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Wheaton MG, Varias AD, Sandhu T, Muñoz Rodríguez PA, Mukunda P, Filippou-Frye M, Millen A, Lombardi A, van Roessel P, Raila H, Anderson K, Linkovski O, Mahnke A, Sanchez C, McCarthy E, Wright B, Mibenge C, Rico Y, Righi S, Halsey C, Torio L, Asgari S, Qiu T, Garcia G, Jo B, Belofsky B, Shuer LJ, Frost RO, Rodriguez CI. Randomized waitlist-controlled trial of buried in treasures facilitated support groups and in-home uncluttering (BIT+) for hoarding disorder. J Psychiatr Res 2024; 176:58-67. [PMID: 38843580 DOI: 10.1016/j.jpsychires.2024.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/27/2024] [Accepted: 05/29/2024] [Indexed: 07/29/2024]
Abstract
OBJECTIVE The Buried in Treasures (BIT) workshop is a promising treatment for hoarding disorder (HD), though many participants struggle with home uncluttering. This randomized waitlist-controlled trial investigated the efficacy of a version of BIT, augmented with in-home uncluttering practice (BIT+). METHOD Adults (N = 41) with hoarding disorder were recruited from the community and randomly assigned to BIT+ or waitlist. BIT+ consisted of 16 sessions of the BIT workshop and 10 uncluttering home visits over 18 weeks. Outcome measures included the Saving Inventory-Revised (self-report) and the Clutter Image Rating Scale (self and independent evaluator rated). Between group repeated measures analyses using general linear modeling examined the effect of BIT+ vs waitlist control on hoarding symptoms after 18 weeks. Within group analyses examined pre-post effects for all BIT+ participants combined after 18 weeks. RESULTS After 18 weeks, BIT+ participants benefited significantly more than waitlist controls on hoarding severity with large effect size (Cohen's d = 1.5, p < .001). BIT+ was also associated with improvement reductions in hoarding symptoms, clutter, and functional impairment. CONCLUSIONS The BIT+ intervention offers promise as a treatment option for hoarding. Adding in-home uncluttering practice may incrementally improve discarding practices. Future controlled trials are warranted.
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Affiliation(s)
| | - Andrea D Varias
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA; Touro University California College of Medicine, Vallejo, CA, 94592, USA
| | - Thasveen Sandhu
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Paula A Muñoz Rodríguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Pavithra Mukunda
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Maria Filippou-Frye
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Andrea Millen
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Anthony Lombardi
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Peter van Roessel
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Hannah Raila
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Kelley Anderson
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Omer Linkovski
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Amanda Mahnke
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Catherine Sanchez
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Elizabeth McCarthy
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Brianna Wright
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Chiseche Mibenge
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Yvette Rico
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Sarah Righi
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Camilla Halsey
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Lilleana Torio
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Sepehr Asgari
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Tori Qiu
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Geronimo Garcia
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Becca Belofsky
- Mutual Support Consulting, LLC, Easthampton, MA, 01027, USA
| | - Lee J Shuer
- Mutual Support Consulting, LLC, Easthampton, MA, 01027, USA
| | | | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
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Kato K, Tomiyama H, Murayama K, Mizobe T, Matsuo A, Nishida N, Matukuma K, Kang M, Sashikata K, Kikuchi K, Togao O, Nakao T. Reduced resting-state functional connectivity between insula and inferior frontal gyrus and superior temporal gyrus in hoarding disorder. Front Psychiatry 2024; 15:1399062. [PMID: 38966185 PMCID: PMC11223522 DOI: 10.3389/fpsyt.2024.1399062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
Background Hoarding disorder (HD) is characterized by cognitive control impairments and abnormal brain activity in the insula and anterior cingulate cortex (ACC) during disposal of personal items or certain executive function tasks. However, whether there are any changes in resting-state functional connectivity of the insula and ACC remains unclear. Methods A total of 55 subjects, including 24 patients with HD and 31 healthy controls (HCs), participated in the study. We acquired resting-state functional magnetic resonance imaging data and examined group differences in functional connectivity from the insula and ACC in whole-brain voxels. Results In patients with HD, functional connectivity was significantly lower between the right insula and right inferior frontal gyrus (IFG) and left superior temporal gyrus (STG) compared to HCs. There was no correlation between these connectivities and HD symptoms. Conclusions Although the clinical implication is uncertain, our results suggest that patients with HD have resting-state functional alterations between the insula and IFG and STG, corresponding with the results of previous fMRI studies. These findings provide new insight into the neurobiological basis of HD.
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Affiliation(s)
- Kenta Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Tomiyama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keitaro Murayama
- Department of Neuropsychiatry, Kyushu University Hospital, Fukuoka, Japan
| | - Taro Mizobe
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Matsuo
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nami Nishida
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kou Matukuma
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mingi Kang
- Graduate School of Human Environment Studies, Kyushu University, Fukuoka, Japan
| | - Kenta Sashikata
- Graduate School of Human Environment Studies, Kyushu University, Fukuoka, Japan
| | - Kazufumi Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Osamu Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Zakrzewski JJ, Doran N, Mayes TL, Twamley EW, Ayers CR. Rates of diagnosis and service utilization in veterans with hoarding disorder. Psychiatry Res 2024; 336:115888. [PMID: 38608540 DOI: 10.1016/j.psychres.2024.115888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
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.
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Affiliation(s)
- Jessica J Zakrzewski
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States.
| | - Neal Doran
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States
| | - Tina L Mayes
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, United States
| | - Catherine R Ayers
- Research Service, VA San Diego Healthcare System, La Jolla, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Psychology Service, VA San Diego Healthcare System, La Jolla, CA, United States.
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Nutley S, Nguyen BK, Mackin RS, Insel PS, Tosun D, Butters M, Aisen P, Raman R, Saykin AJ, Toga AW, Jack C, Weiner MW, Nelson C, Kassel M, Kryza-Lacombe M, Eichenbaum J, Nosheny RL, Mathews CA. Relationship of Hoarding and Depression Symptoms in Older Adults. Am J Geriatr Psychiatry 2024; 32:497-508. [PMID: 38092621 PMCID: PMC11055473 DOI: 10.1016/j.jagp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 03/21/2024]
Abstract
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.
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Affiliation(s)
- Sara Nutley
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL; Department of Epidemiology (SN), University of Florida, Gainesville, FL
| | - Binh K Nguyen
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL
| | - Robert Scott Mackin
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA
| | - Philip S Insel
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA
| | - Duygu Tosun
- San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Meryl Butters
- Department of Psychiatry (MB), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Paul Aisen
- University of Southern California (PA, RR), San Diego, CA; Alzheimer's Therapeutic Research Institute (PA, RR), University of Southern California, San Diego, CA
| | - Rema Raman
- University of Southern California (PA, RR), San Diego, CA; Alzheimer's Therapeutic Research Institute (PA, RR), University of Southern California, San Diego, CA
| | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center and Department of Radiology and Imaging Sciences (AS), Indiana University School of Medicine, Indianapolis, IN
| | - Arthur W Toga
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine (AT), University of Southern California, Los Angeles, CA
| | | | - Michael W Weiner
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA; Department of Neurology (MW), University of California, San Francisco, San Francisco, CA
| | - Craig Nelson
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA
| | - Michelle Kassel
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA
| | - Maria Kryza-Lacombe
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; Mental Illness Research Education and Clinical Centers (MK-L), Veterans Administration Medical Center, San Francisco, CA
| | - Joseph Eichenbaum
- San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Rachel L Nosheny
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Carol A Mathews
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL.
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Córcoles D, Guerrero L, Malagon A, Bellsolà M, Gonzalez AM, León J, Sabaté A, Pérez V, Bulbena A, Martín LM, Mane A. Hoarding behaviour: special features and complications in real-world clinical practice. Int J Psychiatry Clin Pract 2024; 28:17-26. [PMID: 38019133 DOI: 10.1080/13651501.2023.2287755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
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.
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Affiliation(s)
- David Córcoles
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Lucía Guerrero
- Servei de Salut de l' Ajuntament de L'Hospitalet, Hospitalet de Llobregat, Barcelona, España
| | - Angeles Malagon
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Magda Bellsolà
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
| | - Ana Maria Gonzalez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
| | - Jordi León
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Agnès Sabaté
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
| | - Victor Pérez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
| | - Antoni Bulbena
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Luis Miguel Martín
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
- Departmento de Psiquiatría y Medicina Forense, Universitat Autonoma de Barcelona. Campus de la UAB, Bellaterra, Barcelona, España
| | - Anna Mane
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, España
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
- Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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Norton M, Kellett S, Huddy V, Simmonds-Buckley M. Household factors and prevalence of squalor: meta-analysis and meta-regression. BMC Public Health 2024; 24:479. [PMID: 38360612 PMCID: PMC10870488 DOI: 10.1186/s12889-024-17983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
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.
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Affiliation(s)
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Trust, Rotherham, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Vyv Huddy
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Melanie Simmonds-Buckley
- Rotherham Doncaster and South Humber NHS Trust, Rotherham, UK
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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7
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McGrath M, Russell AM, Masterson C. 'A more human approach … I haven't found that really': experiences of hoarding difficulties and seeking help. Behav Cogn Psychother 2024; 52:1-13. [PMID: 37737054 DOI: 10.1017/s1352465823000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
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.
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Grassi G, Moradei C, Cecchelli C, van Ameringen M. Who really hoards? Hoarding symptoms in adults with attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and healthy controls. J Psychiatr Res 2023; 166:74-79. [PMID: 37741062 DOI: 10.1016/j.jpsychires.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/16/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
Although hoarding disorder (HD) is included in the DSM-5 in the obsessive-compulsive and related disorders chapter, in the last few years, HD has been consistently associated with attention-deficit hyperactivity disorder (ADHD). Some studies on HD patients show higher comorbidity with ADHD than with OCD and some studies on ADHD patients found significant higher rates of HD symptoms compared to the general population. However, the aim of the present study was to be the first direct comparison of the prevalence of HD and HD symptoms across adults with a primary diagnosis of ADHD, OCD and a sample of matched healthy controls (HCs). METHODS 57 adult patients with a primary diagnosis of ADHD and 50 adult patients with a primary diagnosis of OCD were enrolled and matched with 50 HCs. The presence of hoarding disorder and symptoms were assessed though the Saving Inventory Revised (SI-R). RESULTS ADHD patients showed significantly higher prevalence of HD comorbidity (32.1%) with respect to both OCD patients (8%) and HCs (4%). The prevalence of HD symptoms was also significantly higher in ADHD patients than in both OCD and HCs. Although OCD patients showed a higher prevalence of HD and HD symptoms with respect to HCs, these differences did not reach statistical significance. CONCLUSION HD is significantly more comorbid in ADHD patients than in OCD and HCs. A better understanding and definition of the boundaries between HD and the OCD and ADHD spectrum could lead to the development of a more precise treatment approach for hoarding disorder.
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Affiliation(s)
| | | | | | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, MacAnxiety Research Centre, Canada
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9
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Raila H, Avanesyan T, Valentine KE, Koo B, Huang C, Tsutsumi Y, Andreeff E, Qiu T, Muñoz Rodríguez PA, Varias A, Filippou-Frye M, van Roessel P, Bullock K, Periyakoil VS, Rodríguez CI. Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults. J Psychiatr Res 2023; 166:25-31. [PMID: 37716272 PMCID: PMC10803069 DOI: 10.1016/j.jpsychires.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/18/2023]
Abstract
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.
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Affiliation(s)
- Hannah Raila
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Department of Psychology, University of California Santa Cruz, Santa Cruz, CA, USA.
| | - Tatevik Avanesyan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Keara E Valentine
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Brenden Koo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Chloe Huang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Yuri Tsutsumi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Elisabeth Andreeff
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Tori Qiu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Paula Andrea Muñoz Rodríguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Andrea Varias
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Maria Filippou-Frye
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Peter van Roessel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, CA, USA; Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Carolyn I Rodríguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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Wong SF, Dewar E, Baldwin PA, Grisham JR. Evaluating the effects of a brief motivational interviewing protocol on excessive acquisition. J Behav Ther Exp Psychiatry 2023; 80:101790. [PMID: 37247973 DOI: 10.1016/j.jbtep.2022.101790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Individuals with hoarding disorder, especially those with problems around acquiring, typically demonstrate a lack of motivation and awareness of their problematic behaviours. Since acquiring behaviours are important targets in interventions for hoarding, effective strategies for increasing motivation in this population are required to enhance the acceptability and efficacy of these interventions. METHODS The aim of the current study was to evaluate the ability of a brief online motivational intervention to reduce acquiring in a community sample of high acquirers (N = 159). Participants were randomly assigned to either a motivational interviewing protocol (n = 73) or progressive muscle relaxation control condition (n = 86). Readiness to change and motivation to acquire was measured via self-report, and acquiring behaviour was measured using a modified version of the Preston Acquisition Decision Making Task (to increase ecological validity). RESULTS In both conditions, participants' readiness and motivation to change increased over time. Contrary to hypotheses, the magnitude of this improvement did not significantly differ between conditions. Furthermore, conditions did not perform differently on the behavioural measure of acquiring. LIMITATIONS Insufficient dose of the intervention may have precluded any differences being observed between conditions. CONCLUSIONS Results underscore the need to better address the problem of lowered motivation in this population.
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Affiliation(s)
- Shiu F Wong
- Department of Psychology, Counselling, and Therapy, La Trobe University, Australia.
| | - Emily Dewar
- School of Psychology, University of New South Wales, Australia
| | - Peter A Baldwin
- Black Dog Institute, University of New South Wales, Australia
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11
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Hussain NM, AlMansouri DH, AlGhareeb M, Almutawa YM, Bucheeri OK, Helmy M, Trabelsi K, Saif Z, Jahrami H. Translating and validating the hoarding rating scale-self report into Arabic. BMC Psychol 2023; 11:233. [PMID: 37587535 PMCID: PMC10433611 DOI: 10.1186/s40359-023-01277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Hoarding disorder is characterized by a persistent inability to part with possessions due to a perceived need to keep them, regardless of their actual value. Arabic-speaking populations currently lack a validated tool specifically designed to assess hoarding symptoms. OBJECTIVE This study aimed to translate, adapt, and validate the Hoarding Rating Scale-Self Report (HRS-SR) into the Arabic-language. METHODS The study employed the gold standard approach to translation, involving forward translation by independent translators and back translation review. We conducted a cross-sectional study using an online survey completed by 500 participants from four Arabic-speaking countries. Psychometric analyses included internal consistency, test-retest reliability, convergent validity against generalized anxiety disorder (GAD-7), and confirmatory factor analysis. RESULTS With a McDonald's omega and Cronbach's alpha of approximately 0.80, the Arabic translation of the HRS-SR showed acceptable test-retest reliability as well as good internal consistency. The survey also showed strong convergent validity with the 7-item survey for GAD-7. Confirmatory factor analysis supported a one-factor structure, confirming that each item measured the same construct. CONCLUSION The HRS-SR is a trustworthy and valid tool for evaluating hoarding symptoms in Arabic-speaking people. This survey could be helpful for both clinical and academic research. Future research should examine cultural variations in hoarding behavior in Arabic-speaking populations and validate the questionnaire in clinical populations.
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Affiliation(s)
| | | | - Muneera AlGhareeb
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | | | - Mai Helmy
- Psychology Department, College of Education, Sultan Qaboos University, Muscat, Oman
- Psychology Department, Faculty of Arts, Menoufia University, Shibin Al Kawm, Egypt
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3000, Tunisia
- Research Laboratory Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, 3000, Tunisia
| | | | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
- Government Hospitals, Manama, Bahrain.
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12
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Jägholm S, Lindstedt S, Andersson E, Mataix-Cols D, Fernández de la Cruz L, Rück C, Ivanov VZ. Study protocol for a randomized controlled trial of in-home decluttering augmentation of group cognitive-behavioral therapy for hoarding disorder: the Joining Forces Trial. Trials 2023; 24:483. [PMID: 37507772 PMCID: PMC10386309 DOI: 10.1186/s13063-023-07509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is a moderately efficacious treatment for hoarding disorder (HD), with most individuals remaining symptomatic after treatment. The Joining Forces Trial will evaluate whether 10 weeks of in-home decluttering can significantly augment the outcomes of group CBT. METHODS A randomized controlled trial of in-home decluttering augmentation of group CBT for HD. Adult participants with HD (N = 90) will receive 12 weeks of protocol-based group CBT for HD. After group CBT, participants will be randomized to either 10 weeks of in-home decluttering led by a social services team or a waitlist. The primary endpoint is 10 weeks post-randomization. The primary outcome measures are the self-reported Saving Inventory-Revised and the blind assessor-rated Clutter Image Rating. Participants on the waitlist will cross over to receive the in-home decluttering intervention after the primary endpoint. Data will be analyzed according to intention-to-treat principles. We will also evaluate the cost-effectiveness of this intervention from both healthcare and societal perspectives. DISCUSSION HD is challenging to treat with conventional psychological treatments. We hypothesize that in-home decluttering sessions carried out by personnel in social services will be an efficacious and cost-effective augmentation strategy of group CBT for HD. Recruitment started in January 2021, and the final participant is expected to reach the primary endpoint in December 2024. TRAIL REGISTRATION ClinicalTrials.gov NCT04712474. Registered on 15 January 2021.
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Affiliation(s)
- Sofia Jägholm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, M48, Karolinska Universitetssjukhuset Huddinge, 14186, Stockholm, Sweden.
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Sara Lindstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, M48, Karolinska Universitetssjukhuset Huddinge, 14186, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Karolinska Institutet, Nobelsväg 9, 17195, Solna, Sweden
| | - David Mataix-Cols
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, M48, Karolinska Universitetssjukhuset Huddinge, 14186, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, M48, Karolinska Universitetssjukhuset Huddinge, 14186, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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13
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Edwards V, Salkovskis PM, Bream V. Do they really care? Specificity of social support issues in hoarding disorder and obsessive-compulsive disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023. [PMID: 37173862 DOI: 10.1111/bjc.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Unmet interpersonal needs may play a role in excessive emotional attachments to objects for people with hoarding disorder (HD). Previous research indicates that social support (but not attachment difficulties) may be specific to HD. The study aimed to evaluate social networks and support in HD relative to clinical controls with obsessive-compulsive disorder (OCD) and healthy controls (HC). The secondary aim was to explore the extent of loneliness and thwarted belongingness. Potential mechanisms for deficits in social support were also considered. DESIGN A cross-sectional between-groups design was used to compare scores on measures in those with HD (n = 37); OCD (n = 31); and HCs (n = 45). METHODS Participants completed a structured clinical interview by telephone (to assign diagnostic categories) followed by online questionnaires. RESULTS Whilst individuals with HD and OCD both report smaller social networks than HC, lower levels of perceived social support appear to be specific to HD. The HD group also showed higher levels of loneliness and thwarted belonging compared to OCD and HC. No differences were found between groups for perceived criticism or trauma. CONCLUSIONS The results support previous findings of lower levels of self-reported social support within HD. Loneliness and thwarted belongingness also appear significantly elevated within HD compared with OCD and HC. Further research is required to explore the nature of felt support and belonging, direction of effect and to identify potential mechanisms. Clinical implications include advocating and promoting support systems (both personal supporters and professionals) for individuals with HD.
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Affiliation(s)
| | | | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic & Oxford Cognitive Therapy Centre, Oxford Health NHS Foundation Trust, Oxford, UK
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Krafft J, Petersen JM, Ong CW, Twohig MP, Levin ME. Processes of change in online acceptance and commitment therapy for hoarding. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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15
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Morein-Zamir S, Ahluwalia S. Hoarding disorder: evidence and best practice in primary care. Br J Gen Pract 2023; 73:182-183. [PMID: 36997219 PMCID: PMC10049603 DOI: 10.3399/bjgp23x732513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
- Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge
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16
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Crowley JJ. Genomics of Obsessive-Compulsive Disorder and Related Disorders: What the Clinician Needs to Know. Psychiatr Clin North Am 2023; 46:39-51. [PMID: 36740354 DOI: 10.1016/j.psc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A wealth of evidence has shown that genetics plays a major role in susceptibility to obsessive-compulsive disorder (OCD) and all of its related disorders. Several large-scale, collaborative efforts using modern genomic methods are beginning to reveal the genetic architecture of these traits and identify long-sought risk genes. In this article, we summarize current OCD and related disorder genomic knowledge and explain how to communicate this information to patients and their families. The article concludes with a discussion of how genomic discovery in OCD and related disorders can inform our understanding of disease etiology and provide novel targets for therapeutic development.
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Affiliation(s)
- James J Crowley
- Department of Genetics, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC 27599, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC 27599, USA.
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17
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Wilson LA, Scarfo J, Suleyman E, Rehm IC, Baldwin PA. A latent factor approach to the Saving Inventory - Revised: Congeneric evaluation of construct and content validity. J Affect Disord 2023; 323:689-697. [PMID: 36526114 DOI: 10.1016/j.jad.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/24/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inconsistencies have been identified in the three-factor structure and item loadings of the most commonly used self-report hoarding screening tool, the Saving Inventory - Revised (SI-R), which assesses difficulty discarding, clutter and acquisition. The current study aimed to confirm the factor structure of the SI-R using congeneric modelling, and evaluate the construct and content validity of this measure. METHODS 139 participants with self-identified hoarding completed the SI-R. Congeneric structural equation modelling was then performed to validate the SI-R factor structure. RESULTS The three-factor structure of the SI-R was confirmed as a valid, reliable and good fitting model. However, the difficulty discarding and clutter subscales were required to covary. CONCLUSIONS The SI-R was confirmed as an appropriate screening tool for hoarding severity; however, revision of item wording may improve content validity. Future research could consider exploring the relationships between a range of hoarding-related constructs and the differential endorsement of SI-R subscales. LIMITATIONS As data were collected during the 2020 COVID-19 pandemic, panic buying and hoarding-related acquiring behaviours may have been exacerbated. In addition, the diagnostic status of participants was not verified, despite the inclusion of individuals endorsing clinically significant hoarding symptoms.
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Affiliation(s)
- Lizzie A Wilson
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia
| | - Jessica Scarfo
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia.
| | - Emra Suleyman
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia
| | - Imogen C Rehm
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia
| | - Peter A Baldwin
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3011, Australia; School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
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18
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The experience of leaving a valuable object: An investigation of emotional processes related to Hoarding disorder features. PLoS One 2023; 18:e0280933. [PMID: 36787312 PMCID: PMC9928071 DOI: 10.1371/journal.pone.0280933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
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.
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Mulligan‐Rabbitt J, O'Connor J, Brien C. “It's not yours. It's mine”: A qualitative study exploring the experience of hoarding. INTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES 2023. [DOI: 10.1002/aps.1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Ciara Brien
- Trinity College University of Dublin Dublin Ireland
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20
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Haighton C, Caiazza R, Neave N. "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. PLoS One 2023; 18:e0282365. [PMID: 36893136 PMCID: PMC9997939 DOI: 10.1371/journal.pone.0282365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/03/2023] [Indexed: 03/10/2023] Open
Abstract
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.
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Affiliation(s)
- Catherine Haighton
- Hoarding Research Group, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne & Wear, United Kingdom
- * E-mail:
| | - Roberta Caiazza
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, Tyne & Wear, United Kingdom
| | - Nick Neave
- Hoarding Research Group, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne & Wear, United Kingdom
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Strom NI, Smit DJA, Silzer T, Iyegbe C, Burton CL, Pool R, Lemire M, Crowley JJ, Hottenga JJ, Ivanov VZ, Larsson H, Lichtenstein P, Magnusson P, Rück C, Schachar RJ, Wu HM, Meier SM, Crosbie J, Arnold PD, Mattheisen M, Boomsma DI, Mataix-Cols D, Cath D. Meta-analysis of genome-wide association studies of hoarding symptoms in 27,537 individuals. Transl Psychiatry 2022; 12:479. [PMID: 36379924 PMCID: PMC9666541 DOI: 10.1038/s41398-022-02248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Hoarding Disorder (HD) is a mental disorder characterized by persistent difficulties discarding or parting with possessions, often resulting in cluttered living spaces, distress, and impairment. Its etiology is largely unknown, but twin studies suggest that it is moderately heritable. In this study, we pooled phenotypic and genomic data from seven international cohorts (N = 27,537 individuals) and conducted a genome wide association study (GWAS) meta-analysis of parent- or self-reported hoarding symptoms (HS). We followed up the results with gene-based and gene-set analyses, as well as leave-one-out HS polygenic risk score (PRS) analyses. To examine a possible genetic association between hoarding symptoms and other phenotypes we conducted cross-trait PRS analyses. Though we did not report any genome-wide significant SNPs, we report heritability estimates for the twin-cohorts between 26-48%, and a SNP-heritability of 11% for an unrelated sub-cohort. Cross-trait PRS analyses showed that the genetic risk for schizophrenia and autism spectrum disorder were significantly associated with hoarding symptoms. We also found suggestive evidence for an association with educational attainment. There were no significant associations with other phenotypes previously linked to HD, such as obsessive-compulsive disorder, depression, anxiety, or attention-deficit hyperactivity disorder. To conclude, we found that HS are heritable, confirming and extending previous twin studies but we had limited power to detect any genome-wide significant loci. Much larger samples will be needed to further extend these findings and reach a "gene discovery zone". To move the field forward, future research should not only include genetic analyses of quantitative hoarding traits in larger samples, but also in samples of individuals meeting strict diagnostic criteria for HD, and more ethnically diverse samples.
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Affiliation(s)
- Nora I Strom
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden.
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Dirk J A Smit
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Talisa Silzer
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Conrad Iyegbe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Christie L Burton
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - René Pool
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Mathieu Lemire
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - James J Crowley
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jouke-Jan Hottenga
- Netherlands Twin Register, Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Hei Man Wu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Sandra M Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Community Health & Epidemiology, Dalhousie University, NS, Dalhousie, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Paul D Arnold
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Departments of Psychiatry and Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Manuel Mattheisen
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Community Health & Epidemiology, Dalhousie University, NS, Dalhousie, Canada
| | - Dorret I Boomsma
- Netherlands Twin Register, Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Danielle Cath
- Rijksuniversiteit Groningen and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
- Department of specialized training, Drenthe Mental Health Care Institute, Assen, The Netherlands
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22
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Porter B, Hanson S. Council tenancies and hoarding behaviours: A study with a large social landlord in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2292-2299. [PMID: 35307891 PMCID: PMC10078723 DOI: 10.1111/hsc.13779] [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: 12/20/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Bryony Porter
- School of Health Sciences, The University of East AngliaNorwichUK
| | - Sarah Hanson
- School of Health Sciences, The University of East AngliaNorwichUK
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23
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Akıncı MA, Turan B, Esin İS, Dursun OB. Prevalence and correlates of hoarding behavior and hoarding disorder in children and adolescents. Eur Child Adolesc Psychiatry 2022; 31:1623-1634. [PMID: 34283287 DOI: 10.1007/s00787-021-01847-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Mehmet Akif Akıncı
- Department of Child and Adolescent Psychiatry, Dr. Ali Kemal Belviranlı Maternity and Children Hospital, Konya, Turkey.
| | - Bahadır Turan
- Autism, Mental Special Needs and Rare Diseases Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
| | - İbrahim Selçuk Esin
- Department of Child and Adolescent Psychiatry, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Onur Burak Dursun
- Autism, Mental Special Needs and Rare Diseases Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
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24
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Thomson HA, Farhat LC, Olfson E, Levine JLS, Bloch MH. Prevalence and gender distribution of trichotillomania: A systematic review and meta-analysis. J Psychiatr Res 2022; 153:73-81. [PMID: 35802953 DOI: 10.1016/j.jpsychires.2022.06.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/29/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022]
Abstract
Epidemiological studies have provided varying prevalence estimates of trichotillomania (TTM) and other hair-pulling behaviors. We performed a systematic review and meta-analysis to provide data-driven prevalence estimates of TTM and hair-pulling. PubMed, PsycInfo and Embase were searched on June 2020 (updated in November 2021). Studies reporting the frequency of TTM defined by Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria or hair-pulling behaviors were included. Prevalence data was extracted for both genders, and female-to-male odds ratios (OR) were computed for TTM and any hair-pulling behaviors. Data were pooled through random-effects meta-analyses. Of the 713 records identified through database searches, 30 studies involving 38,526 participants were included. Meta-analyses indicated TTM had a prevalence of 1.14% (95% CI 0.66%, 1.96%), while any hair-pulling behavior had a prevalence of 8.84% (95% CI 6.33%, 12.20%). Meta-analyses demonstrated females were at an increased risk of any hair-pulling when noticeable hair loss was required (OR = 2.23, 95% CI 1.60, 3.10, p < 0.0001), but not of any hair-pulling when noticeable hair loss was not required (OR = 0.90, 95% CI 0.72, 1.64, p = 0.33). Meta-analyses did not indicate female preponderance in TTM (k = 10; N = 22,775; OR = 1.29; 95% CI 0.91, 1.83; I2 = 28%, p = 0.15), although there was considerable heterogeneity across studies. This study demonstrates that TTM impacts ∼1% of the population, while general hair-pulling behaviors affects ∼8%, highlighting the significant public health impact of this understudied condition. Additional research should clarify the gender distribution of TTM in epidemiological samples.
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Affiliation(s)
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Emily Olfson
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | | | - Michael H Bloch
- Yale Child Study Center, Yale University, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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25
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Wilkinson J, Schoultz M, King HM, Neave N, Bailey C. Animal hoarding cases in England: Implications for public health services. Front Public Health 2022; 10:899378. [PMID: 36111188 PMCID: PMC9468330 DOI: 10.3389/fpubh.2022.899378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/09/2022] [Indexed: 01/22/2023] Open
Abstract
Hoarding disorder is characterized by an accumulation of possessions due to excessive acquisition of or difficulty discarding possessions, regardless of their actual value and is estimated to affect 2-6% of the population. Animal hoarding, a distinct subset of hoarding disorder, has a significant public health impact on the humans involved, as well as animal welfare. Individuals exhibit self-neglect, apathy, social withdrawal and object hoarding; living within squalid, deteriorated, structurally unsafe and uninhabitable premises, alongside neglected animals. Cases are complex, costly and impact on a range of responding service providers. Effective case management is poorly understood and researched, with published literature in England particularly sparse. Improving understanding of the characteristics of these cases is the first step in informed case management. This research is the first exploration of the characteristics of animal hoarders in England and the areas where cases were located. Information about prosecutions involving large numbers of animals that were reported in the media was systematically obtained. This identified 66 cases between January 2015 and December 2020. Geospatial analysis exploring characteristics of locations where animal hoarding cases are also reported. Findings were broadly consistent with the international literature in that females (64%), those living alone (71%) and those with a mean age of 49 were well represented. Cats (61.5%) and dogs (60%) were the most commonly hoarded species. There was a mean of 44 animals per case and dead or animals requiring euthanasia found in 53% of cases. Key characteristics of the areas where cases were found highlight urban, densely populated, and high levels of deprivation being the most represented. Evidence of recidivism was evident in 39% of cases, suggesting that prosecution is not an effective rehabilitator. Animal hoarding raises serious implications for Public Health Services, and the lack of current effective case management strategies are discussed.
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Affiliation(s)
- Justine Wilkinson
- Department of Engineering & Environment, Northumbria University, Newcastle upon Tyne, United Kingdom,*Correspondence: Justine Wilkinson
| | - Mariyana Schoultz
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Helen M. King
- Department of Engineering & Environment, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Nick Neave
- Hoarding Research Group, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Catherine Bailey
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, United Kingdom
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26
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Moreno-Amador B, Cervin M, Falcó R, Marzo JC, Piqueras JA. Body-dysmorphic, hoarding, hair-pulling, and skin-picking symptoms in a large sample of adolescents. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03477-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractFew studies have investigated body-dysmorphic, hoarding, hair-pulling, and skin-picking symptoms in adolescents and how they relate to mental health, quality of life, suicide attempts, and non-suicidal self-harm. We used a quota sampling procedure and contacted 100 secondary centres in the Southeast of Spain, of which 34 participated in the study. A sample of 5,345 adolescents (12–18 years) completed dimensional measures of body-dysmorphic, hoarding, hair-pulling, and skin-picking symptoms. The proportion of adolescents with clinically significant symptoms within each symptom type was estimated and associations with other indicators of mental health examined. Clinically significant body-dysmorphic symptoms were reported by 3.7%, hoarding by 0.9%, hair-pulling by 0.7%, and skin-picking by 1.8%. Body-dysmorphic symptoms were more common in girls and in those over 14 years of age. Body-dysmorphic, hoarding, hair-pulling, and skin-picking symptoms were moderately to strongly associated with obsessive-compulsive symptoms, internalizing symptoms, externalizing symptoms, and poor quality of life. Those with significant body-dysmorphic, hoarding, hair-pulling, and skin-picking symptoms were much more likely to have attempted suicide and engaged in non-suicidal self-harm during the last twelve months than those without such symptoms. Body-dysmorphic symptoms showed the strongest associations with internalizing symptoms and poor quality of life. Limitations are the sole use of self-report and a sample from only two regions in Spain, but findings suggest that body-dysmorphic, hoarding, hair-pulling, and skin-picking symptoms are common and impairing during adolescence.
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What is underneath all that stuff? A Q-methodological exploration of profiles of beliefs and vulnerabilities in hoarding disorder. Behav Cogn Psychother 2022; 50:538-555. [PMID: 35854656 DOI: 10.1017/s1352465822000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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28
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Sordo Vieira L, Nguyen B, Nutley SK, Bertolace L, Ordway A, Simpson H, Zakrzewski J, Jean Gilles ME, Nosheny R, Weiner M, Mackin RS, Mathews CA. Self-reporting of psychiatric illness in an online patient registry is a good indicator of the existence of psychiatric illness. J Psychiatr Res 2022; 151:34-41. [PMID: 35436704 PMCID: PMC10024540 DOI: 10.1016/j.jpsychires.2022.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/20/2022]
Abstract
Online registries offer many advantages for research, including the ability to efficiently assess large numbers of individuals and identify potential participants for clinical trials and genetic studies. Of particular interest is the validity and utility of self-endorsement of psychiatric disorders in online registries, which, while increasingly more common, remain understudied. We thus assessed the comparability of prevalence estimated from self-endorsement of psychiatric disorders in one such registry, the Brain Health Registry (BHR) to prevalence computed from large US-based epidemiological studies and the degree to which BHR participants report psychiatric disorders consistently. We also examined the concordance between self-report and clinically determined diagnoses of various DSM-5 psychiatric disorders in a subset of participants who underwent direct assessments and identified possible reasons for discordance. Rates of self-reported psychiatric disorders were closest to previously reported population prevalence rates when endorsed at multiple timepoints, and accuracy was at least 70% for all except Hoarding Disorder as compared to the clinical diagnoses. Clinical data suggested that self-endorsement of a given psychiatric diagnosis was indicative of the presence of a closely related condition, although not necessarily for the specific disorder, with the exception of major depressive disorder, panic disorder, and hoarding disorder, which had high positive predictive values (85%, 73%, 100%, respectively). We conclude that self-reporting of psychiatric conditions in an online setting is a fair indicator of psychopathology, but should be accompanied by more in-depth interviews if using data from a participant for a specific disorder.
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Affiliation(s)
- Luis Sordo Vieira
- Department of Medicine, University of Florida, Gainesville, FL, United States; Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Binh Nguyen
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Sara K Nutley
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Lyvia Bertolace
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Ashley Ordway
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Heather Simpson
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Jessica Zakrzewski
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Marie E Jean Gilles
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Rachel Nosheny
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Michael Weiner
- San Francisco VA Medical Center, San Francisco, CA, United States; Department of Radiology, University of California, San Francisco, San Francisco, CA, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - R Scott Mackin
- San Francisco VA Medical Center, San Francisco, CA, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States.
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Chan J, Powell C, Collett J. Profiling Hoarding Within the Five-Factor Model of Personality and Self-Determination Theory. Behav Ther 2022; 53:546-559. [PMID: 35473656 DOI: 10.1016/j.beth.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 11/02/2022]
Abstract
This study investigated the dispositional profile associated with hoarding symptoms by applying a personality and motivational trait perspective. A community sample oversampling high hoarding symptoms (N = 649, ages 18-74 years) completed an online questionnaire assessing hoarding, the five-factor model of personality, and general causality orientations drawn from self-determination theory. Personality aspects (10 traits), a level of measurement intermediate to factors (5 traits) and facets (30 traits), were assessed to provide greater specificity than a factor-level approach. Hoarding was correlated with neuroticism and conscientiousness. Aspects predicting hoarding were industriousness (C), orderliness (C), withdrawal (N), and assertiveness (E). Hoarding was significantly related to impersonal and control orientations, albeit with only slight (1.4%) incremental validity for general causality orientations above personality aspects in predicting hoarding. These findings may not generalize to a clinical treatment sample, and possible configurative interactions between traits were not assessed. This study extended the existing literature by reporting aspect-level personality and general causality orientation correlates of hoarding. These data may inform preventative monitoring and intervention programs, as well as predicting meaningful personality characteristics of hoarding clients.
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30
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The roles of intolerance of uncertainty, anxiety sensitivity and distress tolerance in hoarding disorder compared with OCD and healthy controls. Behav Cogn Psychother 2022; 50:392-403. [PMID: 35301971 DOI: 10.1017/s1352465822000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is suggested that the different psychological vulnerability factors of intolerance of uncertainty (IU), anxiety sensitivity (AS) and distress tolerance (DT) may be in important in hoarding disorder (HD). However, the extent to which these factors are specific to HD compared with other disorders remains unclear. AIMS The current study aimed to investigate differences in IU, AS and DT in three groups: HD (n=66), obsessive compulsive disorder (OCD; n=59) and healthy controls (HCs; n=63). METHOD Participants completed an online battery of standardised self-report measures to establish the independent variable of group membership (HD, OCD and HC) and the dependent variables (IU, AS and DT). RESULTS A MANOVA analysis indicated statistically significant differences in IU, AS and DT between the clinical groups and HCs. Follow-up analyses showed no statistically significant differences between the HD and OCD group for any of the three constructs. The results remained the same when examining the effects of co-morbid HD and OCD. An unexpected finding was the trend for IU, AS and DT to be more severe when HD and OCD were co-morbid. CONCLUSIONS The evidence suggests the absence of a specific relationship between IU, AS or DT in HD and instead is consistent with existing research which suggests that these psychological vulnerability factors are transdiagnostic constructs across anxiety disorders. The implications of the findings are discussed.
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31
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Interpersonal functioning in hoarding: An investigation of the link between hoarding symptoms and social support, social anhedonia, and social rewards. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Working together when the problem is multi-faceted: understanding inter-agency working for the benefit of people with hoarding problems. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Hoarding disorder is a surprisingly common problem which impacts on most areas of life. People who hoard typically have multiple agencies involved in their care due to the complex health and safety impact and risks associated with hoarding. ‘Treatment’ involves finding ways of supporting discarding large amounts, typically underpinned by CBT principles. We evaluated the impact and outcomes of a conference designed to boost professionals’ confidence and understanding in working with hoarding problems, both individually and with other agencies with a view to improving inter-agency service provision. Changes in professionals’ confidence and understanding were evaluated immediately before and after the conference. Conference participants’ qualitative responses related to service improvements were analysed using content analysis. People with personal experience of hoarding issues subsequently participated in a focus group where the results of the conference were presented. These data were analysed using thematic analysis. Confidence and understanding in working with hoarding problems substantially increased from pre- to post-conference. Professionals identified a range of possible improvements, most commonly working more closely and improving communication with other agencies. People with personal experience suggested improvements across three over-arching themes: developing an improved understanding of hoarding, the need for improved resources, and improved multi-agency working. A multi-agency conference increased confidence and understanding in professionals working with hoarding problems, and improvements specified by both people with personal experience and professionals provide a useful guide to service improvement. Results provide a framework in which CBT approaches should be embedded.
Key learning aims
(1)
To assess the effectiveness of a multi-agency hoarding conference at improving understanding and confidence in working with hoarding problems.
(2)
To explore professionals’ perceptions of improvements to multi-agency service provision.
(3)
To explore perceptions of improvements that could be made to multi-agency service provision from people with personal experience of hoarding problems.
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Zakrzewski JJ, Henderson R, Archer C, Vigil OR, Mackin S, Mathews CA. Subjective cognitive complaints and objective cognitive impairment in hoarding disorder. Psychiatry Res 2022; 307:114331. [PMID: 34920395 DOI: 10.1016/j.psychres.2021.114331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/24/2022]
Abstract
Individuals with Hoarding Disorder (HD) frequently complain of problems with attention and memory. These self-identified difficulties are often used as justification for saving and acquiring behaviors. Research using neuropsychological measures to examine verbal and visual memory performance and sustained attention have reported contradictory findings. Here we aim to determine the relationship between self-reported problems with memory and attention, objective memory and attention performance, and self-reported depression and anxiety symptoms in HD. Data was available for 319 individuals who participated in a treatment study of HD. Multiple regression was used to assess the relationship between self-reported complaints and objective measures, with age, education, and measures of depression and anxiety included as covariates. We found no association between self-reported memory difficulties and objective verbal or visual memory performance. Self-reported problems with attention were associated with objective attentional performance, although this relationship was partially accounted for by anxiety symptom severity. There was a small association between visual memory performance at baseline and improvements in hoardingrelated functional abilities following treatment. Improvements in subjective memory complaints pre-to-post treatment were associated with improvements in hoarding symptom severity and hoarding-related functioning. These results demonstrate a dissociation between perceived and objective functioning in HD.
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Affiliation(s)
- Jessica J Zakrzewski
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America.
| | - Rebecca Henderson
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
| | - Christian Archer
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
| | - Ofilio R Vigil
- Department of Psychiatry, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Scott Mackin
- Department of Psychiatry, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, FL, United States of America
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A Spanish translation of the Hoarding Rating Scale: Differential item functioning and convergent validity. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021; 43:946-959. [PMID: 34924690 DOI: 10.1007/s10862-021-09894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hoarding disorder (HD) involves extreme difficulties discarding possessions and significant clutter in living areas. Although hoarding occurs worldwide, cross-cultural research remains in nascent stages, hampered in part by a lack of validated measures in non-English languages. We aimed to validate a Spanish translation of the Hoarding Rating Scale (HRS), a widely used measure of core HD symptoms. Our sample (N=736) included participants responding in English (n=548; 45.4% female; 7.9% Latinx) or Spanish (n=188; 46.3% female; 79.9% Latinx) to questionnaires via Amazon's Mechanical Turk. An item response theory (IRT) approach was used to test differential item functioning (DIF) of the English and Spanish HRS. We also examined convergent validity of each language version with other HD. Initial comparisons revealed that hoarding symptoms were elevated in the Spanish-speaking sample compared to the English-speaking sample. DIF tests flagged the clutter item for potential bias (McFadden's β=.069), but closer examination revealed that the impact was negligible. The Spanish HRS was significantly linked with other hoarding measures (Saving Inventory-Revised: β=.497, p<.001; Obsessive-Compulsive Inventory-Revised-Hoarding Subscale: β=.329, p=.008), controlling for mood, anxiety, stress, and non-hoarding OCD symptoms. However, the Spanish HRS was not significantly associated with Clutter Image Rating scores. Findings supported the utility of the HRS to measure of HD symptoms in Spanish speakers, though cross-linguistic assessment of clutter and the applicability of clinical cutoffs with Spanish-speaking samples merits further study.
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35
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Cunha GRD, Martins CM, Pellizzaro M, Pettan-Brewer C, Biondo AW. Sociodemographic, income, and environmental characteristics of individuals displaying animal and object hoarding behavior in a major city in South Brazil: A cross-sectional study. Vet World 2021; 14:3111-3118. [PMID: 35153400 PMCID: PMC8829411 DOI: 10.14202/vetworld.2021.3111-3118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Graziela Ribeiro da Cunha
- Department of Health Science, School of Veterinary Medicine, Positivo University, Curitiba, Paraná, Brazil
| | - Camila Marinelli Martins
- Department of Nursing and Public Health, Ponta Grossa State University, Ponta Grossa, Paraná, Brazil; AAC&T Research Consulting, Curitiba, Paraná, Brazil
| | - Maysa Pellizzaro
- Department of Post-Graduate Program in Collective Health, Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Christina Pettan-Brewer
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, Washington, USA; One Health Brasil Association, Brazil
| | - Alexander Welker Biondo
- Department of Veterinary Medicine, Federal University of Paraná State, Curitiba, Paraná, Brazil
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Morein-Zamir S, Kasese M, Chamberlain SR, Trachtenberg E. Elevated levels of hoarding in ADHD: A special link with inattention. J Psychiatr Res 2021; 145:167-174. [PMID: 34923357 PMCID: PMC7612156 DOI: 10.1016/j.jpsychires.2021.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 10/29/2022]
Abstract
Hoarding Disorder (HD) is under recognised and under-treated. Though HD develops by early adulthood, patients present only later in life, resulting in research based largely on samples of predominantly older females. Whilst formerly associated with Obsessive-Compulsive Disorder (OCD), it is now recognised that individuals with HD often have inattention symptoms reminiscent of Attention Deficit/Hyperactivity Disorder (ADHD). Here, we investigated HD in adults with ADHD. Patients in an ADHD clinic (n = 88) reported on ADHD, HD and OCD-related symptoms, and compared with age, gender and education matched controls (n = 90). Findings were assessed independently in an online UK sample to verify replication using a dimensional approach (n = 220). Clinically significant hoarding symptoms were found in ∼20% versus 2% of ADHD and control groups, respectively, with those with hoarding being on average in their thirties and with approximately half being male. Greater hoarding severity was noted even in the remaining patients compared with controls (d = 0.89). Inattention was the only significant statistical predictor of hoarding severity in patients. Similarly, inattention, alongside depression and anxiety were the greatest predictors of hoarding in the independent sample where 3.2% identified as having clinically significant hoarding. Patients with ADHD had a high frequency of hoarding symptoms, which were specifically linked to inattention. HD should be routinely assessed in individuals with ADHD, as they do not typically disclose associated difficulties, despite these potentially leading to impaired everyday functioning. Research in HD should also investigate adults with ADHD, who are younger and with a greater prevalence of males than typical HD samples.
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Affiliation(s)
- Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK.
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Fontenelle LF, Muhlbauer JE, Albertella L, Eppingstall J. The impact of coronavirus on individuals with problematic hoarding behaviours. J Psychiatr Res 2021; 144:405-411. [PMID: 34741838 PMCID: PMC8554288 DOI: 10.1016/j.jpsychires.2021.10.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/24/2021] [Accepted: 10/27/2021] [Indexed: 10/24/2022]
Abstract
We aimed at investigating the impact of the coronavirus pandemic on individuals with problematic hoarding behaviors. One hundred seventeen subjects with hoarding problems responded to the Coronavirus Stressful and Traumatic Rating Scale (COROTRAS), an instrument that quantified the number of coronavirus-related events, whether they were experienced as stressful, and the range of emotions resulting from them. The research subjects also answered self-report tools to evaluate the severity of hoarding, hoarding beliefs/motivations, social support, self-efficacy, internalized stigma, and other psychopathological symptoms. The number of stressful coronavirus-related events was predicted by lower age at onset of hoarding, decreased social support, greater severity of obsessive-compulsive symptoms, and lower intensity of concerns over memory as drivers of hoarding. Two emotional states experienced in the aftermath of trauma, namely greater helplessness and lower sadness, and higher depression, anxiety and distress, predicted greater severity of hoarding. In conclusion, we were able to find significant associations between hoarding disorder phenotypes and covid-19 related stressful events.
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Affiliation(s)
- Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia,Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ) & D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil,Corresponding author. Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
| | - Julia E. Muhlbauer
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ) & D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Lucy Albertella
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
| | - Jan Eppingstall
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
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Fontenelle LF, Albertella L, Brierley ME, Thompson EM, Destrée L, Chamberlain SR, Yücel M. Correlates of obsessive-compulsive and related disorders symptom severity during the COVID-19 pandemic. J Psychiatr Res 2021; 143:471-480. [PMID: 33958180 PMCID: PMC8548281 DOI: 10.1016/j.jpsychires.2021.03.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/06/2021] [Accepted: 03/24/2021] [Indexed: 01/04/2023]
Abstract
We investigated changes in the severity of obsessive-compulsive and related disorders (OCRDs) symptoms as a result of the COVID-19 pandemic. An Amazon Mechanical Turk sample of 829 individuals was evaluated with a series of instruments assessing the severity of the OCRDs before and during the pandemic. Additional questionnaires about sociodemographic factors, personal and family histories of OCRD, COVID-19 related events, compulsivity and impulsivity traits, schizotypal symptoms, and the severity of depression, anxiety and stress levels, were also used. Participants reported that OCD, hoarding disorder (HD) and skin picking disorder (SPD) symptoms significantly worsened during the pandemic along with increased disability, more affective symptoms and reduced quality of life. Female gender, a higher number of COVID-19 related stressful events, and higher pre-COVID-19 fear of harm and symmetry symptoms predicted more severe OCD symptoms during the pandemic, whereas lack of a HD diagnosis by a mental health professional and more severe schizotypal symptoms predicted worsened hoarding symptoms. Greater compulsivity traits were associated with more severe COVID-19 pandemic obsessive-compulsive and hoarding symptoms. These data indicate that the immense distress resulting from the COVID-19 included significant deterioration of OCRDs' symptoms, particularly of OCD, HD and SPD. It was also possible to identify a pre-pandemic profile of people most at risk of pandemic-related deterioration in OCRDs' symptoms, which may prove valuable for preventative initiatives in relation to the likely future waves of COVID-19 or of other communicable diseases. Future studies should follow up these findings longitudinally.
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Affiliation(s)
- Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ) & D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil,Corresponding author. Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
| | - Lucy Albertella
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
| | - Mary-Ellen Brierley
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
| | - Emma M. Thompson
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
| | - Louise Destrée
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
| | - Sam R. Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, & Southern Health NHS Foundation Trust, Southampton, UK
| | - Murat Yücel
- Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
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Chia K, Pasalich DS, Fassnacht DB, Ali K, Kyrios M, Maclean B, Grisham JR. Interpersonal attachment, early family environment, and trauma in hoarding: A systematic review. Clin Psychol Rev 2021; 90:102096. [PMID: 34717158 DOI: 10.1016/j.cpr.2021.102096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/07/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Kerryne Chia
- Research School of Psychology, The Australian National University, Canberra, Australia.
| | - Dave S Pasalich
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Daniel B Fassnacht
- Research School of Psychology, The Australian National University, Canberra, Australia; Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia
| | - Kathina Ali
- Research School of Psychology, The Australian National University, Canberra, Australia; Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia
| | - Michael Kyrios
- Research School of Psychology, The Australian National University, Canberra, Australia; Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia
| | - Bronte Maclean
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
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Diagnosis and Treatment of Obsessive-Compulsive and Related Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:455-456. [PMID: 35747304 PMCID: PMC9063580 DOI: 10.1176/appi.focus.19408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Bratiotis C, Muroff J, Lin NXY. Hoarding Disorder: Development in Conceptualization, Intervention, and Evaluation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:392-404. [PMID: 35747296 PMCID: PMC9063579 DOI: 10.1176/appi.focus.20210016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions because of strong urges to save the items. Difficulty discarding often includes items others consider to be of little value and results in accumulation of a large number of possessions that clutter the home. Cognitive-behavioral therapy (CBT) with exposure and response prevention and selective serotonin reuptake inhibitor medications traditionally used to treat obsessive-compulsive disorder are generally not efficacious for people with hoarding problems. A specialized CBT approach for hoarding has shown progress in reaching treatment goals and has been modified to be delivered in group, peer-facilitated, and virtual models. Research on hoarding remains in the early phases of development. Animal, attachment, and genetic models are expanding. Special populations, such as children, older adults, and people who do not voluntarily seek treatment need special consideration for intervention. Community-based efforts aimed at reducing public health and safety consequences of severe hoarding are needed.
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Affiliation(s)
- Christiana Bratiotis
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Jordana Muroff
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Nancy X Y Lin
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
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Mitra S, Bult-Ito A. Bidirectional Behavioral Selection in Mice: A Novel Pre-clinical Approach to Examining Compulsivity. Front Psychiatry 2021; 12:716619. [PMID: 34566718 PMCID: PMC8458042 DOI: 10.3389/fpsyt.2021.716619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) and related disorders (OCRD) is one of the most prevalent neuropsychiatric disorders with no definitive etiology. The pathophysiological attributes of OCD are driven by a multitude of factors that involve polygenic mechanisms, gender, neurochemistry, physiological status, environmental exposures and complex interactions among these factors. Such complex intertwining of contributing factors imparts clinical heterogeneity to the disorder making it challenging for therapeutic intervention. Mouse strains selected for excessive levels of nest- building behavior exhibit a spontaneous, stable and predictable compulsive-like behavioral phenotype. These compulsive-like mice exhibit heterogeneity in expression of compulsive-like and other adjunct behaviors that might serve as a valuable animal equivalent for examining the interactions of genetics, sex and environmental factors in influencing the pathophysiology of OCD. The current review summarizes the existing findings on the compulsive-like mice that bolster their face, construct and predictive validity for studying various dimensions of compulsive and associated behaviors often reported in clinical OCD and OCRD.
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Affiliation(s)
- Swarup Mitra
- Department of Pharmacology and Toxicology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Abel Bult-Ito
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, United States
- OCRD Biomed LLC, Fairbanks, AK, United States
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Abstract
OBJECTIVES The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST). DESIGN This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science. SETTING Program activities took place in San Diego County, mainly within clients' homes or community, with some activities in-office. PARTICIPANTS Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD. INTERVENTION A manualized, mobile protocol that incorporated CREST was utilized. MEASUREMENTS The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation. RESULTS Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three. CONCLUSION Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.
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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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Strom NI, Soda T, Mathews CA, Davis LK. A dimensional perspective on the genetics of obsessive-compulsive disorder. Transl Psychiatry 2021; 11:401. [PMID: 34290223 PMCID: PMC8295308 DOI: 10.1038/s41398-021-01519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022] Open
Abstract
This review covers recent findings in the genomics of obsessive-compulsive disorder (OCD), obsessive-compulsive symptoms, and related traits from a dimensional perspective. We focus on discoveries stemming from technical and methodological advances of the past five years and present a synthesis of human genomics research on OCD. On balance, reviewed studies demonstrate that OCD is a dimensional trait with a highly polygenic architecture and genetic correlations to multiple, often comorbid psychiatric phenotypes. We discuss the phenotypic and genetic findings of these studies in the context of the dimensional framework, relying on a continuous phenotype definition, and contrast these observations with discoveries based on a categorical diagnostic framework, relying on a dichotomous case/control definition. Finally, we highlight gaps in knowledge and new directions for OCD genetics research.
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Affiliation(s)
- Nora I Strom
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Takahiro Soda
- Department of Psychiatry, Duke University, Durham, NC, USA
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Lea K Davis
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
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Fontenelle LF, Destrée L, Brierley ME, Thompson EM, Yücel M, Albertella L. Are different stressful or traumatic life events related to types of obsessive-compulsive and related disorders? An online study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Ong CW, Krafft J, Levin ME, Twohig MP. A systematic review and psychometric evaluation of self-report measures for hoarding disorder. J Affect Disord 2021; 290:136-148. [PMID: 33993080 DOI: 10.1016/j.jad.2021.04.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/08/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hoarding disorder (HD) affects approximately 2.5% of the general population, leads to significant distress and impairment, and is notoriously difficult to treat. The crux of developing effective treatments for HD is our ability to reliably and validly measure relevant constructs in HD to better understand its presentation and, subsequently, formulate appropriate interventions. METHODS We identified measures specific to HD and evaluated their psychometric properties using rating criteria formulated by the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) group. RESULTS The 17 included measures were developed to assess adult and pediatric hoarding severity, functional impairment, and maladaptive processes (e.g., material scrupulosity). The Saving Inventory-Revised, the most widely used measure of HD severity showed the strongest psychometric properties. However, psychometric investigations were generally of poor quality across all measures and results indicated unsatisfactory performance of measures. LIMITATIONS The current review excluded non-English measures and ratings inherently contain some element of subjectivity despite use of predetermined criteria and two independent reviewers. CONCLUSIONS We suggest that clinical researchers continue to develop and modify measures used to conceptualize and, ultimately, improve treatment for HD.
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Affiliation(s)
- Clarissa W Ong
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, United States.
| | - Jennifer Krafft
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, United States
| | - Michael E Levin
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, United States
| | - Michael P Twohig
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, United States
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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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Marazziti D, Pozza A, Mucci F, Dettore D. Compulsive Hoarding Symptoms and the Role of Mindfulness Skills During Social Distancing for the COVID-19 Pandemic: An Exploratory Survey. Front Psychiatry 2021; 12:634454. [PMID: 34194342 PMCID: PMC8236584 DOI: 10.3389/fpsyt.2021.634454] [Citation(s) in RCA: 2] [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] [Received: 11/27/2020] [Accepted: 05/14/2021] [Indexed: 01/18/2023] Open
Abstract
People reporting compulsive hoarding symptoms (CHS) have lower mindfulness skills than those without such symptoms. Mindfulness skills can have the role of a protective buffer against stressful periods. The quarantine imposed to contain the COVID-19 spread had a negative impact on daily habits and healthy behaviors (including social interactions). An increased attachment to objects might be one of the under-recognized psychological consequences of these difficult times, yet no study focused on CHS. Through an online survey in men who were on quarantine during the pandemic, this exploratory survey examined the prevalence of men reporting CHS during this period and explored the role of mindfulness skills on CHS controlling for anxious-depressive/stress symptoms. Forty-three men from the general population completed the Obsessive Compulsive Inventory-Revised (OCI-R), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) and Depression Anxiety Stress Scales-21 (DASS-21). Twenty-eight percent reported CHS. No differences on the scores of the questionnaires emerged between men with and without CHS, except on CAMS-R Attention scores. In a logistic regression analysis lower CAMS-R Attention scores predicted CHS (β = -0.34, p = 0.03). This is the first, yet preliminary investigation on CHS during quarantine. The prevalence of CHS appears higher than the rates (4%) reported in the last years before the COVID-19 outbreak. Perhaps people showed more intense hoarding tendencies during quarantine/social distancing, and this pattern should be monitored. Larger samples, longitudinal designs and clinician-rated instruments are needed to support or not our findings.
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Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
- BRF Foundation, Lucca, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Federico Mucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Davide Dettore
- Department of Health Sciences, University of Florence, Florence, Italy
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