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Norberg MM, Meares S, Stevenson RJ, Tame J, Wong G, Aldrich P, Olivier J. Attention, response inhibition, and hoarding: A neuropsychological examination. J Behav Addict 2023; 12:827-839. [PMID: 37773748 PMCID: PMC10562813 DOI: 10.1556/2006.2023.00053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/30/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023] Open
Abstract
Background and aims The prominent cognitive-behavioral model of hoarding posits that information processing deficits contribute to hoarding disorder. Although individuals with hoarding symptoms consistently self-report attentional and impulsivity difficulties, neuropsychological tests have inconsistently identified impairments. These mixed findings may be the result of using different neuropsychological tests, tests with poor psychometric properties, and/or testing individuals in a context that drastically differs from their own homes. Methods One hundred twenty-three participants (hoarding = 63; control = 60) completed neuropsychological tests of sustained attention, focused attention, and response inhibition in cluttered and tidy environments in a counterbalanced order. Results Hoarding participants demonstrated poorer sustained attention and response inhibition than the control group (CPT-3 Omission and VST scores) and poorer response inhibition in the cluttered environment than when in the tidy environment (VST scores). CPT-3 Detectability and Commission scores also indicated that hoarding participants had greater difficulty sustaining attention and inhibiting responses than the control group; however, these effect sizes were just below the lowest practically meaningful magnitude. Posthoc exploratory analyses demonstrated that fewer than one-third of hoarding participants demonstrated sustained attention and response inhibition difficulties and that these participants reported greater hoarding severity and greater distress in the cluttered room. Discussion and conclusions Given these findings and other studies showing that attentional difficulties may be a transdiagnostic factor for psychopathology, future studies will want to explore whether greater sustained attention and response inhibition difficulties in real life contexts contribute to comorbidity and functional impairment in hoarding disorder.
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Somma A, Krueger RF, Markon KE, Gialdi G, Di Leva N, Falcone E, Villa M, Frau C, Fossati A. Are problem buying and problem gambling addictive, impulsive, or compulsive in nature? A network analysis and latent dimension analysis study in Italian community-dwelling adults. Psychiatry Res 2023; 321:115100. [PMID: 36774751 DOI: 10.1016/j.psychres.2023.115100] [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: 08/02/2022] [Revised: 01/28/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Prominent scholars suggested that the impulsive-obsessive compulsive continuum may represent a framework to understand both substance and behavioral addictions. However, the characterization of pathological buying (PB) and problem gambling (PG) within the compulsive-impulsive spectrum has not been extensively investigated. To explore the relationships among PB, PG, alcohol and substance abuse, DSM-5 obsessive-compulsive and related disorders, and impulsive dimensions, a sample of 1,005 Italian community-dwelling adult participants (55.5% female), was administered self-reported measures of PB, PG, and other theoretically-relevant constructs. We expected to observe a multidimensional structure in our data; moreover, DSM-5 obsessive compulsive and related disorders were hypothesized to be accounted for by a common dimension. Three dimensions were identified and replicated across two different, non-redundant methods (i.e., exploratory graph analysis and exploratory factor analysis), namely, substance use and gambling, obsessive and compulsive phenomena, and impulsivity dimensions. Specifically, PG seemed to represent a behavioral variant of addiction vulnerability, PB seemed more akin to obsessive-compulsive spectrum disorders, and disinhibition dimension represented the common core of negative urgency, lack of premeditation, lack of perseverance, sensation seeking (SS), and positive urgency. Our findings may be helpful in improving our knowledge on the similarities and differences between PB and PG.
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Affiliation(s)
- Antonella Somma
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Giulia Gialdi
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicole Di Leva
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Università della Svizzera Italiana, Lugano, Switzerland
| | - Elena Falcone
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Università della Svizzera Italiana, Lugano, Switzerland
| | - Marisole Villa
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Università della Svizzera Italiana, Lugano, Switzerland
| | - Claudia Frau
- Università della Svizzera Italiana, Lugano, Switzerlande: ISIPSÉ Institute, Rome, Italy
| | - Andrea Fossati
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.
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Heffernan T, Hamilton C, Neave N. Self-reported memory and executive function in adult non-clinical hoarders. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:153-158. [PMID: 34061688 DOI: 10.1080/23279095.2021.1917578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hoarding is the excessive acquisition of, and failure to discard of, large numbers of items, leading to personal distress. Impairments on memory and executive functions have been systematically associated with hoarding behavior, predominantly focusing upon clinical (mainly middle-aged-elderly) patients with hoarding and/or PTSD. We were interested in hoarding-related memory and executive problems in younger non-clinical hoarders or non-hoarders, based on their Saving Inventory-Revised scores. In total, 113 young adults (aged 18-35 years) were assigned to either a hoarder group (N = 40) or non-hoarder group (N = 73) determined by their scores on the Saving Inventory-Revised (SI-R). Working memory (WM) and inhibition control (IC) were measured using the Adult Executive Functioning Inventory (ADEXI) and the Dysexecutive Questionnaire Revised (DEX-R) measured general executive function (EF). The Hospital Anxiety and Depression Scale measured anxiety and depression. After controlling for gender and anxiety, the analysis revealed that the hoarders reported significantly more problems than the non-hoarders on both the IC and general EF. There was no significant between-group difference on the WM sub-scale ADEXI. Self-reported deficits in IC and EF are associated with hoarding behavior. The IC deficits cold explain hoarders' inability to resist urges to buy, and general EF deficits suggest other domains are involved.
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Affiliation(s)
- Tom Heffernan
- Hoarding Research Group, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Colin Hamilton
- Hoarding Research Group, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nick Neave
- Hoarding Research Group, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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4
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Patel DA, Graupmann V, Ferrari JR. Reactance, Decisional Procrastination, and Hesitation: A Latent Class Analysis of Clutter Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2061. [PMID: 36767429 PMCID: PMC9915205 DOI: 10.3390/ijerph20032061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
During the 2019-2020 global pandemic, mandated time at home suggested engagement in personal projects, such as home decluttering. Clutter (an overabundance of possessions) may impede one's quality of life by interfering with space livability and social connections and prompting negative affect and financial problems. The present study explored action-state orientation, psychological reactance, and decisional procrastination with 227 American adults (M age = 49.9 years old). A latent class analysis tested for differences in cognition across groups. Results supported that persons who struggle with clutter reflect clusters or "classes" given their self-reported cognitive processes, with hesitant and indecisive participants experiencing greater negative impacts of clutter than action-oriented and decisive participants. Our findings suggested improving the decision-making and goal-directed capacities of those struggling with clutter may be effective as preventive and/or interventive strategies. Future research might consider when hesitation to initiate challenging tasks and indecision emerge in the decluttering timeline and how those who are prone to these cognitions may be supported in managing their personal possessions.
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Worden BL, Tolin DF. Co-occurring Obsessive-Compulsive Disorder and Hoarding Disorder: A Review of the Current Literature. J Cogn Psychother 2022; 36:271-286. [PMID: 36635053 DOI: 10.1891/jcp-2021-0010] [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: 01/13/2023]
Abstract
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.
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Affiliation(s)
| | - David F Tolin
- Institute of Living, Hartford, CT.,Yale University School of Medicine, New Haven, CT
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6
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Gong Y, Tan Y, Huang R. Exploring the relationship between dispositional mindfulness and hoarding behavior: A moderated multi-mediation model. Front Psychol 2022; 13:935897. [PMID: 36033020 PMCID: PMC9415804 DOI: 10.3389/fpsyg.2022.935897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Abnormal Relationships Between Functional Connectivity and Emotional State Point Toward Emotional Dysregulation in Hoarding Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:945-946. [PMID: 34625221 DOI: 10.1016/j.bpsc.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
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8
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David J, Visvalingam S, Norberg MM. Why did all the toilet paper disappear? Distinguishing between panic buying and hoarding during COVID-19. Psychiatry Res 2021; 303:114062. [PMID: 34175712 PMCID: PMC8520319 DOI: 10.1016/j.psychres.2021.114062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/12/2021] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic led to panic buying in many countries across the globe, preventing vulnerable groups from accessing important necessities. Some reports inaccurately referred to the panic buying as hoarding. Although hoarding is a separate issue characterised by extreme saving behaviour, the two problems may be influenced by similar factors. Participants from Australia and the United States (final N = 359) completed online self-report measures of panic buying, hoarding, shopping patterns, perceived scarcity, COVID-19 illness anxiety, selfishness, and intolerance of uncertainty. Our findings showed that panic buying was related to hoarding symptoms (r's = .23 - .36), and yet, both were uniquely associated with different psychological factors. Whilst panic buying was most strongly related to greater perceived scarcity (r's = .38 - .60), hoarding was most related to a general intolerance of uncertainty (r's = .24 - .57). Based on our findings, future strategies to prevent panic buying should focus on reducing perceived scarcity cues in the community, as this seems to be the primary driver of panic buying. Another preventative strategy to reduce excessive acquiring and saving may be to implement educational programs to increase people's ability to tolerate distress and uncertainty.
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Affiliation(s)
- Jonathan David
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, NSW, Australia
| | - Shanara Visvalingam
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, NSW, Australia
| | - Melissa M Norberg
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, NSW, Australia.
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9
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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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10
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Li JB, Zhang R, Wang LX, Dou K. Chinese public's panic buying at the beginning of COVID-19 outbreak: The contribution of perceived risk, social media use, and connection with close others. CURRENT PSYCHOLOGY 2021; 41:8157-8166. [PMID: 34334986 PMCID: PMC8300064 DOI: 10.1007/s12144-021-02072-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 01/31/2023]
Abstract
Panic buying is a globally witnessed behavior during the outbreak of COVID-19. This consumer behavior is related to many undesirable consequences, ranging from disrupting economic stability to hindering timely provision of supplies to those in dire need. As such, to understand the causes and underlying mechanisms of panic buying is crucial. Based on terror management theory, this study examined the contribution of perceived risk, social media use, and connection with close others to panic buying. Data were collected through an online survey from 972 Chinese citizens (65.9% female, M age = 33.69 years) at the beginning period of COVID-19 in early February 2020. The results found that individuals with a higher level of perceived risk were more prone to engage in panic buying, but this link was mitigated by connection with close others when individuals less used social media. Theoretically, this study advances the understandings of the psychological processes of panic buying during health crisis. Practically, alleviating individuals' perceived risk, establishing a healthy habit of social media use, and strengthening social ties are important to circumventing panic buying in times of COVID-19.
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Affiliation(s)
- Jian-Bin Li
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rui Zhang
- Department of Psychology and Research Center of Adolescent Psychology and Behavior, School of Education, Guangzhou University, Guangzhou, 510006 China
- Developmental and Educational Psychology, Institute of Education, University College London, London, UK
| | - Lin-Xin Wang
- Department of Psychology and Research Center of Adolescent Psychology and Behavior, School of Education, Guangzhou University, Guangzhou, 510006 China
| | - Kai Dou
- Department of Psychology and Research Center of Adolescent Psychology and Behavior, School of Education, Guangzhou University, Guangzhou, 510006 China
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11
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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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12
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Abstract
Hoarding and squalor are complex conditions with a range of physical and mental comorbidities GPs play a key role in identifying people who experience these conditions, screening for safety risks, referral to specialist services and encouraging people to accept treatment and ongoing monitoring. Treatment for contributing and comorbid conditions should be optimised, with the help of specialist services when required. Medicines should be reviewed and adherence confirmed For moderate to severe hoarding and squalor, referral to specialist psychiatry, geriatrics and allied health services is recommended for thorough assessment, treatment of underlying conditions and ongoing management.
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Affiliation(s)
- Andrew Gleason
- Department of Consultation Liaison Psychiatry, Concord Repatriation General Hospital, Sydney.,Melbourne Dementia Research Centre, Florey Institute of Neuroscience and Mental Health, Melbourne.,Hoarding and Squalor Service, Sydney Local Health District, Mental Health Service, Marrickville Health Centre, Sydney.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney.,Discipline of Psychiatry, School of Medicine, University of NSW, Sydney.,Older Persons' Mental Health, Concord Centre for Mental Health, Sydney
| | - Danielle Perkes
- Department of Consultation Liaison Psychiatry, Concord Repatriation General Hospital, Sydney.,Melbourne Dementia Research Centre, Florey Institute of Neuroscience and Mental Health, Melbourne.,Hoarding and Squalor Service, Sydney Local Health District, Mental Health Service, Marrickville Health Centre, Sydney.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney.,Discipline of Psychiatry, School of Medicine, University of NSW, Sydney.,Older Persons' Mental Health, Concord Centre for Mental Health, Sydney
| | - Anne Pf Wand
- Department of Consultation Liaison Psychiatry, Concord Repatriation General Hospital, Sydney.,Melbourne Dementia Research Centre, Florey Institute of Neuroscience and Mental Health, Melbourne.,Hoarding and Squalor Service, Sydney Local Health District, Mental Health Service, Marrickville Health Centre, Sydney.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney.,Discipline of Psychiatry, School of Medicine, University of NSW, Sydney.,Older Persons' Mental Health, Concord Centre for Mental Health, Sydney
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13
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David J, Blonner M, Forbes MK, Norberg MM. Motives for acquiring and saving and their relationship with object attachment. Curr Opin Psychol 2021; 39:1-5. [PMID: 32777684 DOI: 10.1016/j.copsyc.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/09/2020] [Indexed: 11/21/2022]
Abstract
Motives for acquiring and saving objects are closely linked to object attachment, but the nature of these associations has not been established. A better understanding of the motives for acquiring and saving possessions and how they relate to object attachment may reveal insights into the underpinnings of hoarding disorder. In turn, these insights can aid in identifying optimal targets for interventions for hoarding problems. In this paper, we propose a simple theoretical model of the dynamic associations among motives to acquire objects, object attachment, and motives to save objects, grounded in a review of the extant literature. Our hope is that this model provides a useful framework to structure future research.
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Affiliation(s)
- Jonathan David
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, NSW, Australia
| | - Marika Blonner
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, NSW, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, NSW, Australia
| | - Melissa M Norberg
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, NSW, Australia.
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Nutley SK, Bertolace L, Vieira LS, Nguyen B, Ordway A, Simpson H, Zakrzewski J, Camacho MR, Eichenbaum J, Nosheny R, Weiner M, Mackin RS, Mathews CA. Internet-based hoarding assessment: The reliability and predictive validity of the internet-based Hoarding Rating Scale, Self-Report. Psychiatry Res 2020; 294:113505. [PMID: 33070108 PMCID: PMC8080473 DOI: 10.1016/j.psychres.2020.113505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
The Hoarding Rating Scale, Self Report (HRS-SR) is a 5-item assessment developed to ascertain the presence and severity of hoarding symptoms. This study aimed to evaluate the validity of an online adaptation of the HRS-SR in a remote, unsupervised internet sample of 23,214 members of the Brain Health Registry (BHR), an online research registry that evaluates and longitudinally monitors cognition, medical and psychiatric health status. Convergent validity was assessed among a sub-sample of 1,183 participants who completed additional, remote measures of self-reported hoarding behaviors. Structured clinical interviews conducted in-clinic and via video conferencing tools were conducted among 230 BHR participants; ROC curves were plotted to assess the diagnostic performance of the internet-based HRS-SR using best estimate hoarding disorder (HD) diagnoses as the gold standard. The area under the curve indicated near-perfect model accuracy, and was confirmed with 10-fold cross validation. Sensitivity and specificity for distinguishing clinically relevant hoarding were optimized using an HRS-SR total score cut-off of 5. Longitudinal analyses indicated stability of HRS-SR scores over time. Findings indicate that the internet-based HRS-SR is a useful and valid assessment of hoarding symptoms, though additional research using samples with more diverse hoarding behavior is needed to validate optimal cut-off values.
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Affiliation(s)
- 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
| | - Luis Sordo Vieira
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Binh Nguyen
- 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
| | - Monica R Camacho
- San Francisco VA Medical Center, San Francisco, California, United States
| | - Joseph Eichenbaum
- San Francisco VA Medical Center, San Francisco, California, United States; Department of Radiology, University of California, San Francisco, San Francisco, California, United States
| | - Rachel Nosheny
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States
| | - Michael Weiner
- Department of Radiology, University of California, San Francisco, San Francisco, California, United States; Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States
| | - R Scott Mackin
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States; Department of Mental Health, Veterans Affairs Medical Center, San Francisco, California, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States.
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15
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Lauderdale SA, Oakes K. Factor Structure of the Revised Indecisiveness Scale and Association with Risks for and Symptoms of Anxiety, Depression, and Attentional Control. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2020. [DOI: 10.1007/s10942-020-00372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Liu TW, Lam SC, Chung MH, Ho KHM. Adaptation and psychometric testing of the hoarding rating scale (HRS): a self-administered screening scale for epidemiological study in Chinese population. BMC Psychiatry 2020; 20:159. [PMID: 32290825 PMCID: PMC7155259 DOI: 10.1186/s12888-020-02539-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hoarding disorder is a chronic and debilitating illness associated with restrictions on activities of daily living, compromised social and occupational functioning, and adverse health outcomes. However, researchers lack a brief and self-administered screening measurement to assess compulsive hoarding in the Chinese speaking population. This study aimed to adapt and validate the Hoarding Rating Scale-Interview (HRS-I) to as a tool for screening compulsive hoarding behavior in Chinese population. METHODS This study comprised two phases. During Phase 1, the English-language HRS-I was translated into Chinese (CHRS) (comprehensible for most Chinese speaking population, e.g., Cantonese & Mandarin) and subjected to an equivalence check. In Phase 2, the CHRS was validated by examining internal consistency, stability, and construct validity. Different samples were used appropriately to verify the items and reflect the psychometric properties. RESULTS In Phase 1, the CHRS yielded satisfactory content (S-CVI = 0.93) and face validity ratings (comprehensibility = 100%, N = 20 participants of general public with age 18-72) and the English and Chinese versions were found to be equivalent (ICC = 0.887; N = 60 university staff and students). Phase 2 revealed satisfactory levels of internal consistency (Cronbach's α = 0.86; corrected item-total correlation = 0.60-0.74; N = 820 participants of general public), 2-week test-retest reliability (ICC = 0.78; N = 60 university students), and construct validity (one-factor CFA solution matched with the hypothesized model, χ2/d.f. = 2.26, RMSEA = 0.049, CFI = 0.99, IFI = 0.99, NFI = 0.99; n = 520 participants of general public). CONCLUSIONS This study provides sufficient evidence of the reliability and validity of the CHRS for compulsive hoarding behavior screening in the Chinese population through self-administered method.
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Affiliation(s)
- Tai Wa Liu
- grid.445014.00000 0000 9430 2093School of Nursing and Health Studies, The Open University of Hong Kong, Ho Man Tin, Hong Kong SAR, China ,grid.16890.360000 0004 1764 6123Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Simon Ching Lam
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
| | - Man Hon Chung
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Ken Hok Man Ho
- grid.462932.80000 0004 1776 2650School of Nursing, Tung Wah College, Ho Man Tin, Hong Kong SAR, China
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Timpano KR, Bainter SA, Goodman ZT, Tolin DF, Steketee G, Frost RO. A Network Analysis of Hoarding Symptoms, Saving and Acquiring Motives, and Comorbidity. J Obsessive Compuls Relat Disord 2020; 25:100520. [PMID: 36212770 PMCID: PMC9544394 DOI: 10.1016/j.jocrd.2020.100520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hoarding disorder is marked by strong attachments to everyday objects, extreme difficulties discarding, and impairing levels of clutter. We examined the associations between hoarding symptoms and associated clinical features using network analysis in a large sample of individuals with established hoarding disorder (n=217) and matched healthy controls (n=130). Network nodes included the three core features of hoarding (difficulties discarding, clutter, and acquiring), along with comorbid symptoms, impairment, and saving and acquiring motives. Models showed hoarding and comorbid symptoms as separate syndromes. Healthy and patient networks differed significantly in both global network strength and structure. For the hoarding patient network, the comorbidity and hoarding clusters were connected by acquiring and anxiety, which served as bridge symptoms. Clutter was the only hoarding node associated with impairment. Hoarding beliefs were not central to the model, and only difficulties discarding was associated with saving and acquiring motives, including emotional attachment and wastefulness beliefs. Our findings indicate that the network approach to mental disorders provides a new and complementary way to improve our understanding of the etiological model of hoarding, and may present novel hypotheses to examine in treatment development research.
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Affiliation(s)
| | | | | | - David F. Tolin
- Institute of Living and Yale University School of Medicine
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18
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Piacentino D, Pasquini M, Cappelletti S, Chetoni C, Sani G, Kotzalidis GD. Pharmacotherapy for Hoarding Disorder: How did the Picture Change since its Excision from OCD? Curr Neuropharmacol 2020; 17:808-815. [PMID: 30678629 PMCID: PMC7059160 DOI: 10.2174/1570159x17666190124153048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 01/10/2023] Open
Abstract
This brief review deals with the various issues that contributed to the creation of the new Diagnostic and Statistical Manual condition of hoarding disorder (HD) and attempts at reviewing its pharmacotherapy. It appears that after the newly founded diagnosis appeared in the literature as an autonomous entity, distinct from obsessive-compulsive disorder, drug trials are not being conducted and the disorder is left in the hands of psychotherapists, who on their part, report fair results in some core dimensions of HD. The few trials on HD specifically regard the serotonin-noradrenaline reuptake inhibitor venlafaxine, and, possibly due to the suggestion of a common biological background of HD with attention-deficit/hyperactivity disorder, the psychostimulant methylphenidate and the noradrenaline reuptake inhibitor atomoxetine. For all these drugs, positive results have been reported, but the evidence level of these studies is low, due to small samples and non-blind designs. Regretfully, there are currently no future studies aiming at seriously testing drugs in HD.
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Affiliation(s)
- Daria Piacentino
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA) Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse (NIDA) Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
| | - Massimo Pasquini
- Department of Neurosciences, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Simone Cappelletti
- Anatomical, Histological, Forensic Medicine, and Orthopedic Sciences (SAIMLAL) Department, Sapienza University, Rome, Italy
| | - Chiara Chetoni
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
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19
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Stevens MC, Levy HC, Hallion LS, Wootton BM, Tolin DF. Functional Neuroimaging Test of an Emerging Neurobiological Model of Hoarding Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:68-75. [PMID: 31676206 DOI: 10.1016/j.bpsc.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Over the past decade, functional neuroimaging studies have found abnormal brain function in several cortical systems when patients with compulsive hoarding behaviors make decisions about personal possessions. The purpose of this study was to use functional magnetic resonance imaging to test a neurobiological model of hoarding disorder (HD) that has begun to emerge from these small studies by confirming HD-related brain dysfunction in previously implicated brain regions in the largest sample of HD patients examined to date. METHODS We compared 79 adults diagnosed with DSM-5 HD with 44 non-HD control participants using a functional magnetic resonance imaging task of decision making to acquire or discard material possessions and on a control task involving semantic processing. RESULTS HD brain activation profiles prominently featured insular and anterior cingulate cortex overengagement during possession-related choices that were not seen in non-HD brain activation profiles and also correlated with hoarders' clutter and difficulty discarding. Although HD patients overengaged the insula when deciding to discard, relative to when performing the non-decision making task contrast, the HD insula also was generally blunted. CONCLUSIONS This study links the defining behavioral symptoms of HD to localized brain dysfunction within cingulo-opercular brain systems and firmly establishes the context-dependent importance of this network dysfunction in HD. The relevance of dysfunction in these brain regions is highlighted by a failure to replicate HD-related abnormalities in other brain regions implicated in prior HD functional magnetic resonance imaging studies. This study also raises the novel possibility that HD may involve abnormality in the inferior frontal cortex engaged for executive control over semantic processing.
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Affiliation(s)
- Michael C Stevens
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Hannah C Levy
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut
| | - Lauren S Hallion
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bethany M Wootton
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David F Tolin
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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20
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Rozenman M, McGuire J, Wu M, Ricketts E, Peris T, O'Neill J, Bergman RL, Chang S, Piacentini J. Hoarding Symptoms in Children and Adolescents With Obsessive-Compulsive Disorder: Clinical Features and Response to Cognitive-Behavioral Therapy. J Am Acad Child Adolesc Psychiatry 2019; 58:799-805. [PMID: 30877053 PMCID: PMC6658336 DOI: 10.1016/j.jaac.2019.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/22/2018] [Accepted: 01/23/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Although adult hoarding disorder is relatively common and often debilitating, few studies have examined the phenomenology of pediatric hoarding. We examined the clinical phenomenology and response to cognitive-behavioral therapy (CBT) treatment in youths with a diagnosis of obsessive-compulsive disorder (OCD) with and without hoarding symptoms. Age was tested as a moderator across analyses, given prior findings that the impact of hoarding symptoms may not become apparent until adolescence. METHOD Youths (N = 215; aged 7-17 years) with OCD pursuing evaluation and/or treatment at a university-based specialty clinic participated in the current study. Presence of hoarding symptoms was assessed as part of a larger battery. Data from a subset of youths (n = 134) who received CBT were included in treatment response analyses. RESULTS Youths with hoarding symptoms did not differ from those without hoarding symptoms with respect to overall OCD symptom severity and impairment. Youths with hoarding met criteria for more concurrent diagnoses, including greater rates of internalizing and both internalizing/externalizing, but not externalizing-only, disorders. Youths with and without hoarding symptoms did not significantly differ in rate of response to CBT. Age did not moderate any of these relationships, suggesting that the presence of hoarding symptoms was not associated with greater impairments across the clinical presentation of OCD or its response to treatment by age. CONCLUSION We found no evidence that hoarding is associated with greater OCD severity or poorer treatment response in affected youth. Theoretical and clinical implications of these findings, including future directions for research on testing developmental models of hoarding across the lifespan, are discussed.
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Affiliation(s)
- Michelle Rozenman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA; University of Denver, CO.
| | | | - Monica Wu
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Emily Ricketts
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Tara Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - R Lindsey Bergman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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21
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Novara C, Cavedini P, Dorz S, Pardini S, Sica C. Structured Interview for Hoarding Disorder (SIHD). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2019. [DOI: 10.1027/1015-5759/a000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The Structured Interview for Hoarding Disorder (SIHD) is a semi-structured interview designed to assist clinicians in diagnosing a hoarding disorder (HD). This study aimed to validate the Italian version of the SIHD. For this purpose, its inter-rater reliability has been analyzed as well as its ability to differentiate HD from other disorders often comorbid. The sample was composed of 74 inpatients who had been diagnosed within their clinical environment: 9 with HD, 11 with obsessive-compulsive disorder (OCD) and HD, 22 with OCD, 19 with major depressive disorder (MDD), and 13 with schizophrenia spectrum disorders (SSD). The results obtained indicated “substantial” or “perfect” inter-rater reliability for all the core HD criteria, HD diagnosis, and specifiers. The SIHD differentiated between subjects suffering from and not suffering from a HD. Finally, the results indicated “good” convergent validity and high scores were shown in terms of both sensitivity and specificity for HD diagnosis. Altogether, the SIHD represents a useful instrument for evaluating the presence of HD and is a helpful tool for the clinician during the diagnostic process.
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Affiliation(s)
- Caterina Novara
- Dipartimento di Psicologia Generale, Università degli Studi di Padova, Italy
| | - Paolo Cavedini
- Dipartimento di Neuroscienze Cliniche, Villa S. Benedetto Menni, Como, Italy
| | | | - Susanna Pardini
- Dipartimento di Psicologia Generale, Università degli Studi di Padova, Italy
| | - Claudio Sica
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze, Italy
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22
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Zaboski BA, Merritt OA, Schrack AP, Gayle C, Gonzalez M, Guerrero LA, Dueñas JA, Soreni N, Mathews CA. Hoarding: A meta-analysis of age of onset. Depress Anxiety 2019; 36:552-564. [PMID: 30958911 DOI: 10.1002/da.22896] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/28/2019] [Accepted: 03/22/2019] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Brian A Zaboski
- Department of Psychiatry, Division of Psychology, Gainesville, Florida.,Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Olivia A Merritt
- Department of Psychiatry and Behavioral Neurosciences, Pediatric OCD Consultation Service, Anxiety Treatment and Research Clinic, McMaster University, Hamilton, Ontario
| | - Anna P Schrack
- Department of Psychiatry, Division of Psychology, Gainesville, Florida.,Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Cindi Gayle
- Department of Psychiatry, Division of Psychology, Gainesville, Florida
| | - Melissa Gonzalez
- Department of Psychiatry, Division of Psychology, Gainesville, Florida.,Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Lisa A Guerrero
- Department of Psychiatry, Division of Psychology, Gainesville, Florida.,Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Julisa A Dueñas
- Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Noam Soreni
- Department of Psychiatry and Behavioral Neurosciences, Pediatric OCD Consultation Service, Anxiety Treatment and Research Clinic, McMaster University, Hamilton, Ontario
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida
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23
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Levy HC, Frost RO, Offermann EA, Steketee G, Tolin DF. A Comparison of Cognitive Restructuring and Thought Listing for Excessive Acquiring in Hoarding Disorder. COGNITIVE THERAPY AND RESEARCH 2019; 43:1065-1074. [PMID: 31819299 DOI: 10.1007/s10608-019-10022-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Excessive acquiring is a common symptom of hoarding disorder (HD). Little is known about subjective distress associated with acquiring in HD. The present study examined acquiring- related distress and reactions to cognitive restructuring (CR) in 92 individuals with HD and 66 community control (CC) participants. All participants identified an item of interest at a high-risk acquiring location and then decided whether or not to acquire the item. HD participants completed the acquiring task while receiving a CR-based intervention or a thought-listing (TL) control condition. Results showed that HD participants reported more severe distress and greater urges to acquire the item of interest than did CC participants. Nevertheless, subjective distress decreased in both groups following the acquiring task. There were no differences in acquiring- related distress between the CR and TL conditions. The findings indicate that subjective distress may decrease after relatively short periods of time in individuals with HD, but that a single session of CR may not alleviate acquiring-related distress in HD participants.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living, Hartford, CT
| | - Randy O Frost
- Department of Psychology, Smith College, Northampton, MA
| | - Elizabeth A Offermann
- Department of Psychology, Smith College, Northampton, MA.,Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD
| | | | - David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, CT.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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25
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Levy HC, Stevens MC, Tolin DF. Validation of a Behavioral Measure of Acquiring and Discarding in Hoarding Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019; 41:135-143. [PMID: 31105379 PMCID: PMC6516472 DOI: 10.1007/s10862-018-9701-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Behavioral assessment is an important component of evidence-based assessment and treatment in anxiety and related disorders. The purpose of the current study was to validate a behavioral measure of difficulty discarding and acquiring, the core features of hoarding disorder (HD). Seventy-eight patients with a primary diagnosis of HD completed a computerized acquiring and discarding task; the task consisted of making simulated decisions about acquiring and discarding items of varying monetary value. A subset of patients (n = 42) went on to receive cognitive behavioral therapy (CBT) for HD and completed the computer tasks again after treatment. An additional 30 age- and sex-matched healthy control participants (HCs) also completed the acquiring and discarding tasks. Results showed that HD patients saved and acquired more items than the HC group, and had longer response times during the tasks. In support of the convergent validity of the tasks, item decisions and reaction times were positively correlated with established measures of HD symptoms. Among treatment completers, items saved and acquired and response times decreased from pre- to post-CBT, suggesting that the tasks were sensitive to detect treatment-related changes in difficulty discarding and acquiring behaviors. The findings support the validity of the discarding and acquiring tasks in measuring HD symptoms, and are discussed in terms of the potential advantages of behavioral measures in HD treatment and research.
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Affiliation(s)
- Hannah C. Levy
- Anxiety Disorders Center, Institute of Living, Hartford Hospital 200 Retreat Avenue, Hartford, CT 06106
| | - Michael C. Stevens
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital 200 Retreat Avenue, Hartford, CT 06106
| | - David F. Tolin
- Anxiety Disorders Center, Institute of Living, Hartford Hospital 200 Retreat Avenue, Hartford, CT 06106
- Department of Psychiatry, Yale University School of Medicine
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26
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Discarding personal possessions increases psychophysiological activation in patients with hoarding disorder. Psychiatry Res 2019; 272:499-506. [PMID: 30616116 DOI: 10.1016/j.psychres.2018.12.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/11/2018] [Accepted: 12/29/2018] [Indexed: 11/23/2022]
Abstract
Difficulty discarding is the core behavioral symptom of hoarding disorder (HD). Patients with HD report greater subjective distress when discarding their own possessions as compared to others' possessions. To date, no prior studies have examined psychophysiological activation, an objective measure of anxious arousal, during discarding among individuals with HD. The current study assessed psychophysiological responses during a baseline resting period and two discarding tasks, one involving personal possessions and the other involving matched control ("experimenter-owned") items in 52 patients with a primary diagnosis of HD. Results showed that, compared to discarding control items, discarding personal possessions increased skin conductance and heart rate and decreased end tidal carbon dioxide. There were no differences in heart rate variability, respiratory sinus arrhythmia, and respiration rate between the two discarding tasks. Despite the fact that discarding increased psychophysiological arousal, self-reported HD symptoms (including difficulty discarding) failed to predict psychophysiological responses during the discarding tasks. The findings suggest that there may be discordance between objective and subjective measures of hoarding-related distress, and are discussed in terms of incorporating psychophysiological measures into the assessment and treatment of HD.
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27
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Pertusa A, Lopez Gaston R, Choudry A. Hoarding revisited: there is light at the end of the living room. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSince 2013, hoarding disorder has been recognised as a standalone diagnosis in the DSM, affecting an estimated 2–6% of the general population. This article outlines the arguments for and against this separate classification and considers the differentiation of hoarding disorder from normative collecting. It then discusses aetiology, assessment, course and treatment (both psychological and pharmacological interventions). It concludes with a discussion of ethical and legal considerations, in particular the fact that the inclusion of hoarding disorder as a distinct diagnosis in DSM-5 confers specific protections for people with the disorder under the Equality Act 2010.LEARNING OBJECTIVES•Be able to define the criteria of hoarding disorder•Be able to recognise the difference between hoarding and collecting•Understand potential treatment options for patients with hoarding disorderDECLARATION OF INTERESTNone.
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Abstract
BACKGROUND AND AIMS People who hoard form intense attachments to their possessions and save items for sentimental and instrumental reasons. Feeling socially excluded may encourage these individuals to anthropomorphize objects (i.e., perceive them as human-like) to fulfill unmet belonging needs, which may increase the sentimental and instrumental values of objects, and then lead to stronger object attachment. METHODS We randomly assigned 331 participants with excessive acquisition tendencies to be excluded, included, or overincluded in an online ball-tossing game before presenting them with five objects that had human characteristics. Participants then completed measures assessing anthropomorphism, sentimental and instrumental values, and object attachment. RESULTS Inconsistent with this study hypothesis, socially excluded participants did not rate unowned objects as more human-like than the included or overincluded participants; however, stronger anthropomorphism predicted greater instrumental and sentimental values, which then predicted greater object attachment. DISCUSSION AND CONCLUSIONS Sentimental and instrumental values may explain how stronger anthropomorphism may lead to greater object attachment. Learning that leads to anthropomorphism may help us better understand object attachment.
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Affiliation(s)
- Cathy Kwok
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Jessica R. Grisham
- School of Psychology, University of New South Wales, Kensington, NSW, Australia
| | - Melissa M. Norberg
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia,Corresponding author: Melissa M. Norberg; Department of Psychology, Centre for Emotional Health, Macquarie University, Bldg C3A, Room 714, Sydney 2109, NSW, Australia; Phone: +61 2 9850 8127; E-mail:
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29
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Prevalence of hoarding behaviours and excessive acquisition in users of online classified advertisements. Psychiatry Res 2018; 270:194-197. [PMID: 30261409 DOI: 10.1016/j.psychres.2018.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022]
Abstract
An estimated 2-6% of the general population is thought to suffer from clinically significant hoarding symptoms, with 80-90% engaging in excessive acquisition. Minimal research has examined the excessive acquisition component of hoarding disorder (HD). Many individuals with HD have limited insight into their condition and are reluctant to seek help, making prevalence estimates difficult to obtain. Online classified advertisement networks provide a venue to list items for sale, often for free. We examined the prevalence of hoarding behaviours among users of online classified advertisements. A link to an online survey was posted between June 26, 2015-March 10, 2017. Participants provided demographic information and completed the Hoarding Rating Scale (HRS); individuals with clinically significant hoarding (High HRS) also completed the Saving Inventory-Revised (SI-R) and Clutter Image Rating (CIR). Feedback regarding hoarding behaviours was provided. The survey was completed by 729 adults and 12.3% (n = 90) self-identified as experiencing clinically significant hoarding as per the HRS (High HRS). Of those in the High HRS group, most (66.7%) were categorized to the 'high acquisition' group based on the SI-R excessive acquisition subscale. Overall this sample revealed high rates of significant hoarding behaviours, almost double that of community samples. Excessive acquisition was prominent and associated with greater hoarding severity, highlighting the need to further study this specifier.
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30
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Kim HS, Hodgins DC, Torres AR, Fontenelle LF, do Rosário MC, de Mathis MA, Ferrão YA, Miguel EC, Tavares H. Dual diagnosis of obsessive compulsive and compulsive buying disorders: Demographic, clinical, and psychiatric correlates. Compr Psychiatry 2018; 86:67-73. [PMID: 30081209 DOI: 10.1016/j.comppsych.2018.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/14/2018] [Accepted: 07/18/2018] [Indexed: 01/22/2023] Open
Abstract
AIM The present research assessed the rates as well as the demographic, clinical, and psychiatric correlates associated with comorbid obsessive-compulsive disorder (OCD) and compulsive buying disorder (CBD). METHOD Participants were drawn from a large (N = 993) multi-center study of people seeking treatment for their OCD. The diagnoses of psychiatric disorders were made using the Structured Clinical Interview for DSM by registered psychologists and psychiatrists. The clinical correlates, including the severity and presence of OCD symptoms and dimensions were assessed using psychometrically sound measures. RESULTS 75 (7.5%) participants met criteria for comorbid CBD. The results of binary logistic regression found that women were more likely to present with comorbid CBD, whereas being a student was a protective factor. The presence of hoarding dimension, poorer insight, social phobia, binge eating disorder, internet use disorder and kleptomania were significantly associated with comorbid CBD. CONCLUSION The results suggest that individuals with a dual diagnosis of OCD and CBD may represent a unique clinical population that warrants tailored interventions. Specifically, they were more likely to present with other psychiatric disorders characterized by high levels of impulsivity and compulsivity. Targeting psychological mechanisms common to impulsivity-compulsivity disorders may enhance treatment utility in this dual-diagnosis population.
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Affiliation(s)
- Hyoun S Kim
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
| | - David C Hodgins
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Albina R Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Leonardo F Fontenelle
- Obsessive, Compulsive and Anxiety Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Brain and Mental Health Laboratory (BMH), Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Maria Conceição do Rosário
- Child and Adolescent Psychiatry Unit (UPIA) at the Department of Psychiatry, Federal University of São Paulo, Brazil; Child Study Center at Yale University, New Haven, CT, USA
| | | | - Ygor A Ferrão
- Department of Psychiatry, Health Sciences Federal University of Porto Alegre, Brazil
| | - Euripedes C Miguel
- Department of Psychiatry, University of São Paulo Medical School, Brazil
| | - Hermano Tavares
- Department of Psychiatry, University of São Paulo Medical School, Brazil; Impulse Control Disorders Outpatient Unit, Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, SP, Brazil
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La Buissonnière-Ariza V, Wood JJ, Kendall PC, McBride NM, Cepeda SL, Small BJ, Lewin AB, Kerns C, Storch EA. Presentation and Correlates of Hoarding Behaviors in Children with Autism Spectrum Disorders and Comorbid Anxiety or Obsessive-Compulsive Symptoms. J Autism Dev Disord 2018; 48:4167-4178. [PMID: 29974314 DOI: 10.1007/s10803-018-3645-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Valérie La Buissonnière-Ariza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Jeffrey J Wood
- Departments of Education and Psychiatry, UCLA, Los Angeles, Los Angeles, CA, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Nicole M McBride
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sandra L Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Adam B Lewin
- Department of Psychiatry and Behavioral Sciences, University of South Florida, Tampa, FL, USA
| | - Connor Kerns
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA.
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
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Nordsletten AE, Fernández de la Cruz L, Aluco E, Alonso P, López-Solà C, Menchón JM, Nakao T, Kuwano M, Yamada S, Fontenelle LF, Campos-Lima AL, Mataix-Cols D. A transcultural study of hoarding disorder: Insights from the United Kingdom, Spain, Japan, and Brazil. Transcult Psychiatry 2018; 55:261-285. [PMID: 29508639 DOI: 10.1177/1363461518759203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Though problematic hoarding is believed to be a universal human behavior, investigations of clinically-defined hoarding disorder (HD) have been confined almost exclusively to Western countries. The current investigation sought to describe and directly compare the features of individuals meeting diagnostic criteria for HD across four distinct cultural settings. Participants were 82 individuals meeting DSM-5 diagnostic criteria for HD, recruited and assessed by trained clinicians at one of four project sites: London, Barcelona, Fukuoka, and Rio de Janeiro. A series of semi-structured interviews and self-report scales were administered, including assessments of socio-demographic characteristics, psychiatric comorbidity, and severity of hoarding and related features. Results indicate that the severity and core features of HD, as well as the cognitions and behaviors commonly associated with this condition, are largely stable across cultures. However, some differences in patient demographics-in particular age, marital status, and clinical expression-as well as comorbid psychiatric features also emerged. These findings confirm that HD, as defined in DSM-5, exists and presents with similar phenomenology across the studied cultures. Future, more fine-grained, research will be needed to study the features of the disorder in additional cultures (e.g., non-industrialized nations) and to evaluate the impact of these cultural aspects on the design of interventions for the disorder.
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Affiliation(s)
| | | | | | - Pino Alonso
- Hospital de Bellvitge.,Bellvitge Biomedical Research Institute-IDIBELL.,CIBERSAM Instituto de Salud Carlos III.,University of Barcelona
| | - Clara López-Solà
- Hospital Universitari Parc Taulí.,CIBERSAM Instituto de Salud Carlos III
| | - José M Menchón
- 16383 Hospital de Bellvitge , Spain.,Bellvitge Biomedical Research Institute-IDIBELL.,CIBERSAM Instituto de Salud Carlos III.,University of Barcelona
| | | | | | | | - Leonardo F Fontenelle
- Institute of Psychiatry of the Federal University of Rio de Janeiro.,Monash University, Australia and D'Or Institute for Research and Education
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Norberg MM, Crone C, Kwok C, Grisham JR. Anxious attachment and excessive acquisition: The mediating roles of anthropomorphism and distress intolerance. J Behav Addict 2018; 7:171-180. [PMID: 29444605 PMCID: PMC6035017 DOI: 10.1556/2006.7.2018.08] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 01/16/2023] Open
Abstract
Background and aims Most individuals with hoarding disorder (HD) are prone to excessively acquiring new possessions. Understanding the factors that contribute to this collecting behavior will allow us to develop better treatment approaches for HD. The aim of this study was to test our assumption that an anxious attachment style is associated with a tendency to anthropomorphize comforting objects and an inability to tolerate distress, which in turn leads to excessive acquisition. Methods A total of 361 participants with subclinical to clinical acquisition problems (77.8% female) completed a series of self-report measures. Results As expected, greater anxious attachment was related to greater distress intolerance and stronger tendencies to anthropomorphize inanimate objects. In turn, greater distress intolerance and anthropomorphism were related to more excessive buying and greater acquisition of free items. Examination of the pathways and indirect effects showed support for double mediation rather than serial mediation, as distress intolerance did not predict anthropomorphism. Discussion and conclusion These novel findings, if replicated, suggest that adding treatment modules that target improving distress tolerance and reducing anthropomorphism to standard treatment for HD may lead to further reductions in excessive acquiring.
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Affiliation(s)
- Melissa M. Norberg
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Cassandra Crone
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Cathy Kwok
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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Tolin DF, Levy HC, Wootton BM, Hallion LS, Stevens MC. Hoarding Disorder and Difficulties in Emotion Regulation. J Obsessive Compuls Relat Disord 2018; 16:98-103. [PMID: 30828541 PMCID: PMC6391883 DOI: 10.1016/j.jocrd.2018.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- David F. Tolin
- Institute of Living, Hartford, CT
- Yale University School of Medicine
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35
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Lee SP, Ong C, Sagayadevan V, Ong R, Abdin E, Lim S, Vaingankar J, Picco L, Verma S, Chong SA, Subramaniam M. Hoarding symptoms among psychiatric outpatients: confirmatory factor analysis and psychometric properties of the Saving Inventory - Revised (SI-R). BMC Psychiatry 2016; 16:364. [PMID: 27784281 PMCID: PMC5081881 DOI: 10.1186/s12888-016-1043-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The growing interest in problematic hoarding as an independent clinical condition has led to the development of the Saving Inventory-Revised (SI-R) to assess hoarding phenomenology. The SI-R is one of the most widely used instruments to measure hoarding symptoms; however, it lacks validation in non-Western samples. METHODS The current study examined the construct, convergent, and discriminant validity of the SI-R among 500 outpatients at a psychiatric hospital in Singapore. The three-factor structure solution of the SI-R was fitted in a confirmatory factor analysis. RESULTS The final model achieved mediocre fit (χ2 = 1026.02, df = 186; RMSEA = 0.095, SRMR = 0.06; CFI = 0.86; NNFI = 0.85). Two reverse-coded items (items 2 and 4) were removed due to insufficient factor loadings, resulting in the modified 21-item SI-R (SIR-21). Our findings indicate the need to further examine the construct validity of the SI-R, particularly in non-Western samples. Nonetheless, correlations with other hoarding-related constructs, such as anxiety (Beck Anxiety Inventory) and depression (Beck Depression Inventory-II), supported the convergent and discriminant validity of the SIR-21 in our sample. CONCLUSIONS Findings in our current majority Chinese sample were consistent with previous observations from other Chinese samples. Implications were discussed from a cross-cultural perspective, such as cultural emphasis on saving for future use and overlap between the concepts of discarding and acquiring in Chinese samples. Future studies should also examine differences among other ethnic groups (e.g., Malay, Indian).
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Affiliation(s)
- Siau Pheng Lee
- Institute of Mental Health, Singapore, Singapore ,The Chinese University of Hong Kong, Shatin, Hong Kong SAR, NT People’s Republic of China
| | - Clarissa Ong
- Institute of Mental Health, Singapore, Singapore ,Present address: Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810 USA
| | - Vathsala Sagayadevan
- Institute of Mental Health, Singapore, Singapore ,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747 Singapore
| | - Rebecca Ong
- Institute of Mental Health, Singapore, Singapore ,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747 Singapore
| | - Edimansyah Abdin
- Institute of Mental Health, Singapore, Singapore ,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747 Singapore
| | - Susan Lim
- Institute of Mental Health, Singapore, Singapore ,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747 Singapore
| | - Janhavi Vaingankar
- Institute of Mental Health, Singapore, Singapore ,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747 Singapore
| | - Louisa Picco
- Institute of Mental Health, Singapore, Singapore ,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747 Singapore
| | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore ,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747 Singapore
| | - Siow Ann Chong
- Institute of Mental Health, Singapore, Singapore ,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747 Singapore
| | - Mythily Subramaniam
- Institute of Mental Health, Singapore, Singapore. .,Present address: Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore. .,Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
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Abstract
The diagnostic conceptualization of hoarding has recently changed, and yet the application of these changes to hoarding in youth remains to be clarified. In this review we examine the literature on hoarding in youth. We discuss issues related to the assessment of pediatric hoarding, and the nature of hoarding in youth. We consider evidence for hoarding disorder as a distinct diagnosis in youth, and review the relationship between pediatric hoarding and other psychiatric disorders. Finally, we describe preliminary models of treatment for pediatric hoarding. We conclude that there is support for hoarding disorder as a distinct diagnosis in youth. However, more precise and developmentally appropriate assessment tools are needed to provide stronger evidence for this claim and to further our knowledge of prevalence and associated clinical characteristics. Although there is no evidence-based treatment for pediatric hoarding, preliminary evidence from case studies suggests that cognitive and behavioral methods may have promise.
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Claes L, Müller A, Luyckx K. Compulsive buying and hoarding as identity substitutes: The role of materialistic value endorsement and depression. Compr Psychiatry 2016; 68:65-71. [PMID: 27234185 DOI: 10.1016/j.comppsych.2016.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/11/2016] [Accepted: 04/03/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE In the present study, we investigated whether the relationship between identity confusion and compulsive buying (offline/online) and hoarding is mediated by materialistic value endorsement and depression. PROCEDURES The community sample consisted of 254 Flemish adults who completed self-report questionnaires to assess identity confusion (Erikson Psychosocial Stage Inventory), compulsive buying tendencies (Compulsive Buying Scale/short-Internet Addiction Scale, adapted for shopping), hoarding tendencies (Saving-Inventory Revised), materialistic value endorsement (Materialistic Value Scale), and depression (Patient Health Questionnaire-9). FINDINGS We found significant positive associations between identity confusion, compulsive buying, and hoarding. The association between identity confusion and compulsive buying was fully mediated by materialistic value endorsement; whereas depression mediated the association between identity confusion and hoarding. CONCLUSIONS The results suggest that the collection or buying of material goods can be considered as identity substitutes.
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Affiliation(s)
- Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium.
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Vickers BD, Preston SD, Gonzalez R, Angott AM. Hoarders Only Discount Consumables and Are More Patient for Money. Front Behav Neurosci 2016; 10:30. [PMID: 26973479 PMCID: PMC4777727 DOI: 10.3389/fnbeh.2016.00030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/08/2016] [Indexed: 11/29/2022] Open
Abstract
Individuals with hoarding disorder (HD) excessively acquire and retain goods while also exhibiting characteristics of impulsivity and addiction. However, HD individuals do not always perform impulsively in experiments, they do not appear interested in money, and they exhibit many features of risk-aversion and future-planning. To examine impulsivity in HD, we compared validated community participants high and low in hoarding tendencies on questionnaire measures of hoarding and impulsivity as well as a standard experimental measure of impulsivity (intertemporal discounting) that was modified to compare decisions about money, pens, and snacks. Common discounting effects were replicated. Compared to the low hoarding group, the high hoarding group was more impatient for consumables (pens and snacks) but they were more patient for money. This increased patience for money in high hoarding individuals is in contrast to all other studies on discounting in disordered populations, but consistent with the phenomenology of HD. HD does not appear to be driven by a fundamental inability to wait, but rather a specific, potent desire for consumable rewards.
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Affiliation(s)
- Brian D Vickers
- Department of Psychology, University of Michigan, Ann Arbor MI, USA
| | | | - Richard Gonzalez
- Department of Psychology, University of Michigan, Ann Arbor MI, USA
| | - Andrea M Angott
- Department of Psychology, University of Michigan, Ann Arbor MI, USA
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40
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Comorbidity variation in patients with obsessive-compulsive disorder according to symptom dimensions: Results from a large multicentre clinical sample. J Affect Disord 2016; 190:508-516. [PMID: 26561941 DOI: 10.1016/j.jad.2015.10.051] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/17/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022]
Abstract
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.
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Hoarding in Youth with Autism Spectrum Disorders and Anxiety: Incidence, Clinical Correlates, and Behavioral Treatment Response. J Autism Dev Disord 2016; 46:1602-12. [DOI: 10.1007/s10803-015-2687-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Shaw AM, Witcraft SM, Timpano KR. The Relationship between Traumatic Life Events and Hoarding Symptoms: A Multi-Method Approach. Cogn Behav Ther 2016; 45:49-59. [PMID: 26895444 DOI: 10.1080/16506073.2015.1101150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hoarding Disorder is characterized by difficulties with discarding and frequently excessively acquiring possessions, resulting in substantial clutter. Previous research has implicated trauma in the development of hoarding, but no study to date has examined the relationship between trauma and hoarding using hypothetical hoarding paradigms. This study investigated the association between traumatic events and both self-report and hypothetical indices of hoarding symptoms. We predicted that frequency of trauma would be associated with greater hoarding symptoms (across self-report and hypothetical indices). Undergraduate students (N = 80) completed self-report measures of hoarding symptoms and trauma, and hypothetical measures of acquiring and saving tendencies. As expected, more frequent trauma, and physical/sexual trauma in particular, was associated with greater acquiring tendencies. However, frequency of trauma was not significantly correlated with saving tendencies or self-reported hoarding symptoms. Future research should replicate these findings using longitudinal designs to confirm whether trauma actually serves as a risk factor for hoarding. Replication in a clinical sample is needed to better understand the implications of these results for intervention.
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Affiliation(s)
- Ashley M Shaw
- a Department of Psychology , University of Miami 5665 Ponce de Leon Blvd. , Coral Gables , USA
| | - Sara M Witcraft
- b Department of Psychology , University of Texas at Austin , Austin , USA
| | - Kiara R Timpano
- a Department of Psychology , University of Miami 5665 Ponce de Leon Blvd. , Coral Gables , USA
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Kress VE, Stargell NA, Zoldan CA, Paylo MJ. Hoarding Disorder: Diagnosis, Assessment, and Treatment. JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Victoria E. Kress
- Department of Counseling, Special Education, and School Psychology; Youngstown State University
| | - Nicole A. Stargell
- Educational Leadership and Development; The University of North Carolina at Pembroke
| | | | - Matthew J. Paylo
- Department of Counseling, Special Education, and School Psychology; Youngstown State University
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Shaw AM, Timpano KR. An Experimental Investigation of the Effect of Stress on Saving and Acquiring Behavioral Tendencies: The Role of Distress Tolerance and Negative Urgency. Behav Ther 2016; 47:116-29. [PMID: 26763502 DOI: 10.1016/j.beth.2015.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 09/30/2015] [Accepted: 10/09/2015] [Indexed: 12/17/2022]
Abstract
Stress has been implicated as a risk factor for hoarding, although past research has relied on cross-sectional and self-report designs. Using experimental methods and objective hypothetical behavioral hoarding paradigms, we investigated the direct effect of stress on in-the-moment saving and acquiring behavioral tendencies. We also evaluated whether distress tolerance (DT) and negative urgency interacted with stress to predict saving and acquiring behavioral tendencies. A sample of young adults (N=80) completed questionnaires about DT and negative urgency. Participants were randomized to either a psychosocial stressor or nonstressful control task prior to completing two hypothetical behavioral hoarding paradigms. The discarding task asked participants to choose between saving and disposing of items. For the acquiring task, participants completed a computer-simulated shopping spree that measured items acquired. Unexpectedly, participants in the stress condition saved and acquired fewer items than those in the control condition. As hypothesized, stress interacted with DT to predict saving tendencies. The current study should be replicated in a clinical sample. Longitudinal studies are needed to further examine the long-term effect of stress on hoarding. This is the first examination of the direct effect of stress on saving and acquiring tendencies. Although some study hypotheses were not supported, several results are consistent with our predictions and suggest a complex relationship between stress and hoarding. If findings are replicated in a clinical sample, it may be that hoarding patients could benefit from treatments incorporating DT strategies.
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van Bennekom MJ, Blom RM, Vulink N, Denys D. A case of digital hoarding. BMJ Case Rep 2015; 2015:bcr-2015-210814. [PMID: 26452411 DOI: 10.1136/bcr-2015-210814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old man presented to our outpatient clinic, preoccupied with hoarding of digital pictures, which severely interfered with his daily functioning. He was formerly diagnosed with autism and hoarding of tactile objects. As of yet, digital hoarding has not been described in the literature. With this case report, we would like to introduce 'digital hoarding' as a new subtype of hoarding disorder. We conclude with differential diagnostic considerations and suggestions for treatment.
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Affiliation(s)
| | - Rianne M Blom
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Damiaan Denys
- Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Science, Amsterdam
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46
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Shaw AM, Llabre MM, Timpano KR. Affect Intolerance and Hoarding Symptoms: A Structural Equation Modeling Approach. Int J Cogn Ther 2015. [DOI: 10.1521/ijct_2015_8_05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Whereas it has been suggested that hoarding is a multidimensional construct comprising distinct but interrelated factors (i.e., difficulty discarding, excessive clutter, and excessive acquisition), a high degree of overlap as well as a lack of discriminant validity among these factors and exogenous constructs suggests that a correlated factors approach may not adequately capture this phenomenon. The factor structure of the Saving Inventory Revised (SIR) was examined in a large non-selected clinic sample (N=490). A bifactor model of hoarding, comprising a general Hoarding factor and orthogonal Urge-Related Acquiring, Distress-Related Acquiring, Difficulty Discarding, and Clutter factors fit the data best. Further, whereas the general Hoarding factor was related to several depression facets, the specific hoarding factors demonstrated differential relations with depression. This study establishes that acquiring behaviors are motivated by both positive/urge-related and negative/distress-related emotions. Additionally, general and distinct factors should be considered to properly contextualize hoarding behavior.
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Affiliation(s)
- Amanda M Raines
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306-4301, USA
| | - Nicholas P Allan
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306-4301, USA
| | - Mary E Oglesby
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306-4301, USA
| | - Nicole A Short
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306-4301, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306-4301, USA.
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Ong C, Pang S, Sagayadevan V, Chong SA, Subramaniam M. Functioning and quality of life in hoarding: A systematic review. J Anxiety Disord 2015; 32:17-30. [PMID: 25847547 DOI: 10.1016/j.janxdis.2014.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/14/2014] [Accepted: 12/14/2014] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- Clarissa Ong
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Shirlene Pang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Vathsala Sagayadevan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
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Saxena S, Ayers CR, Dozier ME, Maidment KM. The UCLA Hoarding Severity Scale: development and validation. J Affect Disord 2015; 175:488-93. [PMID: 25681559 PMCID: PMC4352402 DOI: 10.1016/j.jad.2015.01.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 01/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Effective management of Hoarding Disorder (HD) must begin with assessment of the severity of hoarding symptoms and functional impairment. We sought to validate the UCLA Hoarding Severity Scale (UHSS), a semi-structured, clinician-administered rating scale that measures the severity of both the core symptoms of HD and the associated features of indecisiveness, perfectionism, task prolongation, and procrastination, which are significantly associated with the diagnosis and impairment of HD. METHODS Hoarding symptom severity was measured in 62 patients who met DSM-5 diagnostic criteria for HD and 65 normal controls, using the UHSS and the Saving Inventory-Revised (SI-R), a well validated self-report measure of hoarding symptoms. RESULTS The UHSS showed significant internal consistency (Cronbach׳s α=.70). Principal components analysis revealed three factors that accounted for 58% of the variance: 1) associated features and functional impairment, 2) clutter volume and social impairment, and 3) difficulty discarding, urges to save, and excessive acquisition. UHSS and SI-R scores were significantly correlated. UHSS and SI-R total and factor scores of HD patients were all significantly different from those of controls. LIMITATIONS Inter-rater and test-retest reliability were not assessed. The initial version of the UHSS did not contain rater instructions, so it lacked quantifiable anchor points for ratings. CONCLUSIONS The UHSS showed internal consistency, construct validity, convergent validity, and known groups discriminant validity. The UHSS validly measures the core symptoms, associated features, and functional impairment of patients with HD. Utilizing a valid clinician-administered scale will provide a more comprehensive and accurate clinical assessment of patients with HD.
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Affiliation(s)
- Sanjaya Saxena
- Department of Psychiatry, UC San Diego School of Medicine, United States.
| | - Catherine R Ayers
- Department of Psychiatry, UC San Diego School of Medicine, United States; Research Service, Veterans Affairs San Diego Healthcare System, United States
| | - Mary E Dozier
- Research Service, Veterans Affairs San Diego Healthcare System, United States
| | - Karron M Maidment
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, United States
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Timpano KR, Çek D, Fu ZF, Tang T, Wang JP, Chasson GS. A consideration of hoarding disorder symptoms in China. Compr Psychiatry 2015; 57:36-45. [PMID: 25483851 DOI: 10.1016/j.comppsych.2014.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/23/2014] [Accepted: 11/08/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hoarding disorder is rarely examined in populations of non-European and/or non-Euro-American descent, especially in East Asian nations like China. Across two studies, the current investigation sets out to examine the psychometric properties of a Chinese version of a widely used measure of hoarding symptoms-the Savings Inventory Revised (SIR)-and to explore the nature of hoarding beliefs compared to a separate US sample. PROCEDURES For the first study, 1828 college students in China completed a Mandarin translation of the SIR and measures of anxiety, depression, and obsessive-compulsive disorder. For the second study, 303 students from China and 87 students from the US completed the SIR and a novel hoarding beliefs questionnaire. FINDINGS In the first study, the Chinese-version of the SIR demonstrated convergent and discriminant validity, as well as internal reliability and preliminary construct validity. However, evidence of temporal stability was modest and requires further investigation. In the second study, the Chinese sample endorsed greater hoarding symptoms and hoarding beliefs compared to the US sample, although only themes of usefulness and wastefulness were associated with hoarding in the Chinese samples, whereas a wider range of beliefs was linked with hoarding in the US sample. In addition, the factor structure of the SIR from the first study did not replicate in second study, suggesting that construct validity of the Chinese SIR may require further corroboration. CONCLUSIONS The current study established preliminary evidence for the reliability and validity of the Chinese SIR, although future research is needed to confirm its temporal stability and factor structure. Hoarding beliefs in China may be centered on themes of usefulness and wastefulness compared to more heterogeneous themes in the West, suggesting differential manifestations of hoarding tendencies in cultures of non-European and/or non-Euro-American descent.
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Affiliation(s)
| | - Demet Çek
- University of Miami, Coral Gables, FL, USA
| | - Zhong-Fang Fu
- Beijing Normal University, Beijing, People's Republic of China
| | - Tan Tang
- Beijing Normal University, Beijing, People's Republic of China
| | - Jian-Ping Wang
- Beijing Normal University, Beijing, People's Republic of China; Capital Medical University, Beijing, People's Republic of China.
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