Neuropsychological impairment associated with compulsive hoarding

The aim of this study is to determine whether neurocognitive performance distinguishes individuals with compulsive hoarding (CH) from those with obsessive-compulsive disorder (OCD). Compared to control subjects, OCD patients and CHs scored significantly worse on the Serial Reaction Time Task suggesting disturbed implicit memory in both patient groups. On the Iowa Gambling Task, an overall learning progression difference over time was found between the CHs, OCD group, and control subjects, suggesting differences in decision-making between the groups. The groups did not differ in performance on the Stop Signal Reaction Time Task (motor inhibition). This study found evidence for impaired implicit memory in CHs, but also in OCD patients, albeit less severe. There was evidence that OCD patients learned more slowly on a decision-making task than CHs and control subjects. This latter finding provides some evidence to suggest that CH and OCD have, at least on this one measure, differing cognitive substrates.

Procedia - Social and Behavioral Sciences, 2013

Researchers have reported that compulsive hoarding is associated with neurocognitive deficits. In this study, tests of general and working memory, attention, and executive control were administered to individuals recruited from the general population in Istanbul, Turkey obtaining markedly elevated scores on a self-administered measure of compulsive hoarding behaviour and matched controls. Participants also completed self-administered inventories assessing executive dyscontrol, disinhibition, inattention, hyperactivity, depressive and obsessive-compulsive (OC) symptoms, and schizotypal personality (SP) characteristics. A measure of major psychiatric syndromes was also administered. Unexpectedly, individuals reporting elevated levels of compulsive hoarding behaviour and control subjects matched for age, educational level, and gender did not obtain significantly different scores on almost all neurocognitive tasks administered. On several neuropsychological tests (i.e., measures of attention, non-verbal memory, and working memory) individuals reporting elevated levels of hoarding behaviour achieved higher scores (including significantly greater scores on delayed non-verbal recall). In contrast, compulsive hoarders obtained significantly greater scores on self-administered inventories of executive dyscontrol, disinhibition, depressive and OC symptoms, and SP characteristics relative to controls. Interestingly, groups did not differ on a measure of major axis-I disorders including obsessive-compulsive disorder (OCD). A substantially greater number of compulsive hoarders, however, met diagnostic criteria for generalized anxiety disorder (GAD). Compulsive hoarding was not associated with deficits on neurocognitive tasks. However, hoarding was related to GAD and higher scores on selfadministered inventories of cognitive dysfunction, disinhibition, depressive and OC symptoms, and SP characteristics relative to matched controls. To our knowledge, this is the first investigation in Turkey of the neurocognitive correlates of compulsive hoarding. Selection and peer review under the responsibility of Prof.

Neuropsychiatric Disease and Treatment, 2015

Hoarding disorder (HD) is associated with significant personal impairment in function and constitutes a severe public health burden. Individuals who hoard experience intense distress in discarding a large number of objects, which results in extreme clutter. Research and theory suggest that hoarding may be associated with specific deficits in information processing, particularly in the areas of attention, memory, and executive functioning. There is also growing interest in the neural underpinnings of hoarding behavior. Thus, the primary aim of this review is to summarize the current state of evidence regarding neuropsychological deficits associated with hoarding and review research on its neurophysiological underpinnings. We also outline the prominent theoretical model of hoarding and provide an up-to-date description of empirically based psychological and medical treatment approaches for HD. Finally, we discuss important future avenues for elaborating our model of HD and improving treatment access and outcomes for this disabling disorder.

Journal of Clinical Psychology, 2011

Hoarding can be a symptom of multiple neurological and psychiatric disorders, including obsessivecompulsive disorder (OCD). Recent evidence suggests that, in many cases, hoarding can also be a standalone problem that presents independently from other conditions; this has led to the proposal of a new diagnostic entity named hoarding disorder. This article reviews the neuropsychological and neuroimaging research on pathological hoarding. Most research in humans has been conducted in the context of individuals with brain damage, dementia, or OCD. Studies of well-characterized samples of individuals with hoarding disorder are extremely rare. Although not possible to establish firm conclusions at this stage, we conclude with a series of observations and recommendations for clinical practice.

2010

According to the cognitive-behavioural model of compulsive hoarding, information processing deficits in the areas of attention, memory, decision-making, and categorization contribute to hoarding behaviour. The purpose of the current study was to examine whether individuals with compulsive hoarding exhibited impairment on executive functioning and categorization tasks. Three groups of participants were recruited (N = 60): individuals with compulsive hoarding syndrome, individuals with an Axis I mood or anxiety disorder, and nonclinical control participants. All participants completed self-report measures of cognitive difficulties, neuropsychological tests of executive functioning and decision-making, and four categorization tasks. Results suggested that hoarding participants reported more cognitive failures and more problems with attention and decision-making than nonclinical control participants. In addition, hoarding participants performed worse than both control groups on the Stockings of Cambridge (SOC), a neuropsychological test of planning ability, and were slower and more anxious during a categorization task. These findings suggest that specific deficits in executive functioning may be associated with the difficulties hoarding patients have organizing their possessions.

Psychiatry Research, 2012

Hoarding has been considered a subtype of obsessive-compulsive disorder (OCD). Planned revisions to the diagnostic criteria propose that hoarding form a separate diagnosis in a larger category of obsessive compulsive related disorders. To date, there have been few direct comparisons between hoarding and those with other symptoms of OCD. This study builds on work that suggests compulsive hoarding, while similar to OCD, comprises a clinically distinct condition. Three groups were compared: those with OCD without compulsive hoarding symptoms (n ¼102), those with compulsive hoarding but not OCD (n¼ 21), and individuals who satisfied both criteria (n ¼ 25). The groups were compared on obsessionality, compulsivity, overvalued ideas, depression, and anxiety. The two hoarding groups were also compared on hoarding symptoms and savings cognitions. Results indicated that the hoarding-only group reported fewer symptoms than both OCD groups, including fewer obsessions and compulsions and lower depression. Both hoarding groups showed significantly higher overvalued ideas when compared to the OCD-only group. These results suggest that hoarders experience less subjective distress than those with OCD, yet have greater difficulty in challenging dysfunctional cognitions associated with the presenting condition. These findings suggest that individuals with hoarding, whether with or without OCD, will show greater difficulty engaging in cognitive-behavioral interventions.

Journal of Psychiatric Research, 2012

Background: Factor analyses indicate that hoarding symptoms constitute a distinctive dimension of obsessive-compulsive disorder (OCD), usually associated with higher severity and limited insight. The aim was to compare demographic and clinical features of OCD patients with and without hoarding symptoms. Method: A cross sectional study was conducted with 1001 DSM-IV OCD patients from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (CTOC), using several instruments. The presence and severity of hoarding symptoms were determined using the Dimensional Yale-Brown Obsessive-Compulsive Scale. Statistical univariate analyses comparing factors possibly associated with hoarding symptoms were conducted, followed by logistic regression to adjust the results for possible confounders. Results: Approximately half of the sample (52.7%, n ¼ 528) presented hoarding symptoms, but only four patients presented solely the hoarding dimension. Hoarding was the least severe dimension in the total sample (mean score: 3.89). The most common lifetime hoarding symptom was the obsessive thought of needing to collect and keep things for the future (44.0%, n ¼ 440). After logistic regression, the following variables remained independently associated with hoarding symptoms: being older, living alone, earlier age of symptoms onset, insidious onset of obsessions, higher anxiety scores, poorer insight and higher frequency of the symmetry-ordering symptom dimension. Concerning comorbidities, major depressive, posttraumatic stress and attention deficit/hyperactivity disorders, compulsive buying and tic disorders remained associated with the hoarding dimension. Conclusion: OCD hoarding patients are more likely to present certain clinical features, but further studies are needed to determine whether OCD patients with hoarding symptoms constitute an etiologically discrete subgroup.

Behaviour Research and Therapy, 2002

Hoarding behavior occurs frequently in obsessive-compulsive disorder (OCD). Results from previous studies suggest that individuals with OCD who have hoarding symptoms are clinically different than non-hoarders and may represent a distinct clinical group. In the present study, we compared 235 hoarding to 389 non-hoarding participants, all of whom had OCD, collected in the course of the OCD Collaborative Genetics Study. We found that, compared to non-hoarding individuals, hoarders were more likely to have symmetry obsessions and repeating, counting, and ordering compulsions; poorer insight; more severe illness; difficulty initiating or completing tasks; and indecision. Hoarders had a greater prevalence of social phobia and generalized anxiety disorder. Hoarders also had a greater prevalence of obsessive-compulsive and dependent personality disorders. Five personality traits were independently associated with hoarding: miserliness, preoccupation with details, difficulty making decisions, odd behavior or appearance, and magical thinking. Hoarding and indecision were more prevalent in the relatives of hoarding than of non-hoarding probands.

American Journal of Psychiatry, 2007