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Grassi G, Moradei C, Cecchelli C, van Ameringen M. Who really hoards? Hoarding symptoms in adults with attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and healthy controls. J Psychiatr Res 2023; 166:74-79. [PMID: 37741062 DOI: 10.1016/j.jpsychires.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/16/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
Although hoarding disorder (HD) is included in the DSM-5 in the obsessive-compulsive and related disorders chapter, in the last few years, HD has been consistently associated with attention-deficit hyperactivity disorder (ADHD). Some studies on HD patients show higher comorbidity with ADHD than with OCD and some studies on ADHD patients found significant higher rates of HD symptoms compared to the general population. However, the aim of the present study was to be the first direct comparison of the prevalence of HD and HD symptoms across adults with a primary diagnosis of ADHD, OCD and a sample of matched healthy controls (HCs). METHODS 57 adult patients with a primary diagnosis of ADHD and 50 adult patients with a primary diagnosis of OCD were enrolled and matched with 50 HCs. The presence of hoarding disorder and symptoms were assessed though the Saving Inventory Revised (SI-R). RESULTS ADHD patients showed significantly higher prevalence of HD comorbidity (32.1%) with respect to both OCD patients (8%) and HCs (4%). The prevalence of HD symptoms was also significantly higher in ADHD patients than in both OCD and HCs. Although OCD patients showed a higher prevalence of HD and HD symptoms with respect to HCs, these differences did not reach statistical significance. CONCLUSION HD is significantly more comorbid in ADHD patients than in OCD and HCs. A better understanding and definition of the boundaries between HD and the OCD and ADHD spectrum could lead to the development of a more precise treatment approach for hoarding disorder.
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Affiliation(s)
| | | | | | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, MacAnxiety Research Centre, Canada
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2
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Linkovski O, Moore TM, Argabright ST, Calkins ME, Gur RC, Gur RE, Barzilay R. Hoarding behavior and its association with mental health and functioning in a large youth sample. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02296-4. [PMID: 37728661 DOI: 10.1007/s00787-023-02296-4] [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: 08/03/2022] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
Hoarding behavior is prevalent in children and adolescents, yet clinicians do not routinely inquire about it and youth may not spontaneously report it due to stigma. It is unknown whether hoarding behavior, over and above obsessive-compulsive symptoms (OCS), is associated with major clinical factors in a general youth population. This observational study included N = 7054 youth who were not seeking help for mental health problems (ages 11-21, 54% female) and completed a structured interview that included evaluation of hoarding behavior and OCS, as a part of the Philadelphia Neurodevelopmental Cohort between November 2009 and December 2011. We employed regression models with hoarding behavior and OCS (any/none) as independent variables, and continuous (linear regression) or binary (logistic regression) mental health measures as dependent variables. All models covaried for age, sex, race, and socioeconomic status. A total of 374 participants endorsed HB (5.3%), most of which reported additional OCS (n = 317). When accounting for OCS presence, hoarding behavior was associated with greater dimensional psychopathology burden (i.e., higher P-factor) (β = 0.19, p < .001), and with poorer functioning (i.e., lower score on the child global assessment scale) (β = - 0.07, p < .001). The results were consistent when modeling psychopathology using binary variables. The results remained significant in sensitivity analyses accounting for count of endorsed OCS and excluding participants who met criteria for obsessive-compulsive disorder (n = 210). These results suggest that hoarding behavior among youth is associated with poorer mental health and functioning, independent of OCS. Brief hoarding-behavior assessments in clinical settings may prove useful given hoarding behavior's stigma and detrimental health associations.
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Affiliation(s)
- Omer Linkovski
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychiatry, Neurodevelopment and Psychosis Section, Perelman School of Medicine, University of Pennsylvania, 10th floor, Gates Pavilion, Hospital of the University of Pennsylvania, 34Th and Spruce Street, Philadelphia, PA, 19104, USA
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, 52900, Ramat-Gan, Israel
| | - Tyler M Moore
- Department of Psychiatry, Neurodevelopment and Psychosis Section, Perelman School of Medicine, University of Pennsylvania, 10th floor, Gates Pavilion, Hospital of the University of Pennsylvania, 34Th and Spruce Street, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute of Children's Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
| | - Stirling T Argabright
- Lifespan Brain Institute of Children's Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA
| | - Monica E Calkins
- Department of Psychiatry, Neurodevelopment and Psychosis Section, Perelman School of Medicine, University of Pennsylvania, 10th floor, Gates Pavilion, Hospital of the University of Pennsylvania, 34Th and Spruce Street, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute of Children's Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Neurodevelopment and Psychosis Section, Perelman School of Medicine, University of Pennsylvania, 10th floor, Gates Pavilion, Hospital of the University of Pennsylvania, 34Th and Spruce Street, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute of Children's Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Neurodevelopment and Psychosis Section, Perelman School of Medicine, University of Pennsylvania, 10th floor, Gates Pavilion, Hospital of the University of Pennsylvania, 34Th and Spruce Street, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute of Children's Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA
| | - Ran Barzilay
- Department of Psychiatry, Neurodevelopment and Psychosis Section, Perelman School of Medicine, University of Pennsylvania, 10th floor, Gates Pavilion, Hospital of the University of Pennsylvania, 34Th and Spruce Street, Philadelphia, PA, 19104, USA.
- Lifespan Brain Institute of Children's Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA.
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.
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Akıncı MA, Turan B, Esin İS, Dursun OB. Prevalence and correlates of hoarding behavior and hoarding disorder in children and adolescents. Eur Child Adolesc Psychiatry 2022; 31:1623-1634. [PMID: 34283287 DOI: 10.1007/s00787-021-01847-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
Although hoarding symptoms are reported to begin in childhood and adolescence, the true prevalence of the disorder in this age group is unknown. This study aims to estimate the prevalence of hoarding disorder (HD) in children and adolescents. The present study was planned as a two-stage epidemiological research. In the first stage, the Children's Saving Inventory (CSI) and informed consent forms were delivered to a group of students' parents. In the second stage, one-on-one psychiatric interviews with a physician were planned with the families and children who had hoarding behavior (HB), as described by their parents. The DSM-5-based HD interview and the Development and Well-Being Assessment (DAWBA) diagnostic tool were used to detect prevalence of HD and comorbid psychiatric disorders. A total of 3249 children were included in the study, and 318 children and their parents were evaluated in the second stage. As a result of the second assessment, 32 out of 318 children met the HD diagnostic criteria. The estimated prevalence of HD was 0.98% (95% CI 0.7-1.4). Hoarding disorder was found more frequently in females (F/M = 3/1). After a logistic regression analysis, variables such as female sex and the presence of any psychopathology were identified as independent correlates of HD. More than half (56.2%) of the children diagnosed as having HD also had a comorbid psychiatric disorder. In the present study, the two-stage evaluation method was used in a large pediatric sample to determine the estimated prevalence of HD, as well as the factors associated with the disorder and comorbid psychiatric disorders.
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Affiliation(s)
- Mehmet Akif Akıncı
- Department of Child and Adolescent Psychiatry, Dr. Ali Kemal Belviranlı Maternity and Children Hospital, Konya, Turkey.
| | - Bahadır Turan
- Autism, Mental Special Needs and Rare Diseases Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
| | - İbrahim Selçuk Esin
- Department of Child and Adolescent Psychiatry, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Onur Burak Dursun
- Autism, Mental Special Needs and Rare Diseases Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
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4
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Morein-Zamir S, Kasese M, Chamberlain SR, Trachtenberg E. Elevated levels of hoarding in ADHD: A special link with inattention. J Psychiatr Res 2021; 145:167-174. [PMID: 34923357 PMCID: PMC7612156 DOI: 10.1016/j.jpsychires.2021.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 10/29/2022]
Abstract
Hoarding Disorder (HD) is under recognised and under-treated. Though HD develops by early adulthood, patients present only later in life, resulting in research based largely on samples of predominantly older females. Whilst formerly associated with Obsessive-Compulsive Disorder (OCD), it is now recognised that individuals with HD often have inattention symptoms reminiscent of Attention Deficit/Hyperactivity Disorder (ADHD). Here, we investigated HD in adults with ADHD. Patients in an ADHD clinic (n = 88) reported on ADHD, HD and OCD-related symptoms, and compared with age, gender and education matched controls (n = 90). Findings were assessed independently in an online UK sample to verify replication using a dimensional approach (n = 220). Clinically significant hoarding symptoms were found in ∼20% versus 2% of ADHD and control groups, respectively, with those with hoarding being on average in their thirties and with approximately half being male. Greater hoarding severity was noted even in the remaining patients compared with controls (d = 0.89). Inattention was the only significant statistical predictor of hoarding severity in patients. Similarly, inattention, alongside depression and anxiety were the greatest predictors of hoarding in the independent sample where 3.2% identified as having clinically significant hoarding. Patients with ADHD had a high frequency of hoarding symptoms, which were specifically linked to inattention. HD should be routinely assessed in individuals with ADHD, as they do not typically disclose associated difficulties, despite these potentially leading to impaired everyday functioning. Research in HD should also investigate adults with ADHD, who are younger and with a greater prevalence of males than typical HD samples.
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Affiliation(s)
- Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK.
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5
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Bratiotis C, Muroff J, Lin NXY. Hoarding Disorder: Development in Conceptualization, Intervention, and Evaluation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:392-404. [PMID: 35747296 PMCID: PMC9063579 DOI: 10.1176/appi.focus.20210016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions because of strong urges to save the items. Difficulty discarding often includes items others consider to be of little value and results in accumulation of a large number of possessions that clutter the home. Cognitive-behavioral therapy (CBT) with exposure and response prevention and selective serotonin reuptake inhibitor medications traditionally used to treat obsessive-compulsive disorder are generally not efficacious for people with hoarding problems. A specialized CBT approach for hoarding has shown progress in reaching treatment goals and has been modified to be delivered in group, peer-facilitated, and virtual models. Research on hoarding remains in the early phases of development. Animal, attachment, and genetic models are expanding. Special populations, such as children, older adults, and people who do not voluntarily seek treatment need special consideration for intervention. Community-based efforts aimed at reducing public health and safety consequences of severe hoarding are needed.
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Affiliation(s)
- Christiana Bratiotis
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Jordana Muroff
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Nancy X Y Lin
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
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6
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Information processing in hoarding disorder: A systematic review of the evidence. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Ivanov VZ, Mataix-Cols D, Serlachius E, Brander G, Elmquist A, Enander J, Rück C. The developmental origins of hoarding disorder in adolescence: a longitudinal clinical interview study following an epidemiological survey. Eur Child Adolesc Psychiatry 2021; 30:415-425. [PMID: 32306089 PMCID: PMC8019421 DOI: 10.1007/s00787-020-01527-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/31/2020] [Indexed: 01/16/2023]
Abstract
Hoarding disorder (HD) is hypothesized to originate in childhood/adolescence but little is known about the presentation of hoarding symptoms in youth and their natural history. In this longitudinal study, we tracked and conducted in-depth psychiatric interviews with twins who participated in an epidemiological survey and screened positive on a measure of hoarding symptoms at age 15. Twins screening positive for clinically significant hoarding symptoms at age 15 (n = 42), their co-twins (n = 33), a group of screen negative twins (n = 49), and their parents underwent a clinical assessment a median of 3 years after the initial screening. The assessment included psychiatric screening, hoarding symptoms and cognitions, in-home or photographic assessment of clutter levels, parental accommodation and familial burden. None of the participants had significant levels of clutter at follow-up and thus did not meet strict criteria for HD. However, twins meeting partial criteria (i.e., DSM-5 criteria A and B) for HD (n = 28) had more psychiatric disorders and scored significantly higher on all measures of hoarding symptoms including researcher-rated levels of clutter in their homes, compared to twins who did not meet partial criteria for HD (n = 46). As currently defined in DSM-5, HD may be rare in young people. A non-negligible proportion of young people who were screen positive on hoarding symptoms at age 15 had substantial hoarding symptoms and other psychopathology at follow-up. Whether and how many of these individuals will develop full-blown HD is unknown but the results offer unique insights about the probable origins of HD in adolescence.
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Affiliation(s)
- Volen Z Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden.
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Gustaf Brander
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Anders Elmquist
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Karolinska University Hospital, SE 171 76, Huddinge, Sweden
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8
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Screening for Pediatric Obsessive-Compulsive Disorder Using the Obsessive-Compulsive Inventory-Child Version. Child Psychiatry Hum Dev 2020; 51:888-899. [PMID: 32030629 DOI: 10.1007/s10578-020-00966-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The study assessed the ability of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) to detect pediatric obsessive-compulsive disorder (OCD) using receiver operating characteristic analyses. The sample consisted of 114 cases with current OCD, 340 cases with other psychiatric disorders (OPD), and 301 healthy controls (HC) ages 7 to 18 years. All 755 participants were assessed with two semi-structured interviews and seven rating scales. In a comparison of current OCD cases and all other participants, the optimal OCI-CV cut-score was 11 with an area under the curve (AUC) of .88. In a comparison of current OCD cases and OPD cases, the optimal OCI-CV cut-score was 11 with an AUC of .82. In a comparison of current OCD cases and HC, the optimal OCI-CV cut-score was 10 with an AUC of .94. The results indicate that the OCI-CV provides an effective screen for pediatric OCD using empirically derived cut-scores.
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9
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Farrell LJ, Lavell C, Baras E, Zimmer-Gembeck MJ, Waters AM. Clinical expression and treatment response among children with comorbid obsessive compulsive disorder and attention-deficit/hyperactivity disorder. J Affect Disord 2020; 266:585-594. [PMID: 32056931 DOI: 10.1016/j.jad.2020.01.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/10/2019] [Accepted: 01/25/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Paediatric obsessive-compulsive disorder (OCD) is highly comorbid with other psychological disorders, including attention deficit/hyperactivity disorder (ADHD). Preliminary evidence suggests that youth with comorbid OCD and ADHD may experience greater impairments than children with other comorbidities; however, there is limited research examining the clinical expression and treatment response of these youth. METHODS Youth (7 to 17 years) with a primary diagnosis of OCD and comorbid ADHD (n = 40) were compared a sample of age and gender matched youth with OCD and other comorbidity (without ADHD, n = 40). The study investigated symptoms, severity, functioning, comorbidity, family accommodation, in addition to parental psychopathology and rearing styles. Treatment response was investigated at post-treatment and six-month follow-up. RESULTS Youth with comorbid OCD and ADHD had fewer sexual obsessions, higher rates of comorbidity, poorer executive functioning and higher family impairment. Families of comorbid youth engaged in significantly more accommodation and reported more negative rearing. Finally, comorbid youth were significantly less likely to be responders or remitters at post-treatment. LIMITATIONS AND CONCLUSIONS Limitations include the cross-sectional design, relatively small clinical sample, and lack of an experimental control group of youth with ADHD without OCD. Current approaches to treatment may be improved for youth with comorbid OCD and ADHD by addressing cooccurring anxiety, behavioural difficulties, and maladaptive family accommodation and rearing. Moreover, given pronounced deficits in executive function, these youth may require a stronger initial dose of CBT to achieve an adequate response.
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Affiliation(s)
- Lara J Farrell
- School of Applied Psychology, Griffith University, Gold Coast Campus, Southport, Qld, Australia, 4222.
| | - Cassie Lavell
- School of Applied Psychology, Griffith University, Gold Coast Campus, Southport, Qld, Australia, 4222
| | - Eden Baras
- School of Applied Psychology, Griffith University, Gold Coast Campus, Southport, Qld, Australia, 4222
| | - Melanie J Zimmer-Gembeck
- School of Applied Psychology, Griffith University, Gold Coast Campus, Southport, Qld, Australia, 4222
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Gold Coast Campus, Southport, Qld, Australia, 4222
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Kajitani K, Tsuchimoto R, Nagano J, Nakao T. Relevance of hoarding behavior and the traits of developmental disorders among university students: a self-reported assessment study. Biopsychosoc Med 2019; 13:13. [PMID: 31171932 PMCID: PMC6545730 DOI: 10.1186/s13030-019-0156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/22/2019] [Indexed: 11/22/2022] Open
Abstract
Background Previous studies have shown that hoarding behavior usually starts at a subclinical level in early adolescence and gradually worsens; however, a limited number of studies have examined the prevalence of hoarding behavior and its association with developmental disorders in young adults. The aims of this study were to estimate the prevalence of hoarding behavior and to identify correlations between hoarding behavior and developmental disorder traits in university students. Methods The study participants included 801 university students (616 men, 185 women) who completed questionnaires (ASRS: Adult ADHD Self-Report Scale version 1.1, AQ16: Autism-Spectrum Quotient with 16 items, and CIR: Clutter Image Rating). Results Among 801 participants, 27 (3.4%) exceeded the CIR cut-off score. Moreover, the participants with hoarding behavior had a significantly higher percentage of ADHD traits compared to participants without hoarding behavior (HB(+) vs HB(−), 40.7% vs 21.7%). In addition, 7.4% of HB(+) participants had autism spectrum disorder (ASD) traits, compared to 4.1% of HB(−) participants. A correlation analysis revealed that the CIR composite score had a stronger correlation with the ASRS inattentive score than with the hyperactivity/impulsivity score (CIR composite vs ASRS IA, r = 0.283; CIR composite vs ASRS H/I, r = 0.147). Conclusions The results showed a high prevalence of ADHD traits in the university students with hoarding behavior. Moreover, we found that the hoarding behavior was more strongly correlated with inattentive symptoms rather than with hyperactivity/impulsivity symptoms. Our results support the concept of a common pathophysiology behind hoarding behavior and ADHD in young adults.
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Affiliation(s)
- Kosuke Kajitani
- 1Center for Health Sciences and Counseling, Kyushu University, 6-1 Kasuga-koen, Kasuga, Fukuoka, 816-8580 Japan
| | - Rikako Tsuchimoto
- 1Center for Health Sciences and Counseling, Kyushu University, 6-1 Kasuga-koen, Kasuga, Fukuoka, 816-8580 Japan
| | - Jun Nagano
- 1Center for Health Sciences and Counseling, Kyushu University, 6-1 Kasuga-koen, Kasuga, Fukuoka, 816-8580 Japan
| | - Tomohiro Nakao
- 2Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan
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11
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Baldwin PA, Whitford TJ, Grisham JR. Psychological and electrophysiological indices of inattention in hoarding. Psychiatry Res 2018; 270:915-921. [PMID: 30551344 DOI: 10.1016/j.psychres.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/03/2018] [Accepted: 11/05/2018] [Indexed: 12/24/2022]
Abstract
Individuals with elevated hoarding symptoms report elevated symptoms of ADHD and these symptoms are related to impaired daily functioning. Neuropsychological studies have found specific deficits in attention, and a recent review of attentional data from numerous hoarding studies concluded that inattention likely represents an etiological factor in hoarding, rather than a comorbidity. Our study aimed to examine which symptoms of ADHD, inattention or hyperactivity, are related to hoarding symptom severity, and whether individuals with hoarding symptoms display a neurophysiological marker of poor attention (Theta/Beta Ratio; THBR) that might explain these associations. The THBR indexes theta power relative to beta power in the frontal cortex and is often atypical in individuals with ADHD. We hypothesised that individuals would report more severe problems with inattention and would exhibit an elevated theta/beta ratio relative to a healthy control group. We also predicted that any relationship between hoarding and inattention would be independent of anxiety and depression symptoms. 17 hoarding-symptomatic participants and 16 healthy control participants completed self-report measures relating to ADHD, hoarding and general psychopathology, and then underwent resting measures of electroencephalography (EEG). Individuals with hoarding symptoms reported greater difficulties with inattention and hyperactivity, however they did not exhibit an elevated theta/beta ratio. When taking into account recent anxiety and depression, only inattention predicted hoarding symptom severity. Further investigations may help clarify this association and help inform attention-based treatments for hoarding.
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Affiliation(s)
- Peter A Baldwin
- School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Thomas J Whitford
- School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia
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12
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Soreni N, Cameron D, Vorstenbosch V, Duku E, Rowa K, Swinson R, Bullard C, McCabe R. Psychometric Evaluation of a Revised Scoring Approach for the Children's Saving Inventory in a Canadian Sample of Youth With Obsessive-Compulsive Disorder. Child Psychiatry Hum Dev 2018; 49:966-973. [PMID: 29797231 DOI: 10.1007/s10578-018-0811-y] [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] [Indexed: 10/16/2022]
Abstract
The Children's Saving Inventory (CSI) was introduced in 2011 and is the first parent-rated questionnaire specifically designed to measure the severity of hoarding symptoms in youth. To date, however, no replication studies of the CSI have been published. Additionally, the total CSI score includes several items measuring acquisition, a behavioural dimension that has since been excluded from DSM-5's hoarding disorder criteria. Given these limitations, the primary goal of the present study was to test a modified, DSM-5-consistent, total score of the CSI. Because a confirmatory factor analysis did not support the 2011 four-factor model of the CSI, we reviewed the original CSI and excluded all acquisition items. An exploratory factor analysis yielded a strong three-factor solution (difficulty discarding, Clutter, and distress/impairment) with good reliability and validity for a 15-item version of the CSI. Overall, our results support the use of the 15-item CSI in youth with OCD.
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Affiliation(s)
- Noam Soreni
- Offord Centre for Child Studies, McMaster University, 175 Longwood Rd S #105, Hamilton, ON, L8P 0A1, Canada. .,Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, 100 West 5th, Hamilton, ON, L8N 3K7, Canada. .,Pediatric OCD Consultation Team, Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
| | - Duncan Cameron
- Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Valerie Vorstenbosch
- Eating Disorders Program, Homewood Health Centre, 150 Delhi Street, Guelph, ON, N1E 6K9, Canada
| | - Eric Duku
- Offord Centre for Child Studies, McMaster University, 175 Longwood Rd S #105, Hamilton, ON, L8P 0A1, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, 100 West 5th, Hamilton, ON, L8N 3K7, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, 100 West 5th, Hamilton, ON, L8N 3K7, Canada
| | - Richard Swinson
- Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, 100 West 5th, Hamilton, ON, L8N 3K7, Canada
| | - Carrie Bullard
- Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Pediatric OCD Consultation Team, Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Randi McCabe
- Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, 100 West 5th, Hamilton, ON, L8N 3K7, Canada
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13
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Weintraub MJ, Brown CA, Timpano KR. The relationship between schizotypal traits and hoarding symptoms: An examination of symptom specificity and the role of perceived cognitive failures. J Affect Disord 2018; 237:10-17. [PMID: 29754020 DOI: 10.1016/j.jad.2018.04.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/21/2018] [Accepted: 04/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hoarding disorder presents significant individual and interpersonal consequences. Because hoarding has only recently been added to the DSM, relatively little is known about associated comorbidity patterns. Several researchers have postulated a relationship between hoarding and schizotypy. To date, however, no investigations have considered which specific types of schizotypal traits relate to hoarding symptoms. METHODS We examined the association between hoarding and schizotypal symptoms using multivariate analyses in two samples-a sample of 120 young adults and a community sample of 291 individuals recruited from Mechanical Turk's online crowdsourcing system. RESULTS Individuals who fell within the clinical range on the Saving Inventory Revised endorsed significantly greater levels of schizotypal symptoms compared to those with normative saving behaviors. Odd speech, magical thinking, and social anxiety were the most consistent schizotypal correlates of hoarding symptoms. Perceived cognitive dysfunction mediated the effects between odd speech and social anxiety and hoarding symptoms, suggesting that shared abnormalities in cognitive functioning may help explain the relationship between hoarding and schizotypy. LIMITATIONS This study examined the spectrum of schizotypy and hoarding symptoms via self-report in two nonclinical populations. CONCLUSIONS Findings underscore the importance of assessing schizotypal traits in patients with hoarding, and suggest future avenues of research to better understand the underlying causes explaining the overlap, as well as potential treatment implications.
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Affiliation(s)
- Marc J Weintraub
- Department of Psychology, University of Miami, Coral Gables, FL, United States; Department of Psychiatry, Semel Institute, University of California, Los Angeles, CA, United States
| | - Caitlin A Brown
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, FL, United States.
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14
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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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15
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Pushkarskaya H, Tolin DF, Henick D, Levy I, Pittenger C. Unbending mind: Individuals with hoarding disorder do not modify decision strategy in response to feedback under risk. Psychiatry Res 2018; 259:506-513. [PMID: 29154203 PMCID: PMC5742085 DOI: 10.1016/j.psychres.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/11/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023]
Abstract
Cognitive-behavioral models of hoarding disorder emphasize impairments in information processing and decision making in the genesis of hoarding symptomology. We propose and test the novel hypothesis that individuals with hoarding are maladaptively biased towards a deliberative decision style. While deliberative strategies are often considered normative, they are not always adaptable to the limitations imposed by many real-world decision contexts. We examined decision-making patterns in 19 individuals with hoarding and 19 healthy controls, using a behavioral task that quantifies selection of decision strategies in a novel environment with known probabilities (risk) in response to feedback. Consistent with prior literature, we found that healthy individuals tend to explore different decision strategies in the beginning of the experiment, but later, in response to feedback, they shift towards a compound strategy that balances expected values and risks. In contrast, individuals with hoarding follow a simple, deliberative, risk-neutral, value-based strategy from the beginning to the end of the task, irrespective of the feedback. This seemingly rational approach was not ecologically rational: individuals with hoarding and healthy individuals earned about the same amount of money, but it took individuals with hoarding a lot longer to do it: additional cognitive costs did not lead to additional benefits.
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Affiliation(s)
- Helen Pushkarskaya
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, United States.
| | - David F Tolin
- Department of Psychology, Yale University, New Haven, CT 06510, United States; Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT 06114, United States
| | - Daniel Henick
- Department of Psychology, Yale University, New Haven, CT 06510, United States
| | - Ifat Levy
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, United States; Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, United States; Department of Psychology, Yale University, New Haven, CT 06510, United States; Child Study Center, Yale School of Medicine, New Haven, CT 06510, United States
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16
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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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17
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Hallion LS, Diefenbach GJ, Tolin DF. Poor Memory Confidence Mediates the Association between Inattention Symptoms and Hoarding Severity and Impairment. J Obsessive Compuls Relat Disord 2015; 7:43-48. [PMID: 31544016 PMCID: PMC6753950 DOI: 10.1016/j.jocrd.2015.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hoarding disorder (HD) is characterized by excessive saving and difficulty discarding possessions, which results in severe clutter and functional impairment. HD shows patterns of elevated comorbidity with the inattentive subtype of attention deficit-hyperactivity disorder (ADHD-I). ADHD-I symptoms are associated with more severe HD pathology (Tolin & Villavicencio, 2011), but the mechanisms underlying this association are unclear. The present study used serial mediation analyses in a sample of individuals with HD (n = 32) and healthy controls (n = 26) to test one potential pathway: ADHD-I symptoms lead to poor memory confidence, which leads to excessive saving of possessions to facilitate remembering, which in turn leads to clutter and corresponding functional impairment. The model provided a strong fit for the data, accounting for over 90% of the variance in functional impairment. Alternate models that did not include ADHD-I symptoms and poor memory confidence provided a weaker fit. These findings support and extend leading cognitive-behavioral conceptualizations of HD (e.g., Frost & Hartl, 1996) and point to inattention symptoms and memory confidence as potential targets for HD prevention and intervention research.
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Affiliation(s)
- Lauren S. Hallion
- Anxiety Disorders Center/Center for CBT, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106
| | - Gretchen J. Diefenbach
- Anxiety Disorders Center/Center for CBT, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106
- Yale School of Medicine, 800 Howard Ave #2, New Haven, CT 06519
| | - David F. Tolin
- Anxiety Disorders Center/Center for CBT, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106
- Yale School of Medicine, 800 Howard Ave #2, New Haven, CT 06519
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18
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Burton CL, Arnold PD, Soreni N. Three Reasons why Studying Hoarding in Children and Adolescents is Important. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2015; 24:128-130. [PMID: 26379725 PMCID: PMC4558984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/04/2015] [Indexed: 06/05/2023]
Abstract
Hoarding is traditionally considered a disorder of adulthood but hoarding symptoms often begin in childhood and adolescence. However, there is very little published research into hoarding in youth. As described in this commentary, the study of hoarding in childhood and adolescence is important because hoarding symptoms: 1) often begin in childhood and adolescence; 2) often are chronic and persist into adulthood; and, 3) are associated with a number of negative outcomes and sequelae. Research into hoarding in youth could help identify individuals at risk for chronic and persistent hoarding disorder as well as determine interventions to change their trajectories. Improved understanding of hoarding in children and adolescents could in turn help minimize the negative effect of hoarding on the affected individuals, their families and society.
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Affiliation(s)
- Christie L. Burton
- Genetics & Genome Biology, Hospital for Sick Children, Toronto, Ontario
- Psychiatry, Hospital for Sick Children, Toronto, Ontario
| | - Paul D. Arnold
- Genetics & Genome Biology, Hospital for Sick Children, Toronto, Ontario
- The University of Calgary, Mathison Centre for Mental Health Research and Education, Calgary, Alberta
| | - Noam Soreni
- Pediatric OCD Consultation Team, Anxiety Treatment and Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
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Frank H, Stewart E, Walther M, Benito K, Freeman J, Conelea C, Garci A. Hoarding behavior among young children with obsessive-compulsive disorder. J Obsessive Compuls Relat Disord 2014; 3:6-11. [PMID: 24860725 PMCID: PMC4029336 DOI: 10.1016/j.jocrd.2013.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Previous research has shown that among the various subtypes of obsessive-compulsive disorder (OCD), adults (e.g. Frost, Krause & Steketee, 1996) and older children and adolescents (Bloch et al., 2009; Storch et al., 2007) with problematic hoarding have distinct features and a poor treatment prognosis. However, there is limited information on the phenomenology and prevalence of hoarding behaviors in young children. The present study characterizes children ages 10 and under who present with OCD and hoarding behaviors. Sixty-eight children received a structured interview-determined diagnosis of OCD. Clinician administered, parent-report, and child-report measures on demographic, symptomatic, and diagnostic variables were completed. Clinician ratings of hoarding symptoms and parent and child endorsement of the hoarding item on the CY-BOCS checklist (Scahill, Riddle, McSwiggin-Hardin, & Ort, 1997) determined inclusion in the hoarding group (n=33). Compared to children without hoarding symptoms (n=35), the presence of hoarding symptoms was associated with an earlier age of primary diagnosis onset and a higher proportion of ADHD and provisional anxiety diagnoses. These results are partially consistent with the adult literature and with findings in older children (Storch et al., 2007). Additional data on clinical presentation and phenomenology of hoarding are needed to form a developmentally appropriate definition of the behavior.
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Affiliation(s)
- Hannah Frank
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center
| | - Elyse Stewart
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center
| | - Michael Walther
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center
| | - Kristen Benito
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center
| | - Jennifer Freeman
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center
| | - Christ Conelea
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center
| | - Abbe Garci
- Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center
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20
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Abstract
This study presents nationally representative data on the prevalence and the correlates of difficulty discarding, a behavior described in many psychiatric disorders, including a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, called hoarding disorder. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a national sample of the US population (N=43,093). Difficulty discarding worn-out/worthless items (assessed by a single item) and diagnoses of psychiatric disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule. The prevalence of difficulty discarding worn-out/worthless items in the general population was 20.6%. Difficulty discarding strongly correlated with axis I and axis II disorders, level of impairment, and use of mental health services. Difficulty discarding worn-out/worthless items is a common behavior that can be associated with various forms of psychopathology. When reported in a clinical setting, it may signal that careful assessment is needed to clarify diagnosis and inform treatment strategies.
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21
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Ivanov VZ, Mataix-Cols D, Serlachius E, Lichtenstein P, Anckarsäter H, Chang Z, Gumpert CH, Lundström S, Långström N, Rück C. Prevalence, comorbidity and heritability of hoarding symptoms in adolescence: a population based twin study in 15-year olds. PLoS One 2013; 8:e69140. [PMID: 23874893 PMCID: PMC3707873 DOI: 10.1371/journal.pone.0069140] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hoarding Disorder (HD) is often assumed to be an 'old age' problem, but many individuals diagnosed with HD retrospectively report first experiencing symptoms in childhood or adolescence. We examined the prevalence, comorbidity and etiology of hoarding symptoms in adolescence. METHODS To determine the presence of clinically significant hoarding symptoms, a population-based sample of 15-year old twins (N = 3,974) completed the Hoarding Rating Scale-Self Report. Co-occurring Obsessive Compulsive Disorder (OCD), Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) were estimated from parental report. Model-fitting analyses divided hoarding symptom scores into additive genetic, shared, and non-shared environmental effects. RESULTS The prevalence of clinically significant hoarding symptoms was 2% (95% CI 1.6-2.5%), with a significantly higher prevalence in girls than boys. Exclusion of the clutter criterion (as adolescents do not have control over their environment) increased the prevalence rate to 3.7% (95% CI 3.1-4.3%). Excessive acquisition was reported by 30-40% among those with clinically significant hoarding symptoms. The prevalence of co-occurring OCD (2.9%), ASD (2.9%) and ADHD (10.0%) was comparable in hoarding and non-hoarding teenagers. Model-fitting analyses suggested that, in boys, additive genetic (32%; 95% CI 13-44%) and non-shared environmental effects accounted for most of the variance. In contrast, among girls, shared and non-shared environmental effects explained most of the variance, while additive genetic factors played a negligible role. CONCLUSIONS Hoarding symptoms are relatively prevalent in adolescents, particularly in girls, and cause distress and/or impairment. Hoarding was rarely associated with other common neurodevelopmental disorders, supporting its DSM-5 status as an independent diagnosis. The relative importance of genetic and shared environmental factors for hoarding differed across sexes. The findings are suggestive of dynamic developmental genetic and environmental effects operating from adolescence onto adulthood.
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Affiliation(s)
- Volen Z Ivanov
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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