Inattention, but not OCD, predicts the core features of Hoarding Disorder

https://doi.org/10.1016/j.brat.2010.12.002Get rights and content

Abstract

Hoarding Disorder (HD), defined as the acquisition of and failure to discard large volumes of possessions, resulting in clutter that precludes normal use of living spaces, is a common and debilitating condition. Although hoarding has historically been conceptualized as a variant of obsessive-compulsive disorder (OCD), increasing evidence suggests that hoarding might be more closely associated with the symptoms of attention deficit-hyperactivity disorder (ADHD). The aim of the present study was to clarify the relationship between the core features of hoarding (clutter, difficulty discarding, acquiring), OCD symptoms, and ADHD symptoms. HD (N = 39), non-hoarding OCD (N = 26), and healthy control (N = 36) participants underwent careful diagnostic interviewing and completed standardized self-report measures of the core features of hoarding (clutter, difficulty discarding, acquiring), OCD symptoms, negative affect, and the inattentive and hyperactive/impulsive symptoms of ADHD. Multiple linear regressions demonstrated that after controlling for global negative affect, OCD symptoms did not significantly predict any of the core features of HD. Conversely, the inattentive (but not hyperactive/impulsive) symptoms of ADHD significantly predicted severity of clutter, difficulty discarding, and acquiring. These results challenge current conceptualizations of hoarding as a subtype of OCD, and suggest an association with neurocognitive impairment.

Section snippets

Participants

Eighty-seven adult participants met inclusion criteria of age 18–65; absence of lifetime bipolar, psychotic, or substance use disorders; absence of metal in the body or pregnancy (participants were primarily being recruited for a functional magnetic resonance imaging study), and (for the clinical groups) symptom duration of 1 year or more. Furthermore, participants were included if they could be classified into one of three diagnostic groups: Hoarding (primary diagnosis of hoarding, no

Sample characteristics

Table 1 shows that the OCD group was younger on average, and consisted of more men, than were the hoarding and healthy control groups. Therefore, subsequent analyses controlled for age and gender. Comorbid anxiety and depressive disorders were common in both the hoarding and OCD groups, and the hoarding group had a higher rate of depressive disorders than did the OCD group. Not surprisingly, the hoarding group exhibited higher SI-R scores than did the other two groups, and the OCD group

Discussion

Until very recently, hoarding has received relatively little empirical attention. This may be, in part, because of the assumption that hoarding was one of many symptoms of OCD. Increasingly, this notion is being challenged, with several authors calling for hoarding to become a unique diagnosis in DSM-V (Abramowitz et al., 2008, Pertusa et al., 2010, Phillips, 2009). Thus, it is important to re-examine the cognitive, emotional, behavioral, and neuropsychological aspects of this disorder in a new

Acknowledgments

This study was funded by NIMH grant #R01MH074934 to Dr. Tolin. The authors thank Dr. Nicholas Maltby and Dr. Melissa Norberg for their assistance.

References (72)

  • J.R. Grisham et al.

    Neuropsychological impairment associated with compulsive hoarding

    Behaviour Research and Therapy

    (2007)
  • J.R. Grisham et al.

    Categorization and cognitive deficits in compulsive hoarding

    Behaviour Research and Therapy

    (2010)
  • T.L. Hartl et al.

    Relationships among compulsive hoarding, trauma, and attention-deficit/hyperactivity disorder

    Behaviour Research and Therapy

    (2005)
  • J.D. Huppert et al.

    The OCI-R: validation of the subscales in a clinical sample

    Journal of Anxiety Disorders

    (2007)
  • P.F. Lovibond et al.

    The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety Inventories

    Behaviour Research and Therapy

    (1995)
  • L.M. McDermott et al.

    A meta-analysis of depression severity and cognitive function

    Journal of Affective Disorders

    (2009)
  • R. Medori et al.

    A randomized, placebo-controlled trial of three fixed dosages of prolonged-release OROS methylphenidate in adults with attention-deficit/hyperactivity disorder

    Biological Psychiatry

    (2008)
  • K. Murphy et al.

    Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments

    Comprehensive Psychiatry

    (1996)
  • A. Pertusa et al.

    Refining the diagnostic boundaries of compulsive hoarding: a critical review

    Clinical Psychology Review

    (2010)
  • S.R. Pliszka

    Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder

    Journal of American Academy of Child and Adolescent Psychiatry

    (2007)
  • S.R. Pliszka et al.

    The Texas Children’s Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2006)
  • S.A. Rasmussen et al.

    The epidemiology and clinical features of obsessive compulsive disorder

    Psychiatric Clinics of North America

    (1992)
  • J.F. Samuels et al.

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

    Behaviour Research and Therapy

    (2008)
  • J.F. Samuels et al.

    Hoarding in obsessive compulsive disorder: results from a case-control study

    Behaviour Research and Therapy

    (2002)
  • S. Saxena et al.

    Paroxetine treatment of compulsive hoarding

    Journal of Psychiatric Research

    (2007)
  • H.B. Simpson et al.

    Are there reliable neuropsychological deficits in obsessive-compulsive disorder?

    Journal of Psychiatric Research

    (2006)
  • T. Spencer et al.

    A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder

    Biological Psychiatry

    (2005)
  • E.A. Storch et al.

    Clinical features of children and adolescents with obsessive-compulsive disorder and hoarding symptoms

    Comprehensive Psychiatry

    (2007)
  • D.F. Tolin et al.

    An open trial of cognitive-behavioral therapy for compulsive hoarding

    Behaviour Research and Therapy

    (2007)
  • D.F. Tolin et al.

    A brief interview for assessing compulsive hoarding: the hoarding rating scale-interview

    Psychiatry Research

    (2010)
  • D.F. Tolin et al.

    The economic and social burden of compulsive hoarding

    Psychiatry Research

    (2008)
  • K.D. Wu et al.

    Hoarding and its relation to obsessive-compulsive disorder

    Behaviour Research and Therapy

    (2005)
  • J.S. Abramowitz et al.

    Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder

    Journal of Consulting and Clinical Psychology

    (2003)
  • J.S. Abramowitz et al.

    Measuring change in OCD: sensitivity of the obsessive-compulsive inventory-revised

    Journal of Psychopathology and Behavioral Assessment

    (2005)
  • Diagnostic and statistical manual of mental disorders

    (2000)
  • S.W. Anderson et al.

    A neural basis for collecting behaviour in humans

    Brain

    (2005)
  • Cited by (90)

    • Toward a biopsychosocial model of hoarding disorder

      2023, Journal of Obsessive-Compulsive and Related Disorders
    View all citing articles on Scopus
    View full text