Prevalence of hoarding disorder among primary care patients

Objectives: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. Methods: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. Results: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. Conclusion: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

Prevalence of hoarding disorder among primary care patients.

OBJECTIVES: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. METHODS: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. RESULTS: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. CONCLUSION: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

Acumuladores de animais: instrumento de vistoria técnica e perfil de casos no município de Guarulhos, SP, Brasil / Animal hoarders: Technical inspection instrument and profile in the city of Guarulhos, SP, Brazil

O transtorno de acumulação de animais, é uma psicopatologia caracterizada pela aquisição de muitos animais mantidos em espaços inadequados, onde os cuidados básicos de saúde, alimentação e bem-estar são negligenciados. O objetivo deste estudo foi caracterizar o perfil de acumuladores de animais no município de Guarulhos e elaborar um instrumento de coleta de dados para ser utilizado em vistoria técnica nestes casos. Foi realizado um levantamento e análise descritiva dos arquivos de casos de acumuladores de animais atendidos pelo serviço municipal. Dentre os 26 casos recebidos no período de 2012-2017, 12 (46,16%) eram referentes a casos de acumulação de animais. Estas ocorrências foram encaminhadas ao serviço de saúde como denúncias. Os dados obtidos, por meio das análises dos prontuários, foram refinados e, posteriormente, transcritos em planilhas considerando as variáveis de interesse, assim, facilitando o processo de interpretação. Para caracterizar o perfil dos casos de acumuladores, os dados adquiridos foram analisados por meio de cálculos de médias e frequências relativas. O perfil de acumuladores se caracterizou por mulheres, solteiras, idosas, desempregadas ou aposentadas, que residem sozinha em casa própria, portadoras de comorbidades ou fatores psicológicos associados, acumulando cães e gatos, especificamente, cães em sua maioria. O instrumento de vistoria em atenção a indivíduos em situação de acúmulo de animais proposto apresenta caracterização do indivíduo, ambiente, condições gerais dos animais e, ainda, indicadores de comprometimento de bem-estar animal ou maus-tratos.

Animal hoarding disorder is a psychopathy characterized by the acquisition of many animals that are kept in improper locations, in which the basic health care, feeding and well-being are neglected. The objective of this study was to characterize the profile of animal hoarders in the city of Guarulhos and to elaborate an instrument of data collection to be used in technical survey in cases of animal hoarding. Amongst the 26 cases analyzed, 12 (46,16%) were related to animal hoarding. These cases were sent to the health care service as denounces. Data obtained through analysis of medical records were refined and later transcribed into spreadsheets considering the variables of interest, thus facilitating the interpretation process. To characterize the profile of the hoarding cases, data were analyzed by means of calculations of means and relative frequencies. Hoarders profile is characterized as female, single, elderly, unemployed or retired, living alone at her own house, with associated comorbidities or psychological disorders, hoarding dogs and cats, specifically dogs in most cases. The proposed instrument presents characterization of the individual, environment, general conditions of the animals and also indicators of impairment of animal welfare or animal abuse.

Transtorno de acumulação: uma revisão / Hoarding disorder: a review

O transtorno de acumulação (TA) pode ser definido como uma dificuldade persistente de desfazer-se de itens devido ao sofrimento associado com o descarte ou uma necessidade percebida de guardar posses a despeito de seu valor real. Tal comportamento pode resultar no acúmulo de objetos, o que compromete significativamente o uso da moradia, causando sofrimento e/ou prejuízo funcional. Os itens acumulados mais frequentemente são objetos e animais. A prevalência do transtorno é de 1,5 a 2,1% na população em geral, podendo ser maior que 6% em idosos. O TA causa riscos à saúde e à segurança dos indivíduos, especialmente dos idosos, gerando um custo relevante para a sociedade. O diagnóstico de TA é clínico e só deve ser feito após a exclusão de condições médicas gerais e outros transtornos mentais que podem levar ao acúmulo de objetos. O TA parece ser um transtorno de curso crônico e progressivo, comumente associado a comorbidades psiquiátricas. Estudos indicam a participação de fatores genéticos, familiares, cognitivos e de experiências traumáticas na etiologia do TA. A abordagem terapêutica mais estudada até o momento foram as psicoterapias, mas os resultados mostram efeito pequeno. Os estudos farmacológicos existentes são muito incipientes, não permitindo conclusões de eficácia.

Hoarding disorder can be defined as a persistent difficulty in discarding items, due to distress associated with such disposal or a perceived need to save items regardless of their actual value. Such behavior must result in the accumulation of clutter, which significantly compromises living conditions, causing distress and/or functional impairment. The most frequently hoarded items are objects and animals. The point prevalence of clinically significant hoarding was estimated to be 1.5 to 2.1% in the general population, and may exceed 6% in the elderly. HD poses a range of health and safety hazards to individuals, especially older adults, generating significant costs to society. The diagnosis of HD is clinical, and should only be established after general medical conditions and other mental disorders that can lead to accumulating behavior have been ruled out. HD appears to follow a chronic, progressive course, and is commonly associated with psychiatric comorbidities. Studies indicate that genetic, familial, cognitive, and traumatic factors are implicated in the etiology of HD. To date, psychotherapies have been the most widely studied therapeutic approaches, but the results of these studies show small effects. Research into pharmacological approaches to HD is still incipient, precluding any conclusions of efficacy

Animal Hoarding Disorder: A new psychopathology?

This study aimed to characterize the sociodemographic profile of animal hoarders in a southern city of Brazil. In addition, it aimed to propose Animal Hoarding Disorder as a new nosological category, distinct from Hoarding Disorder. Thirty-three individuals with Animal Hoarding Disorder, 73% female and 60% elderly, composed the sample. The average age of the sample was 61.39 years (SD = 12.69) and the average period that individuals hoarded or lived with a large number of animals was 23.09 years (SD = 15.98.) It was observed that 56.7% of the sample hoarded other inanimate objects, besides the animals. The total number of hoarded animals was 1.357 and the average number of animals per hoarder was approximately 41 (SD = 24.41). Significant differences between hoarding disorder and animal hoarding are discussed. Unlike hoarded objects, hoarded animals generally do not obstruct domicile environments. The processes of disengaging from or donating animals also differ from those of object hoarding, since there is an affectional bond with lives and not with unanimated objects. In this sense, the characterization of Animal Hoarding Disorder as a new mental disorder may arouse great interest from both clinical professionals and researchers.

Vallejo-Nágera (1926-1990) and the concept of 'soteric neurosis': a forgotten sketch of hoarding disorder in the obsessive-compulsive spectrum literature.

Juan Antonio Vallejo-Nágera, psychiatrist, painter and writer, wrote a widely adopted textbook of psychiatry in Spanish- and Portuguese-speaking countries, particularly during the 1970s, the famous Introducción a la psiquiatría. There, he advanced the concept of soteric neurosis, a condition regarded as a 'mirror image' of phobias and similar to the diagnostic entity described in DSM-5 under the heading of hoarding disorder. Indeed, much earlier than the recent nosological discussions on hoarding, Vallejo-Nágera already reported soteric neurosis to be distinct from obsessive-compulsive disorder and to be associated with excessive attachment to objects and positive affect (pleasure), leading to accumulation, decreased treatment seeking, increasing interference in daily activities and blurred boundaries with normality. Vallejo-Nágera also made several predictions, including the propensity soteric neurosis patients may have towards the development of separation anxiety, obesity and other 'masked' symptoms. In the light of his original and insightful contributions to the concept of hoarding disorder, it would be interesting to assess his hypotheses in future studies.

Hoarding disorder: a new diagnostic category in ICD-11?

Despite the long-held view that hoarding is a symptom of both obsessive-compulsive disorder and obsessive-compulsive personality disorder, increased evidence has emerged during the last 20 years suggesting that hoarding represents a distinct form of psychopathology. This study reflects the discussions on the nosological status of hoarding carried out by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. The distinctiveness of hoarding is based on its having core symptoms that differ from those of other disorders, as well as distinctive neurobiological correlates and treatment responses. Furthermore, data showing the clinical utility, global applicability, and appropriateness of the concept of hoarding disorder outside specialty mental health settings suggest that this condition should be included in ICD-11. Finally, given the focus of ICD-11 on primary care and public health, the Working Group suggests that poor insight and severe domestic squalor may be considered as specifiers for hoarding disorder in ICD-11.

Hoarding disorder: a new diagnostic category in ICD-11?

Despite the long-held view that hoarding is a symptom of both obsessive-compulsive disorder and obsessive-compulsive personality disorder, increased evidence has emerged during the last 20 years suggesting that hoarding represents a distinct form of psychopathology. This study reflects the discussions on the nosological status of hoarding carried out by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. The distinctiveness of hoarding is based on its having core symptoms that differ from those of other disorders, as well as distinctive neurobiological correlates and treatment responses. Furthermore, data showing the clinical utility, global applicability, and appropriateness of the concept of hoarding disorder outside specialty mental health settings suggest that this condition should be included in ICD-11. Finally, given the focus of ICD-11 on primary care and public health, the Working Group suggests that poor insight and severe domestic squalor may be considered as specifiers for hoarding disorder in ICD-11.

Clinical features of obsessive-compulsive disorder with hoarding symptoms: a multicenter study.

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 = 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 = 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.