, the CHRS yielded satisfactory content (S-CVI = 0.93) and face validity ratings (comprehensibility = 100%, N = 20 participants of general public with age 18-72) and the English and Chinese versions were found to be equivalent (ICC = 0.887; N = 60 university staff and students). Phase 2 revealed satisfactory levels of internal consistency (Cronbach's α = 0.86; corrected item-total correlation = 0.60-0.74; N = 820 participants of general public), 2-week test-retest reliability (ICC = 0.78; N = 60 university students), and construct validity (one-factor CFA solution matched with the hypothesized model, χ2/d.f. = 2.26, RMSEA = 0.049, CFI = 0.99, IFI = 0.99, NFI = 0.99; n = 520 participants of general public).

CONCLUSIONS

This study provides sufficient evidence of the reliability and validity of the CHRS for compulsive hoarding behavior screening in the Chinese population through self-administered method.

Visually mediated functioning improves following treatment of hoarding disorder

BACKGROUND

Hoarding disorder (HD) is a highly debilitating psychiatric disorder that affects 2-6% of adults. Neuropsychological deficits in visual memory, detection, and categorization have been reported in HD. To date, no study has examined the relationship between neurocognitive functioning and treatment for HD. We aim to determine the association between neurocognitive functioning and treatment outcomes, as well as the impact of HD-specific treatment on cognitive functioning.

METHODS

323 individuals with HD were randomized to 20 weeks of peer- or clinician-led group behavioral treatment. 242 participants completed pre- and post-treatment neuropsychological testing covering eight neurocognitive domains. Rates of cognitive impairment (CI) were assessed for each neurocognitive domain. The association of baseline neurocognitive function on treatment response was examined using multiple regression. MANOVA and post-hoc tests were used to determine neurocognitive performance change pre- to post treatment.

RESULTS

Sixty-seven percent of participants had CI on ≥1 cognitive domain. There was no significant effect of pre-treatment neurocognitive functioning on treatment outcome. Post-treatment improvements were observed in visual memory, visual detection, decision making, information processing speed, visuospatial processing, attention/working memory (p≤.001). Declines in performance were found in visual reaction time and categorization.

LIMITATIONS

This was a non-inferiority trial to examine two treatment types with no normative comparison group. Treatment seeking individuals are more likely to be insightful, motivated, and have other features which limit generalizability.

CONCLUSIONS

Patterns of cognitive impairment in HD are similar to previous reports. Pre-treatment neurocognitive functioning did not impact treatment response. Neuropsychological functioning improved across multiple domains following targeted treatment.