The Impact of Hoarding Disorder on Family Members, Especially the Significant Other.

Hoarding disorder, also known as compulsive hoarding, comes under the umbrella term of obsessive-compulsive disorder and related disorders. The constant building of clutter in the house of hoarders makes it impossible for family members to live a healthy life. It can have appalling effects on their mental health and can lead to severe depression and suicidal ideation. The shame and humiliation attached to hoarding does not allow the hoarders to seek help, causing them distress and hence continuing the vicious cycle of hoarding. By presenting the case of a patient with a spouse with a hoarding disorder, we want to bring to light the severity of the impact hoarding disorder can have on the partner and the grave need to spread awareness about it so that the patient or the family members can seek timely help.

Study protocol for a randomized controlled trial of in-home decluttering augmentation of group cognitive-behavioral therapy for hoarding disorder: the Joining Forces Trial.

BACKGROUND: Cognitive behavioral therapy (CBT) is a moderately efficacious treatment for hoarding disorder (HD), with most individuals remaining symptomatic after treatment. The Joining Forces Trial will evaluate whether 10 weeks of in-home decluttering can significantly augment the outcomes of group CBT. METHODS: A randomized controlled trial of in-home decluttering augmentation of group CBT for HD. Adult participants with HD (N = 90) will receive 12 weeks of protocol-based group CBT for HD. After group CBT, participants will be randomized to either 10 weeks of in-home decluttering led by a social services team or a waitlist. The primary endpoint is 10 weeks post-randomization. The primary outcome measures are the self-reported Saving Inventory-Revised and the blind assessor-rated Clutter Image Rating. Participants on the waitlist will cross over to receive the in-home decluttering intervention after the primary endpoint. Data will be analyzed according to intention-to-treat principles. We will also evaluate the cost-effectiveness of this intervention from both healthcare and societal perspectives. DISCUSSION: HD is challenging to treat with conventional psychological treatments. We hypothesize that in-home decluttering sessions carried out by personnel in social services will be an efficacious and cost-effective augmentation strategy of group CBT for HD. Recruitment started in January 2021, and the final participant is expected to reach the primary endpoint in December 2024. TRAIL REGISTRATION: ClinicalTrials.gov NCT04712474. Registered on 15 January 2021.

[Problématiques d'accumulation chez les aînés : l'expérience de proches aidants québécois au sein des services communautaires et publics].

Cette recherche qualitative traite de la situation des proches aidants des aînés composant avec une problématique d'accumulation (trouble d'accumulation compulsive, autonégligence, syndrome de Diogène). Il s'agit d'un contexte de la proche aidance qui a été jusqu'à maintenant peu étudié, où les réalités du vieillissement et de la santé mentale sont en interaction. Onze proches aidants et huit intervenants sociaux des régions de la Capitale-Nationale et de Chaudière-Appalaches ont participé à des entretiens semi-dirigés, lesquels ont été soumis à une analyse thématique de contenu. Nos résultats indiquent que malgré l'interaction du vieillissement et de problématiques de santé mentale, ce sont les enjeux liés au vieillissement qui déclenchent le début de la proche aidance, puis le maintien de cet engagement dans la durée. Ils nous montrent aussi que des efforts de concertation et de coordination devraient être déployés afin que les différents acteurs interpellés prévoient des trajectoires de services pour la personne âgée et les proches avant que le problème d'accumulation engendre des enjeux de sécurité importants. Dans ces trajectoires, les organisations sociosanitaires gagneraient à davantage reconnaître les savoirs des proches et à mettre à leur disposition les services requis pour répondre à leurs besoins spécifiques.

Acompanhamento terapêutico na atenção básica: Estratégia de cuidado para acumuladores compulsivos / Therapeutic monitoring in primary health care: Strategies for caring for hoarding disorders / Acompañamiento terapéutico en la atención básica: Estrategia de cuidado para acumuladores compulsivos

O projeto de extensão "Acompanhamento Terapêutico em Saúde Mental: suporte para inclusão e (re)construção do cotidiano", advindo da parceria entre a Diretoria de Saúde Mental de Curitiba e os Departamentos de Psicologia, Terapia Ocupacional e Enfermagem da Universidade Federal do Paraná, visou oferecer Acompanhamento Terapêutico (AT) a usuários dos serviços de saúde mental do município, com uma vertente específica de atuação junto a acumuladores compulsivos. Este trabalho se destina a relatar a experiência desse projeto, aprofundando a estratégia da utilização do AT num caso de acumulação compulsiva de animais. Para prover suporte à compilação e análise dos dados, utilizou-se como técnica de coleta de dados os diários de campo das acompanhantes terapêuticas envolvidas no caso. As anotações foram realizadas com base nas descrições objetivas das situações vivenciadas, reflexões e impressões pessoais e grupais dos profissionais que acompanhavam o caso. Após análise e categorização, conclui-se que a abordagem da pessoa com transtorno de acumulação tem especificidades que ressaltam a importância do cuidado e do trabalho em rede. Ademais, o AT se apresenta como um importante recurso no manejo de casos de acumuladores compulsivos e potencializador do trabalho em rede, por meio de ações singulares e estratégicas.

The extension project "Therapeutic Monitoring in Mental Health: support for inclusion and daily life (re)construction", resulting from a partnership between the Mental Health Directorship of Curitiba and the departments of Psychology, Occupational Therapy, and Nursing of the Federal University of Paraná, aimed to offer Therapeutic Monitoring to users of the mental health services of the city, with a specific application to compulsive hoarders. The present study aims to report on the experience of the therapeutic monitoring carried out in this project, in order to discuss the potential of this clinical device in the management of an animal hoarding case. For data collection, this study used field diaries kept by the therapeutic monitors involved in the case. The notes were taken as objective descriptions of the situations and personal and group reflections of the professionals that followed the case. After analyzing and categorizing the data, it was concluded that the approach of the person with hoarding disorder has distinct particularities that highlight the importance of care and networking. In addition, therapeutic monitoring may be an important resource in the management of hoarding cases and a catalyst for the networking, prompting singular and strategic actions.

El proyecto de extensión "Acompañamiento Terapéutico en Salud Mental: soporte para inclusión y (re)construcción de lo cotidiano", realizado por la asociación entre la Dirección de Salud Mental de Curitiba y los departamentos de Psicología, Terapia Ocupacional y Enfermería de la Universidad Federal de Paraná, tuvo como objetivo ofrecer Acompañamiento Terapéutico (AT) a usuarios de los servicios de salud mental del municipio, actuando junto a acumuladores compulsivos. El trabajo objetiva relatar la experiencia del proyecto, profundizando la estrategia de la utilización del AT junto a un caso de acumulación compulsiva de animales. Para la compilación de los datos, se utilizó los diarios de campo de las acompañantes terapéuticas involucradas en el caso. Las anotaciones se realizaron con base en las descripciones objetivas de las situaciones vividas, reflexiones e impresiones personales y grupales de los profesionales que acompañaban el caso. Después del análisis y categorización, se concluye que el abordaje de la persona con trastorno de acumulación posee especificidades que resaltan la importancia del cuidado y del trabajo en red. Además, el AT se presenta como un importante recurso en el manejo de casos de acumuladores compulsivos y potenciador del trabajo en red, por medio de acciones singulares y estratégicas.

The Prevalence of Compulsive Buying and Hoarding Behaviours in Emerging, Early, and Middle Adulthood: Multicentre Epidemiological Analysis of Non-clinical Chinese Samples.

Behavioural addictions, such as compulsive buying (CB) and hoarding, are increasingly recognised in the current psychiatric nosology, particularly in developed countries. The prevalence of these disorders may not be static but possibly altered across different age groups. However, studies on this area are rare, and only few have focused on Chinese population. This epidemiological study employs population-based cross-sectional design and collects data in two regions, i.e., Hong Kong and Mainland China. A self-reported questionnaire is constructed based on carefully validated Chinese versions of Richmond Compulsive Buying Scale and Hoarding Rating Scale. A total of 2,439 valid samples are collected and divided into three age groups, i.e., emerging, early and middle adulthood. CB and hoarding behaviours have displayed an inverted u-shaped pattern across the above age groups. In addition, the strength of correlation between the two compulsive behaviours is consistent and maintained across different age groups. These results suggest that the compulsive behaviours vary among different stages of adulthood in major cities in China. This newly discovered pattern of compulsive disorders in Chinese population is different from those in American and European populations.

The Relationship Between Compulsive Buying and Hoarding in China: A Multicenter Study.

There is no previous research that has explored the correlation between compulsive buying and hoarding in the Chinese population. This study aims to determine the relationship between compulsive buying and hoarding in a sample of the Chinese population comprising participants from mainland China (emerging economy) and Hong Kong (developed economy). Self-reported measures consisting of demographic questions, the Chinese version of the Hoarding Rating Scale (CHRS), and Richmond Compulsive Buying Scale-Traditional Chinese (RCBS-TC) were administered to participants. After data collection, common method biases were precluded. The RCBS-TC and CHRS were validated by confirmatory factor analysis and found correlated by Pearson correlation coefficient. The RCBS-TC and CHRS demonstrated satisfactory levels of internal consistency (Cronbach's α = 0.872 and 0.828, respectively). A three-factor model, including hoarding, obsessive-compulsive, and impulse control disorders, was obtained through Confirmatory Factor Analysis (CFA) with the satisfactory fit for the total sample from Hong Kong and mainland China. A significant correlation was found between RCBS-TC and CHRS (r = 0.473). Findings also showed that 14% of the participants exhibited compulsive buying behavior. This study provides sufficient proof of the reliability and validity of RCBS-TC and CHRS. Their relationship was explored based on two sets of samples from different regions in Asia, which contributes more applicability in a cross-cultural context.

Compulsive Hoarding Symptoms and the Role of Mindfulness Skills During Social Distancing for the COVID-19 Pandemic: An Exploratory Survey.

People reporting compulsive hoarding symptoms (CHS) have lower mindfulness skills than those without such symptoms. Mindfulness skills can have the role of a protective buffer against stressful periods. The quarantine imposed to contain the COVID-19 spread had a negative impact on daily habits and healthy behaviors (including social interactions). An increased attachment to objects might be one of the under-recognized psychological consequences of these difficult times, yet no study focused on CHS. Through an online survey in men who were on quarantine during the pandemic, this exploratory survey examined the prevalence of men reporting CHS during this period and explored the role of mindfulness skills on CHS controlling for anxious-depressive/stress symptoms. Forty-three men from the general population completed the Obsessive Compulsive Inventory-Revised (OCI-R), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) and Depression Anxiety Stress Scales-21 (DASS-21). Twenty-eight percent reported CHS. No differences on the scores of the questionnaires emerged between men with and without CHS, except on CAMS-R Attention scores. In a logistic regression analysis lower CAMS-R Attention scores predicted CHS (ß = -0.34, p = 0.03). This is the first, yet preliminary investigation on CHS during quarantine. The prevalence of CHS appears higher than the rates (4%) reported in the last years before the COVID-19 outbreak. Perhaps people showed more intense hoarding tendencies during quarantine/social distancing, and this pattern should be monitored. Larger samples, longitudinal designs and clinician-rated instruments are needed to support or not our findings.

Cognitive behaviour therapy with compulsive hoarding: a single case study.

The current case study used cognitive behaviour treatment (CBT) for the management of a 35-year-old, married man who presented with complaint of compulsive hoarding. The complaint of compulsive hoarding (excessive acquisition, difficulty in discarding saved material and cluttering) was accompanied by feeling of anger, sad mood, low confidence, decreased sleep and appetite, poor problem solving ability, indecisiveness and interpersonal conflicts. The study was approved by the institutional research committee (Departmental Doctoral Programme Committee) and followed by the university research committee (Advance Studies and Review Board) as academic requirement for the duration of 2013-2020. Written consent was also taken from the individual to publish the results of the case. Twenty-eight CBT sessions of one-hour duration were conducted, over a period of six months. Management plan mainly comprised decision-making techniques, cognitive restructuring, behavioural experiments, problem solving and social skills training. The individual was assessed on pre, mid, post and follow up levels. Assessment showed significant decrease in the symptoms. The present case report will help clinicians dealing with individuals with compulsive hoarding and its associated features, effectively with CBT.

Object attachment and emotions in hoarding disorder.

BACKGROUND AND AIMS: Object attachment is a core feature of hoarding disorder (HD), but it also occurs in people without HD. It is therefore critical to clarify differences between normal and abnormal object attachment. Although previous studies show that HD is associated with high emotional reactivity, no study to date has examined the nature and intensity of discrete emotions in people with and without HD in relation to object attachment. METHOD: Individuals with HD (n = 93) and matched controls (n = 93) were recruited via MTurk. They identified and described a possession of low monetary value that they were emotionally attached to and found difficult to discard. Participants rated their object attachment and the intensity of emotions when imagining being with the object (Scenario A) and irretrievably losing the same object (Scenario B). RESULTS: Unexpectedly, there were no significant between-group differences on object attachment; however, the HD group experienced more incongruent emotions about their possessions; they reported significantly higher disgust, anxiety and anger than controls when they imagined being with their chosen object (Scenario A) and were more relaxed compared to controls when the object was lost (Scenario B). There were no significant differences between groups on congruent emotions (i.e., positive emotions in Scenario A or negative emotions in Scenario B). CONCLUSION: People with and without HD experience similar emotional attachment for sentimental items but people with HD experience more mixed emotions, consistent with an insecure object attachment.

The cognitive-behavioural model of hoarding disorder: Evidence from clinical and non-clinical cohorts.

The cognitive-behavioural model of hoarding disorder incorporates information processing difficulties, maladaptive attachment to possessions, erroneous beliefs about the nature of possessions, and mood problems as etiologically significant factors, although developmental experiences such as a compromised early family environment have also been proposed in an augmented model. This study examined the specificity and relevance of variables highlighted in the augmented cognitive-behavioural model. Various clinical participants (n = 89) and community controls (n = 20) were assessed with structured clinical interviews to verify diagnosis. Participants completed self-report measures of hoarding severity, cognitions, meta-memory, and early developmental experiences (e.g., memories of warmth and security in one's family). Hoarding cohorts (with and without obsessive-compulsive disorder) reported poor confidence in memory, but relative to other groups (obsessive-compulsive disorder without hoarding disorder, anxiety disorders, and healthy controls), hoarding-relevant cognitions, need to keep possessions in view, and concerns about the consequences of forgetting were significantly higher. Hoarding groups reported the lowest recollections of warmth in their family, although no differences were found between hoarding and non hoarding clinical cohorts for uncertainty about self and others. Nonetheless, clinical cohorts reported generally higher scores of uncertainty than healthy controls. When predicting hoarding severity, after controlling for age and mood, recollections of lack of warmth in one's family was a significant predictor of hoarding severity, with hoarding-related cognitions and fears about decision-making being additional unique predictors. The study supports the augmented cognitive-behavioural model of hoarding, inclusive of the importance of early developmental influences in hoarding.

Using Virtual Reality in the Inference-Based Treatment of Compulsive Hoarding.

The present study evaluated the efficacy of adding a virtual reality (VR) component to the treatment of compulsive hoarding (CH), following inference-based therapy (IBT). Participants were randomly assigned to either an experimental or a control condition. Seven participants received the experimental and seven received the control condition. Five sessions of 1 h were administered weekly. A significant difference indicated that the level of clutter in the bedroom tended to diminish more in the experimental group as compared to the control group F(2,24) = 2.28, p = 0.10. In addition, the results demonstrated that both groups were immersed and present in the environment. The results on posttreatment measures of CH (Saving Inventory revised, Saving Cognition Inventory and Clutter Image Rating scale) demonstrate the efficacy of IBT in terms of symptom reduction. Overall, these results suggest that the creation of a virtual environment may be effective in the treatment of CH by helping the compulsive hoarders take action over their clutter.

Executive Functioning in Participants Over Age of 50 with Hoarding Disorder.

OBJECTIVES: The current investigation utilized mid-life and late-life participants diagnosed with hoarding disorder (HD) to explore the relationship between executive functioning and hoarding severity. DESIGN: Correlational analyses were used to investigate the associations between executive functioning and hoarding severity in nondemented participants. Multiple regression was used to determine if executive functioning had a unique association with HD severity when accounting for depressive symptoms. SETTING: Participants were recruited from the San Diego area for HD intervention studies. PARTICIPANTS: Participants were 113 nondemented adults aged 50-86 years who met DSM-5 criteria for HD. The mean age of the sample utilized in the analyses was 63.76 years (SD, 7.2; range, 51-85 years). The sample was mostly female (72%), Caucasian (81.4%), and unmarried (78%). MEASUREMENTS: Hoarding severity was assessed using the Saving Inventory-Revised and the Clutter Image Rating and depression was assessed using the Hospital Anxiety and Depression Scale. Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST-128) and the Trail Making and Verbal Fluency subtests of the Delis-Kaplan Executive Function System. RESULTS: Executive function (operationalized as perseveration on the WCST-128) was significantly associated with Clutter Image Ratings. In a multivariate context, executive function and depressive symptom severity were both significant predictors of variance in Clutter Image Rating. CONCLUSIONS: Our results suggest that executive function is related to severity of HD symptoms and should be considered as part of the conceptualization of HD.

Transtorno de acumulação compulsiva de idosos: Possibilidades de cuidados e questões de saúde pública / Disorder of compulsive hoarding elderly: Possibilities of care and public health issues

Este artigo relata o fenômeno do aumento do índice do transtorno de acumulação compulsiva por parte de pessoas idosas, que são fascinadas e controladas pelas coisas, objetos, animais e, em alguns casos, tornando suas próprias casas espaços inabitáveis, em função da quantidade de itens que guardam. O transtorno de acumulação compulsiva se caracteriza como uma doença com necessidade de intervenção. O aumento significativo de casos do transtorno de acumulação compulsiva por idosos foi detectado por meio de visitas realizadas pelo Núcleo de Apoio à Atenção Saúde da Família (NASF). O relato aborda a compreensão da temática do assunto e relata possibilidades de cuidados e enfrentamento aos desafios na atenção subjetiva da pessoa idosa e questões de saúde pública.

This article describes the phenomenon in the increase of the index of compulsive hoarding disorder on the part of older people who are fascinated and controlled by things, objects, animals and in some cases making their homes uninhabitable spaces depending on the amount of items that hold. The compulsive hoarding disorder is characterized as a disease in need of intervention. The significant increase in cases of compulsive hoarding disorder for the elderly was detected through visits by the Center for Support to Family Health Care (NASF). The report shows the understanding of the subject and thematic reports possibilities of care and coping with the challenges in the subjective mind of the elderly and health issues public.

Transtorno de acumulação compulsiva de idosos: Possibilidades de cuidados e questões de saúde pública / Disorder of compulsive hoarding elderly: Possibilities of care and public health issues

Este artigo relata o fenômeno do aumento do índice do transtorno de acumulação compulsiva por parte de pessoas idosas, que são fascinadas e controladas pelas coisas, objetos, animais e, em alguns casos, tornando suas próprias casas espaços inabitáveis, em função da quantidade de itens que guardam. O transtorno de acumulação compulsiva se caracteriza como uma doença com necessidade de intervenção. O aumento significativo de casos do transtorno de acumulação compulsiva por idosos foi detectado por meio de visitas realizadas pelo Núcleo de Apoio à Atenção Saúde da Família (NASF). O relato aborda a compreensão da temática do assunto e relata possibilidades de cuidados e enfrentamento aos desafios na atenção subjetiva da pessoa idosa e questões de saúde pública.(AU)

This article describes the phenomenon in the increase of the index of compulsive hoarding disorder on the part of older people who are fascinated and controlled by things, objects, animals and in some cases making their homes uninhabitable spaces depending on the amount of items that hold. The compulsive hoarding disorder is characterized as a disease in need of intervention. The significant increase in cases of compulsive hoarding disorder for the elderly was detected through visits by the Center for Support to Family Health Care (NASF). The report shows the understanding of the subject and thematic reports possibilities of care and coping with the challenges in the subjective mind of the elderly and health issues public.(AU)

Poor Memory Confidence Mediates the Association between Inattention Symptoms and Hoarding Severity and Impairment.

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.

Hoarding disorder in older adulthood.

OBJECTIVE: Hoarding disorder (HD) is a chronic condition associated with moderate to severe impairment in health and functioning. HD has been primarily studied in midlife adults, and there is limited research on HD in late life. METHODS: In this review, we summarize research on the presentation and characteristics of HD and hoarding symptoms in older adults, including evidence for associated impairment in daily functioning, physical health, and cognitive function. Finally, we review the evidence available for intervention outcomes for treating HD in older adults. RESULTS: Geriatric HD is characterized by severe functional impairment, medical and psychiatric comorbidities, and cognitive dysfunction. CONCLUSION: There is a lack of randomized controlled trials investigating evidence-based treatments for geriatric HD.

Transtorno da Acumulação: características clínicas e epidemiológicas / Hoarding Disorder: clinical and epidemiological aspects / Trastorno por Acumulación: características clínicas y epidemiológicas

O Transtorno da Acumulação (TA) caracteriza-se pela aquisição compulsiva de objetos desnecessários, desorganização e dificuldade em desfazer-se das posses. Nas edições anteriores do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM), não existia um diagnóstico específico para sujeitos com esses sintomas, sendo normalmente classificados com Transtorno Obsessivo-Compulsivo (TOC) e Transtorno da Personalidade Obsessivo-Compulsiva (TPOC). Este trabalho consiste em uma revisão bibliográfica consultada em bases de indexação internacionais que visa discutir as características clínicas, epidemiológicas e de tratamento no TA. Embora não exista uma consensualidade na literatura, os achados sugerem que o transtorno constitui uma patologia independente e com alta prevalência de comorbidades, sendo necessária a realização de intervenções terapêuticas focadas em aspectos cognitivos e de comportamento do sujeito. Por fim, enfatiza-se a realização de pesquisas com esse perfil de pacientes salientando a realidade brasileira.

Hoarding Disorder (HD) is characterized by the compulsive acquisition of unnecessary objects, clutter, and difficulty in discarding possessions. Previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) showed no specific diagnosis for subjects presenting these symptoms, which were usually classified as Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD). This work consists on a literature review based on international indexing databases, and it aims to discuss the epidemiological, clinical, and treatment aspects of HD. Although there is no consensual in the literature, the findings suggest that the disorder is an independent disease, and with high prevalence of comorbidities, requiring therapeutic interventions focused on the cognitive and behavioral characteristics of these subjects. Finally, carrying out researches with this profile of patients, emphasizing the reality of Brazil is suggested.

El Trastorno por Acumulación (TA) se caracteriza por la adquisición compulsiva de objetos innecesarios, desorganización y dificultad para descartar lo que se posee. En ediciones anteriores del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM) no había diagnóstico específico para sujetos con estos síntomas, clasificándolos con Trastorno Obsesivo Compulsivo y Trastorno de la Personalidad Obsesivo Compulsivo. Este trabajo consiste en una revisión de literatura encontrada en las bases de indexación internacionales con el objetivo de analizar las características epidemiológicas, clínicas y de tratamiento del TA. Aunque no hay consenso en la literatura, los hallazgos sugieren que el trastorno es un síndrome independiente y con alta prevalencia de comorbilidades, que requiere de intervenciones terapéuticas centradas en aspectos cognitivos y conductuales. Por último, se hace recomienda la realización de investigaciones con estos pacientes destacando la realidad brasileña.

Behavioral and experiential avoidance in patients with hoarding disorder.

BACKGROUND AND OBJECTIVES: This study examined the relationship between experiential and behavioral avoidance and hoarding symptom severity, controlling for anxiety and depression symptoms, in 66 adult individuals (M age = 61.41; SD = 9.03) with HD. METHODS: Hierarchical regression was used to test the associations between hoarding severity, as defined by the Savings Inventory-Revised (SI-R) total and its three subscales, and avoidance, as defined by the Acceptance and Action Questionnaire II (AAQ-II) and two scales from the Brief COPE (Self-Distraction and Behavioral Disengagement) when controlling for anxiety and depression symptoms. RESULTS: Experiential avoidance (AAQ-II) and behavioral avoidance (Brief COPE subscales Self-Distraction and Behavioral Disengagement) uniquely accounted for aspects of hoarding severity (SI-R) in regression models. Behavioral avoidance contributed significant additional variance to the SI-R Clutter subscale, whereas experiential avoidance was uniquely predictive of additional variance in the SI-R Difficulty Discarding and the SI-R Acquisition subscales. LIMITATIONS: Future research should examine the effect of experiential avoidance on hoarding behaviors experimentally. CONCLUSIONS: Given that the AAQ-II and Self-Distraction and Behavioral Disengagement subscales were not correlated, these findings suggest that experiential and behavioral avoidance are two distinct processes contributing to the severity of specific HD. Results support the utility of avoidance in the cognitive-behavioral model for HD.

Cognitive behavior therapy for hoarding disorder: follow-up findings and predictors of outcome.

BACKGROUND: A cognitive-behavioral model of hoarding posits deficits in information processing, maladaptive beliefs about and attachments to possessions that provoke distress and avoidance, and positive emotional responses to saving and acquiring that reinforce these behaviors. A 26-session individual cognitive-behavioral therapy (CBT) based on this model showed significant reductions in hoarding symptoms and large effect sizes (Steketee et al.([1])). METHODS: The present study presents findings at follow-up (up to 12 months), as well as predictors of outcome at posttreatment (n = 37) and follow-up (n = 31). RESULTS: Significant improvements at post-treatment were sustained at follow-up with large effects, and Clinical Global Impression-Improvement (CGI-I) ratings by clinicians and patients at follow-up indicated that 62 and 79% of patients were rated "much improved" or "very much improved," respectively. The most prevalent patterns of outcome were improvement followed by stable gains or little improvement across all time points. Pretreatment severity of hoarding, overall clinical status, gender, perfectionism, and social anxiety were all associated with worse outcome. Only perfectionism and gender emerged as significant predictors after controlling for initial hoarding severity. CONCLUSIONS: The present findings suggest general stability of individual CBT outcomes for hoarding and indicated that gender, perfectionism, and social anxiety may affect outcomes. More research on larger samples is needed to direct efforts to improve treatment for hoarding.