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An exploration of economic reasoning in hoarding disorder patients

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Abstract

Current models of hoarding disorder (HD) emphasize problems of decision-making. Evidence for neuropsychological impairment in HD, however, has been mixed. The present study examined whether HD patients show problems of economic reasoning that could be associated with decision-making problems. Forty-two HD patients, 29 obsessive-compulsive disorder (OCD) patients, and 36 healthy control participants completed the Iowa gambling task (IGT), a computerized card playing game that assesses participants’ ability to learn and utilize a rule of sacrificing short-term gain for long-term gain, and a cognitive dissonance reduction task that measured changes in preference for items (art prints) after selecting or rejecting them. Results showed no deficits on the IGT for HD participants, and no difference in dissonance reduction results after selecting or rejecting items on the dissonance reduction task. Furthermore, performance on these two tasks was unrelated to hoarding symptom severity or self-reported indecisiveness. It is suggested that the problems of cognitive processing in HD patients may be largely related to as-yet understudied processes, including idiosyncratic categorization problems for personally-owned items as well as other aspects of economic reasoning.

Highlights

► Explored economic reasoning in hoarding patients, OCD patients, and healthy controls. ► Iowa gambling task and a dissonance reduction task were used. ► No evidence was found for problems of economic reasoning in hoarding patients.

Section snippets

Participants

One hundred seven adult participants met inclusion criteria of age 18–65; fluent in English; absence of lifetime bipolar, psychotic, developmental, or substance use disorders; absence of medical conditions known to impact brain function; and (for the clinical groups) symptom duration of 1 year or more and Clinician’s Global Impressions (CGI; Guy, 1976) rating of 4 (moderately ill) or higher. Furthermore, participants were included if they could be classified into one of three diagnostic groups:

Sample description

Table 1 shows that the OCD group was younger on average than were the hoarding and healthy control groups. Subsequent analyses therefore corrected for age. As expected, the hoarding group exhibited higher SI-R scores than did the other two groups (the OCD group also showed some elevation, but were well within the nonclinical range on the SI-R). The OCD and healthy control groups’ SI-R scores were somewhat lower than those found in previous research (Frost et al., 2004). The two clinical groups

Discussion

The HD patients in the present study reported higher fear of decision-making and lower positive feelings about decision-making than did OCD patients or healthy controls, replicating and extending the findings of previous research (Frost and Gross, 1993, Frost and Shows, 1993, Samuels et al., 2002, Steketee et al., 2003). However, they did not exhibit abnormalities of economic reasoning on the behavioral tasks used. HD patients performed adequately on the IGT, a finding that contrasts with

Acknowledgments

This study was funded by NIMH grant #R01MH074934 to Dr. Tolin.

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      Investigations using self-report measures show that both OCD and HD are associated with decisional procrastination or indecisiveness (e.g. Ferrari & McCown, 1994; Fitch & Cougle, 2013; Frost & Gross, 1993; Frost & Shows, 1993; Grisham, Norberg, Williams, Certoma, & Kadib, 2010). Additionally, self-reports show that people with OCD are less confident in their decision-making abilities (Nedeljkovic & Kyrios, 2007), and that people who hoard tend to delay decisions, feel regret after making decisions, and report more fears about – and less positive attitudes toward – decision-making (Fitch & Cougle, 2013; Frost, Tolin, Steketee, & Oh, 2011; Grisham, Norberg, Williams, Certoma, & Kadib, 2010; Kyrios et al., 2018; Steketee, Frost, & Kyrios, 2003; Tolin & Villavicencio, 2011; Wincze, Steketee, & Frost, 2007). In studies employing laboratory decision-making tasks, people with OCD and people with HD are slower to make decisions and report greater distress about decisions when compared to clinical and healthy controls (Foa et al., 2003; Grisham et al., 2010; Luchian, McNally, & Hooley, 2007; Tolin, Kiehl, Worhunsky, Book, & Maltby, 2009; Wincze et al., 2007).

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      Lawrence et al. (2006) found evidence of a “link between hoarding and [increased] risky behavior on the IGT,” while the OCD group did not differ from controls. In contrast, neither Grisham et al. (2007), nor Tolin and Villavicencio (2011) found that hoarding participants differed from controls on the IGT (Grisham et al., 2007; Tolin and Villavicencio, 2011). A large study by Mackin and colleagues found no differences between HD, OCD, or age matched controls on the IGT (Mackin et al., 2015).

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      However, direct group comparisons again demonstrated graded performance with no significant differences. Thus, it is possible that weakness in cognitive flexibility in OCD and hoarders are a matter of degree (see also Tolin and Villavicencio, 2011). This weakness may also become more pronounced in older adults as it may interact with normal aging related decline (Ayers et al., 2013).

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