Hoarding and its relation to obsessive–compulsive disorder

doi:10.1016/j.brat.2004.06.013

Behaviour Research and Therapy

Volume 43, Issue 7, July 2005, Pages 897-921

https://doi.org/10.1016/j.brat.2004.06.013 Get rights and content

Abstract

Although hoarding is observed in some patients with obsessive–compulsive disorder (OCD), it has not been shown to share a specific relation with OCD. Across two studies, we found that (a) whereas the classic OCD symptoms of checking, rituals, and contamination intercorrelated consistently strongly with one another, hoarding related only moderately to both these OCD symptoms and to depression; (b) OCD patients were distinguished from both other patients and non-patients by classic OCD symptoms, but not by hoarding; and (c) whereas OCD symptoms showed consistent relations with Negative Affect, hoarding largely was uncorrelated with this dimension. These results do not support a specific OCD-hoarding relation but rather call into question the trend of considering it a specific symptom of OCD.

Introduction

Obsessive–compulsive disorder (OCD) is an anxiety disorder marked by recurrent and intrusive thoughts, images, or impulses (obsessions) and/or repetitive behaviors, including mental acts (compulsions). Within the last decade, research has focused less on the dichotomy of obsessions vs. compulsions toward identification of several clusters of symptoms that subsume both obsessions and compulsions. Among the clusters identified consistently as belonging to the core of OCD are those related to checking, rituals, and contamination (e.g., Leckman et al., 1997; Summerfeldt, Richter, Antony, & Swinson, 1999; Wu & Watson, 2003). In addition to these clusters, many researchers have begun to include the domain of hoarding within OCD assessment instruments (e.g., Baer, 1991; Foa, Kozak, Salkovskis, Coles, & Amir, 1998; Foa et al., 2002; Goodman et al., 1989). Other researchers even have characterized hoarding as (a) a symptom of OCD (e.g., Frost, Steketee, Williams, & Warren, 2000; Stein, Seedat, & Potocnik, 1999), (b) a manifestation of OCD (Shafran & Tallis, 1996), or (c) a variant of OCD (Saxena et al., 2002). It is noteworthy, however, that hoarding never has been included as a DSM diagnostic criterion of OCD, nor is the term hoarding once mentioned in DSM-IV's text description of OCD (APA, 2000). This discrepancy between (a) contemporary treatments of hoarding in the OCD literature and (b) the official DSM classification scheme is striking, and it raises fundamental conceptual and assessment issues regarding the relation between hoarding and OCD. In this paper, therefore, we examine data relevant to the question of whether hoarding should be recognized as a basic symptom of OCD.

Section snippets

The nature of hoarding

Although scholars have debated distinctions among terms such as normal collecting, obsessive collecting, and pathological hoarding, hoarding typically is defined as the collecting of—and inability to discard—excessive quantities of useless or valueless items (Frost & Gross, 1993; Winsberg, Cassic, & Koran, 1999). Further, there is relative agreement that to qualify as psychopathological, hoarded items must occupy excessive amounts of space and also interfere with one's daily functioning (Frost

Study 1

Study 1 addresses the nature of the relation between OCD and hoarding in two basic ways. First, to investigate the strength of intercorrelations among hoarding and OCD symptoms, such as checking, rituals, and contamination, we administered two OCD questionnaires to a large sample of college students. Whereas structural analyses of OCD symptoms have proven useful for understanding the multidimensionality of OCD assessment instruments, examination of convergent/discriminant correlation matrices

Study 2

Study 2 was conducted to replicate and extend the findings of Study 1. We report three basic sets of analyses. First, using samples of students, mixed psychiatric outpatients, and OCD patients, we examined group-level differences on OCD and hoarding symptoms. As noted earlier, if hoarding symptoms are specific to OCD, then OCD patients should report levels of hoarding that are higher than those of either (a) non-OCD patients or (b) non-patients. Second, we examine levels of intercorrelation

General discussion

In recent years, increased attention has been paid to the domain of hoarding, especially as a purported symptom of OCD. The current research was conducted to examine several issues relevant to the assertion of a specific OCD-hoarding relation. Overall, our analyses failed to support such a relation. In Study 1, we examined the strength of correlations among OCD symptoms and hoarding using two different measures. The main result was that whereas the classic OCD scales of each instrument (e.g.,

Limitations and future directions

Although successful with respect to their primary goals, these studies had three main limitations. First, both studies relied primarily on questionnaire data. Thus, shared method variance potentially influenced the pattern of correlations that we obtained. Future research should attempt to use alternate methods to assess OCD symptoms and other relevant variables (e.g., personality, mood, and distress), such as (a) structured interviews with patients, (b) collateral ratings obtained from

Acknowledgements

The authors thank Lee Anna Clark for her important role in the conduct of this research and in the preparation of this manuscript. This research was supported in part by a grant from the University of Minnesota Press awarded to the first author.

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Citation Excerpt :
Historically, hoarding has been conceptualized as a subtype or dimension of obsessive–compulsive disorder (OCD). However, most individuals with HD do not meet other symptom criteria for OCD (Frost et al., 2011), most individuals with OCD do not report significant hoarding behaviors (Samuels et al., 2007), and hoarding demonstrates weak correlations with classic OCD symptoms (Wu and Watson, 2005; Abramowitz et al., 2008). Furthermore, the prevalence of HD may actually be higher than that of OCD (Samuels et al., 2008).
Although hoarding disorder (HD) has been historically conceptualized as a subtype or dimension of obsessive–compulsive disorder (OCD), preliminary evidence suggests that these two disorders have distinct neural underpinnings. The aim of the present study was to compare the hemodynamic responses of HD patients, OCD patients, and healthy controls (HC) during response inhibition on a high-conflict Go/NoGo task that has previously proved sensitive to OCD. Participants comprised 24 HD patients, 24 OCD patients, and 24 HCs who completed a Go/NoGo task during functional magnetic resonance imaging (fMRI). Although behavioral data showed no difference among the groups in Go/NoGo task performance, significant differences in hemodynamic activity were noted. During correct rejects (successful response inhibition), HD patients showed greater right precentral gyrus activation, whereas OCD patients exhibited greater right orbitofrontal activation, as assessed using a region of interest approach. During errors of commission (response inhibition failures), OCD patients, but not HD patients, were characterized by excessive activity in left and right orbitofrontal gyrus. The present results lend further support to the biological distinction between HD and OCD, and they are consistent with previous research suggesting frontal hypoactivity in HD patients during hoarding-unrelated tasks.
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The aims of this study were to evaluate early maladaptive schemas (EMSs) of patients with obsessive-compulsive disorder (OCD) and to clarify relationships between particular EMSs and the five factor-analyzed symptom dimensions and other clinical variables. Fifty-seven patients with OCD and 70 normal controls completed the Young Schema Questionnaire, the Yale–Brown Obsessive Compulsive Scale (Y–BOCS), the Y–BOCS symptom checklist, and the Beck Depression Inventory. Patients with OCD had significantly higher scores for schema related to defectiveness/shame, social isolation/alienation, and failure than did normal controls. Among the five OCD symptom dimensions, the sexual/religious dimension was only significantly correlated with two schemas of vulnerability to harm or illness and enmeshment/undeveloped self. These two schemas were significant predictors of the sexual/religious dimension, accounting for 33% of the total variance in this dimension. Any EMSs in patients with OCD were not related to clinical variables such as severity of OCD and duration of illness. These findings may constitute evidence to improve our understandings of OCD from a perspective of schema theory.

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View full text

Hoarding and its relation to obsessive–compulsive disorder

Abstract

Introduction

Section snippets

The nature of hoarding

Study 1

Study 2

General discussion

Limitations and future directions

Acknowledgements

Behaviour Research and Therapy

The investigation of personality

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

American Journal of Geriatric Psychiatry

Comprehensive Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Contributions to the theory of the anal character

Getting controlovercoming your obsessions and compulsions

Fear, panic, anxiety and disorders of emotion

Nebraska Symposium on Motivation

EQS structural equations program manual

Preliminary study of an obsessive thoughts checklistvalidation and factorial analysis

L’Encephale

Manual for the schedule for nonadaptive and adaptive personality

Tripartite model of anxiety and depressionpsychometric evidence and taxonomic implications

Journal of Abnormal Psychology

Diagnosis and classification of psychopathologychallenges to the current system and future directions

Annual Review of Psychology

Hoardinga symptom, not a syndrome

Journal of Clinical Psychiatry

Obsessive–compulsive disorderthe facts

Eysenck personality questionnaire manual

The obsessive–compulsive inventorydevelopment and validation of a short version

Psychological Assessment

DSM-IV field trialobsessive–compulsive disorder

American Journal of Psychiatry

The validation of a new obsessive–compulsive disorder scalethe obsessive–compulsive inventory

Psychological Assessment

Hoarding in anorexia nervosa

British Journal of Medical Psychiatry