Characterizing the hoarding phenotype in individuals with OCD: associations with comorbidity, severity and gender

Decluttering Minds: Psychological interventions for hoarding disorder - A systematic review and meta-analysis

BACKGROUND

Cognitive Behavioural Therapy (CBT) is conventionally considered the primary intervention for Hoarding Disorder (HD), yet various psychological interventions have recently emerged. This study, pre-registered at Prospero (CRD42023427534), aims to comprehensively assess a range of psychological interventions, including CBT, for reducing HD symptomatology.

METHODS

A systematic literature search using PubMed and SCOPUS identified 41 eligible studies comprising 47 samples (N = 1343). Risk of bias for RCTs was assessed using the Cochrane RoB2 tool, and methodological quality for all studies was evaluated using the Psychotherapy Outcome Study Methodology Rating Form (POMRF).

RESULTS

Pre-post effects revealed a large reduction in HD symptomatology (g = -1.09), sustained at follow-up in 18 studies (g = -1.12, N = 588). Additionally, 8 Randomized Controlled Trials (RCTs) demonstrated a substantial end-of-trial reduction in HD symptoms compared to controls (g = -0.75). Meta-regression found no moderating effects for: demographics, medication use, number of treatment sessions, or study quality. Similarly, no differences were observed between group and individual therapy, therapy with or without home visits, or CBT versus other psychological interventions.

CONCLUSION

This study confirms psychological therapies are effective in reducing hoarding symptoms, while indicating no superiority for CBT. Despite the benefits, symptoms often persist above the clinical cut-off for HD, highlighting the enduring clinical challenges in achieving symptomatic remission. The findings underscore the need to address methodological limitations and possible age and gender bias in future research to enhance the efficacy and inclusivity of psychological interventions for HD.

Co-occurring Obsessive-Compulsive Disorder and Hoarding Disorder: A Review of the Current Literature

Current research suggests obsessive-compulsive disorder (OCD) co-occurs in around 20% of people with hoarding disorder (HD). The article discusses the theoretical conceptualization of co-occurring HD and OCD (HD+OCD), highlighting similarities between the disorders that may contribute to comorbidity, such as potentially overlapping etiological factors, comorbidity profiles, and phenomenological aspects; and differences that are important to consider in differential diagnosis and conceptualization, such as belief patterns, ego-syntonicty/dystonicity, and trajectory. The combination of HD+OCD versus either disorder alone appears to be associated with a profile characterized by higher nonhoarding OCD symptoms, anxiety symptoms, depression, and tic disorders, and which may be more treatment-refractory. The authors discuss some commonly used measures to assess hoarding that may be relevant in the context of OCD, as differential diagnosis of hoarding behaviors is often difficult, and hoarding may be difficult to detect in patients with OCD, especially in children. The article ends with a discussion on considerations for the treatment of HD+OCD with cognitive-behavioral therapy, as hoarding symptoms are less likely to respond to gold-standard exposure and response prevention, and there are no established treatment protocols that are designed to treat co-occurring HD and OCD.

Hoarding symptoms are associated with higher rates of disability than other medical and psychiatric disorders across multiple domains of functioning

BACKGROUND

Hoarding symptoms are associated with functional impairment, though investigation of disability among individuals with hoarding disorder has largely focused on clutter-related impairment to home management activities and difficulties using space because of clutter. This analysis assesses disability among individuals with hoarding symptoms in multiple domains of everyday functioning, including cognition, mobility, self-care, interpersonal and community-level interactions, and home management. The magnitude of the association between hoarding and disability was compared to that of medical and psychiatric disorders with documented high disability burden, including major depressive disorder (MDD), diabetes, and chronic pain.

METHODS

Data were cross-sectionally collected from 16,312 adult participants enrolled in an internet-based research registry, the Brain Health Registry. Pearson's chi-square tests and multivariable logistic regression models were used to quantify the relationship between hoarding and functional ability relative to MDD, diabetes, and chronic pain.

RESULTS

More than one in ten participants endorsed clinical (5.7%) or subclinical (5.7%) hoarding symptoms (CHS and SCHS, respectively). After adjusting for participant demographic characteristics and psychiatric and medical comorbidity, CHS and SCHS were associated with increased odds of impairment in all domains of functioning. Moderate to extreme impairment was endorsed more frequently by those with CHS or SCHS compared to those with self-reported MDD, diabetes, and/or chronic pain in nearly all domains (e.g., difficulty with day-to-day work or school: CHS: 18.7% vs. MDD: 11.8%, p < 0.0001) except mobility and self-care. While those with current depressive symptoms endorsed higher rates of impairment than those with hoarding symptoms, disability was most prevalent among those endorsing both hoarding and comorbid depressive symptoms.

CONCLUSIONS

Hoarding symptoms are associated with profound disability in all domains of functioning. The burden of hoarding is comparable to that of other medical and psychiatric illnesses with known high rates of functional impairment. Future studies should examine the directionality and underlying causality of the observed associations, and possibly identify target interventions to minimize impairment associated with hoarding symptomatology.

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

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

Development of a scale to assess obsessive-compulsive tendencies among Japanese university students

Obsessive-compulsive (OC) tendencies refer to obsessions and compulsions in a nonclinical group, which are risk factors for obsessive-compulsive disorder (OCD). OC tendencies and OC symptoms are mainly assessed using five factors: ordering, obsessions, cleaning, hoarding, and checking. However, since hoarding is now classified as an independent diagnosis in the DSM-V, this factor was not included and was instead replaced by indecisiveness. Furthermore, many established scales used for measuring OC tendencies were originally created for OCD patients; thus, they cannot adequately capture OC tendencies. Therefore, this study aimed to develop a scale to assess OC tendencies among Japanese university students with a revised five-factor structure: ordering, obsessions, cleaning, indecisiveness, and checking. We examined the factor structure, reliability, criterion-related validity, and convergent validity of the OC tendencies scale by administering two surveys. In Survey 1 (N = 216), an exploratory factor analysis (EFA) was conducted to examine the criterion-related and convergent validity and reliability of the OC tendencies scale. In Survey 2 (N = 202), a confirmatory factor analysis (CFA) was conducted. EFA and CFA utilized a five-factor structure comprising checking, ordering, indecisiveness, cleaning, and obsessions. Correlations with other scales indicated that the OC tendencies scale had efficient convergent validity, criterion-related validity, internal consistency, and test-retest reliability. This study validated the five-factor structure of OC tendency in Japanese university students. However, indecisiveness was also strongly correlated with trait-anxiety. As this scale is easy to administer among large groups, it has the potential to contribute to mental health support for university students by measuring OC tendencies experienced on a daily basis, which have not been adequately measured in the past.

Mental Health Factors That Guide Individuals to Engage in Overconsumption Behavior During the COVID-19 Pandemic: A Cross-Cultural Study Between USA and Ecuador

Background

This study tests a framework that examines the role of several mental health factors (mood, wellbeing, health consciousness, and hoarding) on individuals' overconsumption behavior under the novel coronavirus context. This examination is relevant to public health literature because it increases our knowledge on how the context of COVID-19 pandemic affects people's mental health and provides answers to why individuals engage in overconsumption behavior. Additionally, this research also follows a cross-cultural perspective aiming to understand how individuals from different cultural orientations cope with the psychological effects of the COVID-19 pandemic.

Methods

This is a cross-sectional study that compares samples from two countries: Ecuador (n = 334) and USA (n = 321). Data was collected via an online survey. The timing of data collection was set during the mandatory lockdowns and social distance measures taken by both countries to fight against the COVID-19 virus breakout. Partial least squares structural equation modeling was used to test the theorized framework. Multi-group analysis was used to explore cultural orientation differences among the relationships included in the model.

Results

The results indicate that individuals' mood state has a positive relationship with health consciousness, as people try to regulate their health concerns by maintaining positive perceptions of their subjective wellbeing. Further, the increased concern individuals express in their health is responsible for them to engage in overconsumption behavior. Cultural orientation (individualism vs. collectivism) moderates the relationship between mood and health consciousness. No moderation effect was found for the relationship between health consciousness and overconsumption.

Conclusions

The COVID-19 pandemic has generated negative effects in individuals' mental health. Findings from this study suggest that maintaining a positive mood is important for individuals at the time of mandatory lockdowns, and this effort is related to a greater concern and awareness of their health. Further, health consciousness is responsible to stimulate overconsumption behavior. This chain of effects can be explained by individuals' interest in their wellbeing. Culture plays a role in these effects. People from individualistic countries (USA) compared to people from collectivistic countries (Ecuador) demonstrate greater motivation in maintaining their positive mood by showing greater health consciousness.

Gender-related romantic attachment and serum oxytocin level difference in adult patients with obsessive compulsive disorder

Background

Given the scarcity of data on gender-related romantic attachment changes and the potential role of oxytocin (OT) in the pathophysiology of obsessive-compulsive illness (OCD), the current study aimed to assess gender-related differences in romantic attachment characteristics and their relationship to serum oxytocin in a set of forty OCD cases compared with a similar group of healthy controls .Simultaneously examining the gender differences in serum oxytocin levels in OCD patients, the diagnosis of OCD patients was determined using DSM-5 criteria, and the severity of OCD was determined using the Y-BOCS rating scale. All of the patients were drug-free and not depressed. The romantic attachment was assessed using the “Experiences in Close Relationship” Questionnaire. Standard ELISA kits were used to assess plasma OT levels.

Results

Regarding romantic attachments, patients with obsessive compulsive disorder scored higher on the anxiety and avoidance domains than controls with no significant gender difference. Serum oxytocin was higher in patients with OCD than in healthy controls, indicating a possible underlying pathophysiology of the illness. Also, there was a significant gender difference, with female patients having higher serum oxytocin and symptoms severity being negatively associated.

Conclusions

Taken together, these findings propose that OT may play a role in OCD pathophysiology with gender specificity. Also, OCD associated with insecure romantic attachment.

Multifaceted impulsivity in obsessive-compulsive disorder with hoarding symptoms

OBJECTIVE

Hoarding is common in obsessive-compulsive disorder (OCD), and OCD with hoarding may have poorer prognostic features than OCD without hoarding. The aim of this study was to investigate the relationship between multifaceted impulsivity and hoarding symptoms in individuals with OCD. This relationship is important to be able to understand the psychopathological mechanisms of hoarding symptoms in OCD patients.

METHODS

The study included 136 individuals with OCD classified as OCD with high hoarding symptoms (OCDwHH, n = 41) and OCD with low/none hoarding symptoms (OCDwLH, n = 95), together with 94 healthy control subjects. All the participants completed the Hoarding Rating Scale-Interview, Barratt Impulsiveness Scale-11, Yale-Brown Obsessions and Compulsions Scale, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale.

RESULTS

The OCDwHH group had more severe anxiety (p = 0.016) and attentional impulsivity (p = 0.002) than OCDwLH. Attentional impulsivity scores were positively correlated with hoarding symptom scores (p < 0.001). Both attentional and motor impulsivity scores were positively correlated with anxiety levels (p = 0.037, p = 0.045, respectively). In partial correlation analysis, motor impulsivity was positively correlated with the severity of hoarding symptoms controlling for anxiety severity (p = 0.045). In hierarchical linear regression analysis, only attentional impulsivity predicted the severity of hoarding symptoms independently of anxiety, severity of obsessive-compulsive symptoms and motor impulsivity (β = 0.268, Adjusted R2 = 0.114, p = 0.006).

CONCLUSION

Attentional impulsivity is associated with hoarding symptoms in OCD. Future studies that reveal this relationship may contribute to treatment modalities for the OCD patients with hoarding symptoms.

Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis

BACKGROUND

Eating disorders (ED) and obsessive-compulsive disorder (OCD) are highly comorbid, but little is known about how this comorbidity is maintained. Prior research suggests that obsessive thoughts and perfectionism may be shared maintenance factors for EDs and OCD.

METHODS

The current study used network analysis to (1) identify bridge pathways in an ED-OCD comorbidity network and (2) test if perfectionism symptoms bridge between ED-OCD symptoms in a combined network model including ED, OCD, and Perfectionism symptoms. Participants (N = 1,619) were a mixed sample of undergraduate students and individuals diagnosed with EDs.

RESULTS

Difficulty controlling thoughts was the symptom with the highest bridge centrality in both models, connecting with ED-related worry and doubts. In the ED-OCD-Perfectionism comorbidity network, doubts about simple everyday things and repeating things over and over bridged between ED and OCD symptoms. Additionally, specific and distinct pathways were identified between OCD and two types of ED pathology: restricting (checking compulsions and rigidity around food) and binge eating (hoarding and binge eating symptoms).

LIMITATIONS

Due to the cross-sectional nature of the data, no directional inferences can be made. Due to a higher OCD symptom prevalence rate than reported in previous studies, our undergraduate sample may not be representative of other college populations.

CONCLUSIONS

The presence of intrusive cognitions and maladaptive perfectionism may contribute to the maintenance of co-occurring ED and OCD symptoms. These findings begin to delineate specific pathways among OCD and ED symptoms, which can be used in the development of interventions to disrupt connections among these disorders.

Predicting marriage and divorce in obsessive-compulsive disorder

Single (N = 472, 51.7%), married or living in stable cohabitation (N = 375, 41.1%) and divorced or separated (N = 66, 7.2%) patients with obsessive-compulsive disorder (OCD) were compared in terms of their sociodemographic features, OCD phenotypes, and comorbidity profile. Using single status as a reference group, a multinominal regression analysis found increased age, lower severity of hoarding, increased rates of panic disorder without agoraphobia, and lower rates of dysthymic disorder to be associated with married or stable cohabitation status. Concomitantly, increased age, higher severity of symmetry symptoms, and increased rates of skin picking disorder were found to be associated with divorced status. These findings suggest that there is a relationship between marital status and different OCD phenotypes.

Hoarding and obsessive-compulsive behaviours in frontotemporal dementia: Clinical and neuroanatomic associations

BACKGROUND

Hoarding and obsessive-compulsive behaviours (OCB) are well documented symptoms in frontotemporal dementia (FTD). While contemporary models consider hoarding and obsessive-compulsive disorder distinct, the related behaviours have not been separately examined in patients with FTD, and the neuroanatomical correlates of hoarding in patients with FTD have not been previously examined (American Psychiatric Association, 2013; Grisham and Baldwin, 2015; Mataix-Cols et al., 2010).

METHODS

Patients with FTD who were evaluated between 2004 and 2018 at our centre were included. Cortical thickness and subcortical volumetric analyses were completed on available T1 high resolution anatomic scans using FreeSurfer.

RESULTS

Eighty-seven patients met inclusion criteria, and 49 had scans available for quantitative MRI volumetric analysis. New hoarding behaviours were present in 29% of patients and were more common in the semantic variant subtype of FTD, while 49% of individuals had new or increased OCB. Hoarding behaviours were associated with decreased thickness in a factor comprised of left temporal, insular and anterior cingulate cortices. The presence of OCB was predicted by reduced cortical thickness and volumes in a factor comprised of the anterior cingulate and subcortical volumes in the bilateral amygdala and hippocampus. OCB were associated with greater right temporal cortical thickness in comparison to patients with hoarding.

DISCUSSION

The association of the semantic variant with hoarding, together with the observed associations between left temporal atrophy and hoarding indicate that degeneration of the left temporal lobe has a role in the emergence of hoarding in FTD. As in current models of Hoarding disorder and Obsessive-Compulsive disorder, our results suggest that in patients with FTD, hoarding and OCB are clinically and anatomically partially dissociable phenomenon. The results may also help to further elucidate the cognitive processes and neural networks contributing to Hoarding disorder and Obsessive-Compulsive disorder in persons without dementia.

Hoarding: A meta-analysis of age of onset

Hoarding disorder is present in 2-6% of the population and can have an immense impact on the lives of patients and their families. Before its inclusion the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, pathological hoarding was often characterized as a symptom of obsessive-compulsive disorder, and several different diagnostic assessment methods were used to identify and characterize it. Although the age of onset of pathological hoarding is an important epidemiological measure, as clarifying the age of onset of hoarding symptoms may allow for early identification and implementation of evidence-based treatments before symptoms become clinically significant, the typical age of onset of hoarding is still uncertain. To that end, this study is a systematic review and meta-analysis of research published in English between the years 1900 and 2016 containing information on age of onset of hoarding symptoms. Twenty-five studies met inclusion criteria. The mean age of onset of hoarding symptoms across studies was 16.7 years old, with evidence of a bimodal distribution of onset. The authors conclude by discussing practice implications for early identification and treatment.

Prevalence of Hoarding in an Adult Inpatient Population and Its Association With Axis I Diagnoses

OBJECTIVE

Hoarding behavior is not limited to obsessive-compulsive disorder (OCD) alone. With the objective of highlighting the association between hoarding behavior and common psychiatric disorders, we explored its occurrence in psychiatric inpatients and co-occurrence with Axis I diagnoses.

METHODS

In this prospective cohort study, we enrolled adult psychiatric inpatients by simple random sampling at an urban, community-based, academic medical center. Patients were screened for hoarding using the validated Hoarding Rating Scale-Interview, and those meeting criteria for clinically significant hoarding were assessed for Axis I disorders.

RESULTS

Clinically significant hoarding was observed in 33% of the 200 acute psychiatry patients admitted to the study. Mood disorders were positively associated with hoarding (p = 0.033), whereas psychotic spectrum disorders had a weaker association with it (p = 0.015).

CONCLUSION

This study indicates a need for clinicians to be mindful that hoarding manifests in many forms of mental illness and is not limited to OCD alone.

Congruence and discrepancy between self-rated and clinician-rated symptom severity on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before and after a low-intensity intervention

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the most common measure of Obsessive-Compulsive symptom severity. The Y-BOCS interview is considered gold standard, but its self-rating format is increasingly used in clinical trials. Few studies investigated congruency and potential changes over treatment. This question is highly relevant, as a systematic bias might obscure results of clinical trials. We examined the relationship of self- and clinician-rated Y-BOCS scores in participants with obsessive-compulsive disorder in pre (N = 128), post, (4 weeks, n = 104) and follow-up (6 months, n = 98) assessments of a randomized-controlled clinical trial. We administered Y-BOCS interview via telephone paralleling online administration of the self-report form. Analyses showed medium-to-strong correlations of Y-BOCS interview and self-rating scores at pre-assessment. Patients rated symptoms lower than clinicians. Larger discrepancies were associated with hoarding and age. Congruency was inferior for obsessions relative to compulsions, largely owing to the "resistance against obsessions" item. Agreement strongly increased at post and follow-up. Though overall congruency between the two Y-BOCS forms was satisfactory, results suggest a "correction over time" effect. Such bias may distort the precise interpretation of treatment effects. Therefore, we made several suggestions to improve the reliability of change scores assessed with the Y-BOCS self-rating.

Obsessive compulsive disorder with and without hoarding symptoms: Characterizing differences

OBJECTIVE

In recent years there has been some ambiguity about the way hoarding and OCD are related to each other. The present study examines the differences between persons with OCD/hoarding and OCD/non-hoarding and examines which characteristics are associated with the OCD/hoarding group. Information is established about prevalences, socio-demographical characteristics, OCD and related characteristics, OCD subtypes, comorbidity (depression, anxiety disorders and PTSD) and personality traits.

METHODS

Data from baseline assessment of The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study are used. The NOCDA sample consists of 419 participants between 18 and 79 years of age, including participants with current or remitted full DSM-IV-TR criteria for OCD.

RESULTS

Results show that 58 persons (14.3%) are classified as persons with OCD/hoarding and 349 persons (85,7%) are classified as persons with OCD/non-hoarding. OCD/hoarding is independently associated with severity of autism symptoms (p<.001), living without a partner (p<.05) and being less conscientious (p<.05). Persons with OCD/hoarding are not associated with childhood trauma (p=.31), PTSD (p=.91) and AD(H)D, inattentive type (p=.22) and hyperactive type (p=.57).

LIMITATIONS

Causal interferences about associations between the risk indicators and hoarding symptoms were precluded since results were based on cross-sectional data.

CONCLUSION

This study confirmed differences between persons with OCD/hoarding and persons with OCD/non-hoarding. The most relevant outcome of this study was the association between persons with OCD/hoarding and the increased severity of autism symptoms. These results provide a better understanding of persons with OCD/hoarding and have the potential to improve treatment.

Genetic differences in the behavioral organization of binge eating, conditioned food reward, and compulsive-like eating in C57BL/6J and DBA/2J strains

Binge eating (BE) is a heritable symptom of eating disorders associated with anxiety, depression, malnutrition, and obesity. Genetic analysis of BE could facilitate therapeutic discovery. We used an intermittent, limited access BE paradigm involving sweetened palatable food (PF) to examine genetic differences in BE, conditioned food reward, and compulsive-like eating between C57BL/6J (B6J) and DBA/2J (D2J) inbred mouse strains. D2J mice showed a robust escalation in intake and conditioned place preference for the PF-paired side. D2J mice also showed a unique style of compulsive-like eating in the light/dark conflict test where they rapidly hoarded and consumed PF in the preferred unlit environment. BE and compulsive-like eating exhibited narrow-sense heritability estimates between 56 and 73%. To gain insight into the genetic basis, we phenotyped and genotyped a small cohort of 133 B6J × D2J-F₂ mice at the peak location of three quantitative trait loci (QTL) previously identified in F₂ mice for sweet taste (chromosome 4: 156 Mb), bitter taste (chromosome 6: 133 Mb) and behavioral sensitivity to drugs of abuse (chromosome 11: 50 Mb). The D2J allele on chromosome 6 was associated with greater PF intake on training days and greater compulsive-like PF intake, but only in males, suggesting that decreased bitter taste may increase BE in males. The D2J allele on chromosome 11 was associated with an increase in final PF intake and slope of escalation across days. Future studies employing larger crosses and genetic reference panels comprising B6J and D2J alleles will identify causal genes and neurobiological mechanisms.

The need to consume: Hoarding as a shared psychological feature of compulsive buying and binge eating

INTRODUCTION

Compulsive buying and binge eating are two frequently co-occurring psychiatric conditions. Hoarding, which is the psychological need to excessively gather and store items, is frequently associated with both compulsive buying severity and binge eating severity. In the present study, we explored whether different dimensions of hoarding are a shared feature of compulsive buying and binge eating.

METHOD

Participants consisted of 434 people seeking treatment for compulsive buying disorder. Registered psychiatrists confirmed the diagnosis of compulsive buying through semi-structured clinical interviews. Participants also completed measures to assess compulsive buying severity, binge eating severity, and dimensions of hoarding (acquisition, difficulty discarding, and clutter). Two-hundred and seven participants completed all three measures.

RESULTS

Significant correlations were found between compulsive buying severity and the acquisition dimension of hoarding. Binge eating severity was significantly correlated with all three dimensions of hoarding. Hierarchical regression analysis found that compulsive buying severity was a significant predictor of binge eating severity. However, compulsive buying severity no longer predicted binge eating severity when the dimensions of hoarding were included simultaneously in the model. Clutter was the only subscale of hoarding to predict binge eating severity in step two of the regression analysis.

CONCLUSION

Our results suggest that the psychological need to excessively gather and store items may constitute a shared process that is important in understanding behaviors characterized by excessive consumption such as compulsive buying and binge eating.

Presentation and Correlates of Hoarding Behaviors in Children with Autism Spectrum Disorders and Comorbid Anxiety or Obsessive-Compulsive Symptoms

We investigated the presentation and correlates of hoarding behaviors in 204 children aged 7-13 with autism spectrum disorder (ASD) and comorbid anxiety or obsessive-compulsive disorder (OCD) symptoms. Approximately 34% of the sample presented at least moderate levels, and with 7% presenting severe to extreme levels of hoarding. Child gender predicted hoarding severity. In addition, child ASD-related social difficulties together with attention-deficit and hyperactivity disorder symptom severity positively predicted hoarding controlling for child gender and restricted and repetitive behaviors. Finally, child anxiety/OCD symptoms positively predicted hoarding, controlling for all other factors. These results suggest hoarding behaviors may constitute a common feature of pediatric ASD with comorbid anxiety/OCD, particularly in girls and children with greater social difficulties and comorbid psychiatric symptom severity.

Subjective cognitive function in hoarding disorder

The aim of the present study was to examine subjective cognitive impairment among adult patients with hoarding disorder (HD). Eighty-three patients with HD and 46 age- and gender-matched healthy control (HC) participants received a diagnostic interview and completed measures of subjective cognitive functioning and motivations for saving behavior, as well as measures of hoarding severity, depression, anxiety, stress, and obsessive-compulsive disorder (OCD) symptoms. The HD group reported more impairment than did the HC group in domains of memory, distractibility, blunders, memory for names, and inattention. These differences generally remained significant when controlling for comorbid symptoms. In the HD group, the degree of cognitive impairment was significantly correlated with severity of saving and acquiring behaviors, although results were attenuated when controlling for comorbid symptoms (overall HD severity, but not saving behavior specifically, remained significantly correlated with cognitive impairment). Subjective cognitive impairment was further associated with a desire to save possessions in order to avoid forgetting, and these results remained significant when controlling for comorbid symptoms. These results comport with current behavioral models of HD that emphasize decision-making deficits, as well as clinician observations suggestive of impaired cognitive function, and complement a growing body of neuropsychological testing studies.

An Examination of the Role of Psychological Inflexibility in Hoarding Using Multiple Mediator Models

Hoarding is associated with functional impairment and impacts quality of life. One process that has been theorized to explain how hoarding develops and leads to impairment is psychological inflexibility, in which behavior is rigidly controlled by a perceived need to regulate internal experiences, at the expense of more effective, valued actions. The present study aimed to test the mediational role of psychological inflexibility in the development of hoarding and its impact on life satisfaction with a sample of 489 college students completing an online survey. Results indicated that multiple measures of psychological inflexibility (overall inflexibility, inattention, and values obstruction) mediated the relationship between distress and hoarding. Other measures of psychological inflexibility (overall inflexibility, cognitive fusion, and lack of values progress) mediated the link between hoarding severity and life satisfaction. These findings suggest that how one responds to distress and hoarding symptoms can influence symptom severity and life satisfaction, and that psychological flexibility may promote more adaptive outcomes. Thus, current interventions for problematic hoarding may be strengthened by targeting psychological inflexibility and related processes.

Self-reported executive function and hoarding in adults with obsessive-compulsive disorder

BACKGROUND

Hoarding behavior may distinguish a clinically and possibly etiologically distinct subtype of obsessive-compulsive disorder (OCD). Little is known about the relationship between executive dysfunction and hoarding in individuals with OCD.

METHODS

The study sample included 431 adults diagnosed with DSM-IV OCD. Participants were assessed by clinicians for Axis I disorders, personality disorders, indecision, and hoarding. Executive functioning domains were evaluated using a self-report instrument, the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). We compared scores on these domains in the 143 hoarding and 288 non-hoarding participants, separately in men and women. We used logistic regression to evaluate relationships between executive function scores and hoarding, and correlation and linear regression analyses to evaluate relationships between executive function scores and hoarding severity, in women.

RESULTS

In men, the hoarding group had a significantly higher mean score than the non-hoarding group only on the shift dimension. In contrast, in women, the hoarding group had higher mean scores on the shift scale and all metacognition dimensions, i.e., those that assess the ability to systematically solve problems via planning and organization. The relationships in women between hoarding and scores on initiating tasks, planning/organizing, organization of materials, and the metacognition index were independent of other clinical features. Furthermore, the severity of hoarding in women correlated most strongly with metacognition dimensions.

CONCLUSIONS

Self-reported deficits in planning and organization are associated with the occurrence and severity of hoarding in women, but not men, with OCD. This may have implications for elucidating the etiology of, and developing effective treatments for, hoarding in OCD.

Hoarding Disorder and Difficulties in Emotion Regulation

The present study aimed to examine self-reported deficits in emotion regulation (ER) among individuals with hoarding disorder (HD). Seventy-seven adult outpatients with HD and 45 age- and gender-matched healthy control (HC) participants received a diagnostic assessment and completed self-report measures of hoarding severity, depression, and anxiety. In addition, participants completed the Difficulties in Emotion Regulation Scale (DERS), which measures lack of emotional clarity (Clarity), difficulty regulating behavior when distressed (Impulse), difficulty engaging in goal-directed cognition and behavior when distressed (Goals), unwillingness to accept emotional responses (Accept), and lack of access to strategies for feeling better when distressed (Strategies). The HD group scored higher on all DERS subscales than did the HC group; self-reported ER deficits remained evident when controlling for baseline depression, anxiety, and stress. The DERS correlated significantly with hoarding severity in the HD group: acquiring was significantly correlated with DERS Impulse, Strategies, and Accept; saving was significantly correlated with DERS Accept. Correlations remained significant when controlling for depression, anxiety, and stress. Results suggest that HD is characterized by self-reported deficits in ER, and that this relationship is not solely attributable to high levels of depression and anxiety.

The cognitive-behavioural model of hoarding disorder: Evidence from clinical and non-clinical cohorts

The cognitive-behavioural model of hoarding disorder incorporates information processing difficulties, maladaptive attachment to possessions, erroneous beliefs about the nature of possessions, and mood problems as etiologically significant factors, although developmental experiences such as a compromised early family environment have also been proposed in an augmented model. This study examined the specificity and relevance of variables highlighted in the augmented cognitive-behavioural model. Various clinical participants (n = 89) and community controls (n = 20) were assessed with structured clinical interviews to verify diagnosis. Participants completed self-report measures of hoarding severity, cognitions, meta-memory, and early developmental experiences (e.g., memories of warmth and security in one's family). Hoarding cohorts (with and without obsessive-compulsive disorder) reported poor confidence in memory, but relative to other groups (obsessive-compulsive disorder without hoarding disorder, anxiety disorders, and healthy controls), hoarding-relevant cognitions, need to keep possessions in view, and concerns about the consequences of forgetting were significantly higher. Hoarding groups reported the lowest recollections of warmth in their family, although no differences were found between hoarding and non hoarding clinical cohorts for uncertainty about self and others. Nonetheless, clinical cohorts reported generally higher scores of uncertainty than healthy controls. When predicting hoarding severity, after controlling for age and mood, recollections of lack of warmth in one's family was a significant predictor of hoarding severity, with hoarding-related cognitions and fears about decision-making being additional unique predictors. The study supports the augmented cognitive-behavioural model of hoarding, inclusive of the importance of early developmental influences in hoarding.

Obsessive-compulsive symptoms and negative affect during tobacco withdrawal in a non-clinical sample of African American smokers

The association between obsessive-compulsive (OC) symptomatology and smoking is poorly understood, particularly in African Americans-a group subject to smoking- and OC-related health disparities. In a non-clinical sample of 253 African American smokers, we tested the negative reinforcement model of OC-smoking comorbidity, purporting that smokers with higher OC symptoms experience greater negative affect (NA) and urge to smoke for NA suppression upon acute tobacco abstinence. Following a baseline visit involving OC assessment, participants completed two counterbalanced experimental visits (non-abstinent vs. 16-h tobacco abstinence) involving affect, smoking urge, and nicotine withdrawal assessment. OC symptom severity predicted larger abstinence-provoked increases in overall NA, anger, anxiety, depression, fatigue, urge to smoke to suppress NA, and composite nicotine withdrawal symptom index. African American smokers with elevated OC symptoms appear to be vulnerable to negative reinforcement-mediated smoking motivation and may benefit from cessation treatments that diminish NA or the urge to quell NA via smoking.

Age-Specific Prevalence of Hoarding and Obsessive Compulsive Disorder: A Population-Based Study

OBJECTIVE

Little is known about the age-specific prevalence of hoarding and obsessive compulsive symptoms (OCS), particularly in older age groups. The objectives of this study were to estimate the age-specific prevalence, severity, and relationships between hoarding and OCS in males and females using a large population-based sample.

METHODS

We assessed the age-specific prevalence rates of hoarding disorder (HD) and OC disorder (OCD) in males and females (at various age ranges between 15 and 97 years) from the Netherlands Twins Register (N = 15,194). Provisional HD and OCD diagnoses were made according to Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition, criteria using self-report measures. We also assessed hoarding and OCS severity in the various age groups and explored specific hoarding and OCS patterns (e.g., difficulty discarding, excessive acquisition, clutter, checking, washing, perfectionism, and obsessions) with age.

RESULTS

Prevalence of provisional HD diagnoses (2.12%) increased linearly by 20% with every 5 years of age (z = 13.8, p < 0.0001) and did not differ between males and females. Provisional OCD diagnoses were most common in younger individuals and in individuals over age 65. Co-occurring OCD increased hoarding symptom severity (coefficient: 4.5; SE: 0.2; 95% CI: 4.1-4.9; t = 22.0, p < 0.0001). Difficulty discarding for HD and checking behaviors for OCD appeared to drive most increases in these diagnoses in older ages.

CONCLUSION

Increased prevalence and severity of HD with age appears to be primarily driven by difficulties with discarding. Increases in OCD prevalence with older age were unexpected and of potential clinical relevance.

Parental bonding and hoarding in obsessive-compulsive disorder

BACKGROUND

Hoarding behavior may indicate a clinically and possibly etiologically distinct subtype of obsessive-compulsive disorder (OCD). Empirical evidence supports a relationship between hoarding and emotional over-attachment to objects. However, little is known about the relationship between hoarding and parental attachment in OCD.

METHOD

The study sample included 894 adults diagnosed with DSM-IV OCD who had participated in family and genetic studies of OCD. Participants were assessed for Axis I disorders, personality disorders, and general personality dimensions. The Parental Bonding Instrument (PBI) was used to assess dimensions of perceived parental rearing (care, overprotection, and control). We compared parental PBI scores in the 334 hoarding and 560 non-hoarding participants, separately in men and women. We used logistic regression to evaluate the relationship between parenting scores and hoarding in women, adjusting for other clinical features associated with hoarding.

RESULTS

In men, there were no significant differences between hoarding and non-hoarding groups in maternal or paternal parenting scores. In women, the hoarding group had a lower mean score on maternal care (23.4 vs. 25.7, p<0.01); a higher mean score on maternal protection (9.4 vs. 7.7, p<0.001); and a higher mean score on maternal control (7.0 vs. 6.2, p<0.05), compared to the non-hoarding group. The magnitude of the relationships between maternal bonding dimensions and hoarding in women did not change after adjustment for other clinical features. Women who reported low maternal care/high maternal protection had significantly greater odds of hoarding compared to women with high maternal care/low maternal protection (OR=2.54, 95% CI=1.60-4.02, p<0.001).

CONCLUSIONS

Perceived poor maternal care, maternal overprotection, and maternal overcontrol are associated with hoarding in women with OCD. Parenting dimensions are not related to hoarding in men. These findings provide further support for a hoarding subtype of OCD and for sex-specific differences in etiologic pathways for hoarding in OCD.

An examination of the role of intolerance of distress and uncertainty in hoarding symptoms

BACKGROUND

Hoarding disorder (HD) is a common and debilitating disorder characterized by an accumulation of and failure to discard one's possessions. The identification and examination of underlying factors that may contribute to hoarding symptoms are needed to elucidate the nature of the disorder and refine existing treatments. Two transdiagnostic vulnerability factors that have been associated with hoarding symptoms are distress intolerance (DI) and intolerance of uncertainty (IU).

OBJECTIVES

This study examined the relationships between DI, IU, and symptoms of hoarding in two samples consisting of outpatients and individuals recruited from Amazon's Mechanical Turk. We hypothesized that DI and IU would show unique and interactive associations with hoarding symptoms.

RESULTS

Across both samples, DI and IU were significantly associated with hoarding symptoms. However, DI and IU did not interact in their prediction of symptoms, and only IU remained a significant predictor, when accounting for relevant covariates.

CONCLUSIONS

Results suggest that IU is a robust predictor of hoarding symptoms and may be a promising and novel treatment target for HD.

Hoarding Symptoms Are Not Exclusive to Hoarders

Hoarding disorder (HD) was originally conceptualized as a subcategory of obsessive compulsive disorder (OCD), and numerous studies have in fact focused exclusively on investigating the comorbidity between OCD and HD. Hoarding behavior can nevertheless also be found in other clinical populations and in particular in patients with eating disorders (ED), anxiety disorders (AD), major depression (MD), and psychotic disorders (PD). The current study was carried out with the aim of investigating, using a validated instrument such as the Saving Inventory-Revised (SI-R), the presence of HD symptoms in patients diagnosed with ED, AD, MD, and PD. Hoarding symptomatology was also assessed in groups of self-identified hoarders and healthy controls. The results revealed that 22.5% of the ED patients exceeded the cut-off for the diagnosis of HD, followed by 7.7% of the patients with MD, 7.4% of the patients with AD, and 5.9% of the patients with PD. The patients with ED had significantly higher SI-R scores than the other groups in the Acquisition and Difficulty Discarding scales while the AD, MD, and PD patients were characterized exclusively by Difficulty Discarding. These data suggest to clinicians that hoarding symptoms should be assessed in other types of patients and especially in those affected by Bulimia and Binge eating.

Hoarding disorder and the legal system: A comparative analysis of South African and Dutch law

Hoarding is an internationally recognised disability. Those who suffer from hoarding behaviour can be comfortably brought within the definition of disability found in the Convention on the Rights of Persons with Disabilities and should be provided with "reasonable accommodation" where doing so does not place an unjustified burden on others. However, hoarding also poses a threat to public health, and hoarders' behaviour may infringe on the rights of their neighbours and landlords. Thus, through their behaviour, hoarders may ultimately come into conflict with various areas of law, including neighbour law, housing law as well as administrative law. This article examines how hoarding may be addressed by the law in both South Africa and the Netherlands. It seeks to answer to what extent hoarders are provided with "reasonable accommodation" when their behaviour brings them into conflict of the law in these two jurisdictions. It also takes cognisance of the need to balance the provision of "reasonable accommodation" with the rights of neighbours and landlords. Finally, it seeks to assess which of the two jurisdictions provides the most balanced approach to handling hoarding, in light of the need for therapeutic jurisprudence.

Psychiatric Comorbidity and Hoarding Symptoms in African Americans With Obsessive-Compulsive Disorder

This study investigated comorbidity and hoarding symptoms in a sample of African American adults with obsessive-compulsive disorder ( N = 75). For lifetime disorders, 87.9% of participants had at least one other comorbid condition. The most prevalent comorbidities were mood disorders (67.1%), anxiety disorders (51.4%), and substance abuse disorders (38.0%). There was low comorbidity with eating disorders, as only 4.1% had binge-eating disorder and none met criteria for anorexia or bulimia nervosa. In terms of gender differences, females were more likely to have posttraumatic stress disorder and males were more likely to have a comorbid alcohol use disorder. Over half of the participants had hoarding compulsions (56.0%) as indicated by the Yale-Brown Obsessive-Compulsive Scale. Individuals with hoarding compulsions were more likely to have comorbid anxiety-related disorders than those without, and experienced greater indecisiveness, pathological slowness, and doubting; they also had less education and earning power than those without these behaviors. African Americans with obsessive-compulsive disorder tend to have high rates of comorbid disorders, with patterns that resemble findings in non-Hispanic White populations.

DISTINCT ETIOLOGICAL INFLUENCES ON OBSESSIVE-COMPULSIVE SYMPTOM DIMENSIONS: A MULTIVARIATE TWIN STUDY

BACKGROUND

Obsessive-compulsive disorder (OCD) is characterized by five major dimensions, including contamination/washing, harm/checking, symmetry/ordering, hoarding, and forbidden thoughts. How these dimensions may relate etiologically to the symptoms of other obsessive-compulsive related disorders (OCRDs) and anxiety disorders (ADs) is not well known. The aim of this study was to examine the genetic and environmental overlap between each major obsessive-compulsive dimension with the symptoms of other OCRDs and ADs.

METHODS

Two thousand four hundred ninety-five twins of both sexes, aged between 18 and 45 years, were recruited from the Australian Twin Registry. Measures used scores on four dimensions (obsessing (forbidden thoughts), washing, checking, and ordering) of the Obsessive-Compulsive Inventory-Revised, Dysmorphic Concerns Questionnaire, Hoarding Rating Scale, Anxiety Sensitivity Index, Social Phobia Inventory, and Stress subscale of the Depression, Anxiety, and Stress Scale. Multivariate twin modeling methods using continuous and categorized variables were performed, also controlling for age and gender.

RESULTS

Our findings suggested that forbidden thoughts and washing demonstrated the strongest genetic overlap with other AD symptoms, while ordering was genetically related to OCRD symptoms. Common genetic influences on checking symptoms were best estimated when modeling OCRDs together with AD symptoms. Common environmental factors of ordering and checking were shared with AD symptoms.

CONCLUSIONS

Important shared genetic and environmental risk factors exist between OCD, OCRDs, and ADs, but which vary alongside the expression of its major dimensions.

Obsessive-Compulsive Symptoms in Medical Students: Prevalence, Severity, and Correlates

OBJECTIVES

The study aims were to estimate the prevalence and correlates of symptoms suggestive of obsessive-compulsive disorder (OCD) among medical students and investigate the severity and correlates of specific obsessive-compulsive symptom (OCS) dimensions in this population.

METHODS

A cross-sectional study with 471 Brazilian medical students, who were assessed using the Obsessive-Compulsive Inventory-Revised (OCI-R). The main outcomes were "probable OCD" (OCI-R score >27) and overall/dimensional OCI-R scores. Sociodemographic data, depressive symptoms, and several aspects of academic life were also investigated. Bivariate analyses were followed by regression models.

RESULTS

Eighteen (3.8%) participants presented probable OCD, which was associated with depression. The mean OCI-R score was 8.9, and greater overall severity was independently associated with being a freshman, difficulty in adaptation, and depressive symptoms. Higher scores in the "checking" and "washing" dimensions were associated with being a freshman, in the "neutralization" and "ordering" dimensions with adaptation difficulties, and in the "hoarding" dimension with adaptation difficulties and depressive symptoms. The "obsession" dimension was associated with being a freshman, difficulty making friends, depressive symptoms, and psychological/psychiatric treatment.

CONCLUSIONS

Probable OCD is more frequent in medical students than in the general population and is associated with depressive symptoms. Efforts are required to identify OCS in this population, particularly among first-year students and to provide treatment, when necessary. Institutional programs that properly receive freshmen, enhancing their integration with other colleagues and their adaptation to the city, may decrease the level of stress and, consequently, OCS severity.

Comorbidity variation in patients with obsessive-compulsive disorder according to symptom dimensions: Results from a large multicentre clinical sample

BACKGROUND

Obsessive-compulsive disorder (OCD) has a heterogeneous and complex phenomenological picture, characterized by different symptom dimensions and comorbid psychiatric disorders, which frequently co-occur or are replaced by others over the illness course. To date, very few studies have investigated the associations between specific OCD symptom dimensions and comorbid disorders.

METHODS

Cross-sectional, multicenter clinical study with 1001 well-characterized OCD patients recruited within the Brazilian Research Consortium on Obsessive-Compulsive and Related Disorders. The primary instruments were the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses between symptom dimensions and comorbidities were followed by logistic regression.

RESULTS

The most common comorbidities among participants (56.8% females) were major depression (56.4%), social phobia (34.6%), generalized anxiety disorder (34.3%), and specific phobia (31.4%). The aggressive dimension was independently associated with posttraumatic stress disorder (PTSD), separation anxiety disorder, any impulse-control disorder and skin picking; the sexual-religious dimension was associated with mood disorders, panic disorder/agoraphobia, social phobia, separation anxiety disorder, non-paraphilic sexual disorder, any somatoform disorder, body dysmorphic disorder and tic disorders; the contamination-cleaning dimension was related to hypochondriasis; and the hoarding dimension was associated with depressive disorders, specific phobia, PTSD, impulse control disorders (compulsive buying, skin picking, internet use), ADHD and tic disorders. The symmetry-ordering dimension was not independently associated with any comorbidity.

LIMITATIONS

Cross-sectional design; participants from only tertiary mental health services; personality disorders not investigated.

CONCLUSIONS

Different OCD dimensions presented some specific associations with comorbid disorders, which may influence treatment seeking behaviors and response, and be suggestive of different underlying pathogenic mechanisms.

Hoarding Symptoms Respond to Treatment for Rapid Cycling Bipolar II Disorder

Although some studies have reported a relationship between hoarding and bipolar disorder, we are unaware of any previous description of how they may interact with each other and how they should be managed appropriately. A 48-year-old male depressed patient with hoarding symptoms and obsessive-compulsive disorder (OCD) was diagnosed with bipolar II disorder after 2 hypomanic episodes. The patient was treated unsuccessfully with different high-dose serotonin reuptake inhibitors and atypical antipsychotics, maintaining a pattern of 6 to 8 discrete, but severe, depressive episodes each year, always in association with a drastic worsening of his OCD and hoarding symptoms. T.he patient did not improve until the dose of the serotonin reuptake inhibitor was decreased and a combination of lamotrigine and methylphenidate was initiated. On this treatment regimen, the patient did not show clinically significant levels of depression or hoarding or other OCD symptoms. This case suggests that, in some patients, (1) hoarding-related cognitions and behaviors may be a part of bipolar depression, (2) the episodic nature of rapid cycling bipolar II disorder may protect against the development of severe clutter, and (3) treatment focusing on bipolar depression (eg, lamotrigine plus methylphenidate) may result in an improvement of hoarding symptoms when these are present in patients with rapid cycling bipolar II disorder.

Functioning and quality of life in hoarding: A systematic review

Hoarding, the acquisition and inability to let go of a large number of possessions, has been found to be associated with high levels of impairment that can compromise functioning and quality of life (QoL). Yet few studies have specifically investigated the relationship between hoarding and functioning/QoL. The present review aimed to summarize the current status of research on functioning and QoL in hoarding as well as identify knowledge gaps in the extant literature. We conducted systematic searches in ProQuest, PsycINFO, PubMed and ScienceDirect, and identified 37 relevant articles for inclusion. There was much evidence to indicate that hoarding has a significant impact on various aspects of functioning and that functioning can improve with treatment, though findings on the relationship between hoarding and QoL were more tenuous. The limitations of previous studies and implications of our findings are discussed.

Neuropsychological and neurophysiological insights into hoarding disorder

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

Helping those with hoarding behaviors

Hoarding--the excessive acquisition of and failure to discard possessions, which preclude the appropriate use of living spaces--undermines safety and health by increasing risk for fire, falls, and infections. Hoarding does not result from deprivation early in life, nor are elders with hoarding behaviors merely "thrifty or frugal." Up to 64% of elders with hoarding behaviors have self-care deficits. Comorbid depression, anxiety, alcohol dependence, physical trauma, and damage to the prefrontal and orbitofrontal cortex are common. Hoarding was historically viewed as a variant of obsessive-compulsive disorder (OCD), but compulsive hoarding is a symptom in just 24% of all OCDs. Approximately half of elders with hoarding behaviors suffer from psychiatric conditions, mostly major depression and mood disorders. Treating elders with hoarding behavior in a medical-psychiatric model is a complex matter that may include prescription medication if an underlying condition contributes to the problem. Hoarding behavior results in placement in a nursing facility when squalor poses a health or safety issue.

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

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

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

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

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

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