A narrative synthesis of possible causes and risk factors of hoarding behaviours.

BACKGROUND: Hoarding is a disorder characterized by excessive acquisition and persistent difficulty in discarding possessions. The behaviour has adverse emotional, physical, social, financial, and legal outcomes for the person with the disorder and family members, and might pose a significant public health problem. Hoarding has been included as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM-5). The prevalence of hoarding disorder is approximately 2-6% globally. The current state of the evidence does not offer clear understanding of the causes of hoarding behaviours. A systematic review of the extant literature was carried out to determine the possible causal factors of hoarding behaviours. METHODS: This review is conducted in line with PRISMA guidelines. The following electronic databases: Medline through Ovid, EMBASE and PsycINFO were searched for relevant articles published between January 2000 and November 2018. Only articles published in English language were included. Two reviewers independently scrutinized the studies and included them in this review. RESULTS: Our search strategy returned a total of 396 references. Preliminary findings suggest that individuals with hoarding behaviours may have a genetic susceptibility; abnormal neural activity in the fronto-temporal, para-hippocampal gyrus and insular parts of the brain has also been identified. Traumatic life experiences have also been posited to predispose individuals to hoard. CONCLUSION: Although the understanding of hoarding disorder hasgrown in recent years, greater efforts are still needed to clarify the etiology and mechanisms of hoarding disorder as these may help in planning of more holistic interventions to treat the problem.

The Etiology of Hoarding Disorder: A Review.

This article will review the evidence of various proposed factors that contribute to the onset and maintenance of hoarding disorder (HD). Data suggests that hoarding is a chronic condition that starts early in life and does not remit if left untreated. There is emerging evidence that a number of factors contribute to the expression of HD symptoms, including genetics, neurocognitive functioning, attachments to possessions, beliefs, avoidance, personality factors, and life events. The extent to which each etiological factor uniquely contributes to hoarding is still unknown. Other demographic factors, such as socioeconomic status, age, and gender, may impact hoarding severity. Research on the causes and characteristics of hoarding has recently started making progress into understanding this newly recognized disorder, yet we still have a ways to go in understanding the biological and environmental causes. This paper will synthesize available literature on the etiology of HD.

An Exploratory Investigation of Animal Hoarding Symptoms in a Sample of Adults Diagnosed With Hoarding Disorder.

OBJECTIVE: The extant research on animal hoarding has a dearth of information on animal hoarding tendencies in adults diagnosed with hoarding disorder (HD). In the present study, we investigated possible recurrent animal hoarding behavioral and symptom patterns in individuals diagnosed with hoarding disorder. METHODS: Hoarding severity scores from baseline assessments for 65 community-dwelling adults diagnosed with HD were analyzed with respect to their present and past animal ownership characteristics. RESULTS: Approximately half of participants reported currently owning pets, and pet owners in the sample reported currently owning an average of two pets. Of the participants who reported currently owning animals, 10% reported having no rules for their pets' behaviors, 51% reported having made at least one sacrifice for their pets, 54% reported having had at least one pet in childhood, and 29% reported that they believed they have a "special ability" to communicate with their pets. The results of the present study suggest that animal hoarding is not necessarily present in individuals diagnosed with HD. CONCLUSION: No significant associations of current pet ownership characteristics with present hoarding severity were observed. Reported maximum number of pets owned in childhood was significantly correlated with present object hoarding symptom severity.

Hoarding in an Asian population: prevalence, correlates, disability and quality of life.

INTRODUCTION: Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value. The objectives of the study were to establish the prevalence of hoarding behaviour among the general population and among individuals with obsessive-compulsive disorder (OCD) in a cross-sectional study conducted in Singapore. MATERIALS AND METHODS: The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older, living in households. The diagnoses of mental disorders were established using Version 3.0 of Composite International Diagnostic Interview (CIDI 3.0). Differences between 3 groups i.e. those diagnosed with lifetime/12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) OCD with hoarding, those diagnosed with lifetime/12-month DSM-IV OCD without hoarding and those with lifetime hoarding behaviour without diagnosis of DSM-IV OCD were determined. RESULTS: The weighted prevalence of lifetime hoarding behaviour was 2% and that of hoarding among those with OCD was 22.6%. Those who met the criteria for hoarding behaviour alone were associated with lower odds of having obsessions of contamination, harming, ordering as well as compulsions of ordering and other compulsions than those who met criteria for both OCD and hoarding. CONCLUSION: Hoarders without OCD were less impaired, in terms of comorbid psychopathology, than those with OCD with and without hoarding, and had a higher quality of life versus those with both OCD and hoarding, though still lower than that of the general population.

Partitioning the etiology of hoarding and obsessive-compulsive symptoms.

BACKGROUND: Until recently, hoarding was considered an obsessive-compulsive symptom (OCS). However, current evidence suggests that these two phenotypes may be clinically, and perhaps etiologically, distinct. Both hoarding and OCS have a genetic etiology, but the degree of unique and shared genetic contributions to these phenotypes has not been well studied. METHOD: Prevalence rates were assessed for hoarding and OCS in a sample of adult twin pairs (n = 7906 twins) and their family members from The Netherlands Twin Register (total sample = 15,914). Using Mplus, genetic analyses using liability threshold models were conducted for both phenotypes, for their co-morbidity, and for specific hoarding symptoms (cluttering, discarding and acquiring). RESULTS: Of the total sample, 6.7% met criteria for clinically significant hoarding; endorsement of all three hoarding symptoms was > or = 79%. Men had slightly higher rates than women. Also, 5.7% met criteria for clinically significant OCS; rates were similar in males and females. Genetic factors accounted for 36% of the variance for hoarding and 40% of the variance for OCS. The genetic correlation between hoarding and OCS was 0.10. There was no evidence of sex-specific genetic contributions for hoarding or OCS. There was evidence for a genetic contribution to all hoarding symptom subtypes. Only cluttering showed evidence of a contribution from the shared environment. CONCLUSIONS: OCS and hoarding are common in this population-based sample, have prevalence rates similar to those previously reported, and show significant heritability. Genetic factors contributed to the co-morbidity of both traits, although the genetic correlation between them was low.

Nosological status of compulsive hoarding: obsessive-compulsive disorder subtype or independent clinical entity.

This theoretical study reviews the main research and findings on the nosological status of compulsive hoarding. Specifically, it describes available empirical evidence in order to determine their independence or inclusion within the obsessive-compulsive disorder (OCD), a mental disorder in which it has traditionally been included as one more subtype or dimension. Regarding this issue, the results found in the scientific literature show that persons with compulsive hoarding have distinct characteristics in different external criteria like sociodemographic variables, premorbid personality, degree of insight, neuroanatomical and genetic factors, neuropsychological profile, clinical course, levels of dysfunctionality and finally, treatment outcome. These conclusions are discussed and the proposal for the creation of a new clinical entity called "hoarding disorder" is evaluated.

The structure of genetic and environmental risk factors for dimensional representations of DSM-5 obsessive-compulsive spectrum disorders.

IMPORTANCE: The new DSM-5 "Obsessive-Compulsive and Related Disorders" chapter contains a series of conditions thought to be etiologically related to obsessive-compulsive disorder (OCD). However, the evidence to support this relatedness remains incomplete. OBJECTIVE: To estimate the degree to which genetic and environmental risk factors are shared and/or unique to dimensionally scored OCD, body dysmorphic disorder (BDD), hoarding disorder (HD), trichotillomania (hair-pulling disorder) (TTM), and excoriation (skin-picking) disorder (SPD). DESIGN, SETTING, AND PARTICIPANTS: Multivariate twin modeling methods involving 5409 female members of the TwinsUK adult population-based twin register. MAIN OUTCOMES AND MEASURES: Scores on the Obsessive-Compulsive Inventory-Revised, the Dysmorphic Concern Questionnaire, the Hoarding Rating Scale, the Massachusetts General Hospital Hairpulling Scale, and the Skin Picking Scale. RESULTS: A 2-latent factor common pathway model fitted the data best; the first latent factor loaded on all 5 phenotypes, particularly on OCD, BDD, and HD. A second factor loaded exclusively on TTM and SPD. Disorder-specific genetic (for OCD, BDD, and HD only) and particularly nonshared environmental risk factors were also evident. Shared environmental influences were negligible. CONCLUSIONS AND RELEVANCE: Obsessive-compulsive and related disorders may be influenced by 2 distinct liability factors rather than a single liability factor. One of these factors was common to all disorders, and another was exclusive to TTM and SPD. Disorder-specific genetic factors unique to OCD, BDD, and HD were also apparent, whereas TTM and SPD were largely influenced by the same latent genetic factor. Environmental influences were largely disorder specific. The results help explain the apparent similarities as well as some important differences between the disorders included in the new Obsessive-Compulsive and Related Disorders chapter.

Can hoarding be a symptom of social anxiety disorder? A case study.

BACKGROUND: Hoarding is defined as the excessive collection and failure to discard possessions of apparently little value, leading to clutter, distress, and disability. Although patients with hoarding typically may feel ludicrous for not discarding useless, and sometimes bizarre, possessions, we are not aware of any previous description of patients displaying hoarding as a result of social anxiety. METHOD: Single case report. RESULTS: In this article, we describe a patient with severe social anxiety disorder who displayed hoarding as a direct consequence of social anxiety-related beliefs and atypical safety behaviors. CONCLUSIONS: This case is of particular interest to current debates concerning the status of hoarding in new versions of classificatory systems. It also indicates that social anxiety disorder should be included in the list of conditions that needs to be excluded in order to diagnose "primary" hoarding disorder.

Approach to hoarding in family medicine: beyond reality television.

OBJECTIVE: To review the presentation of hoarding and provide basic management approaches and resources for family physicians. SOURCES OF INFORMATION: PubMed was searched from 2001 to May 2011. The MeSH term hoarding was used to identify research and review articles related to the neuropsychological aspects of hoarding and its diagnosis and treatment. MAIN MESSAGE: Hoarding is often a hidden issue in family medicine. Patients with hoarding problems often present with a sentinel event such as a fall or residential fire. Although hoarding is traditionally associated with obsessive-compulsive disorder, patients more commonly have secondary organic disease associated with hoarding behaviour or have hoarding in absence of substantial compulsive traits. Hoarding disorder is expected to be included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Management is best provided by a multidisciplinary approach when possible, and an increasing number of centres provide programs to improve symptoms or to reduce harm. Pharmacologic management has been shown to be of some help for treating secondary causes. In the elderly, conditions such as dementia, depression, and substance abuse are commonly associated with hoarding behaviour. Attempts should be made to keep patients in their homes whenever possible, but an assessment of capacity should guide the approach taken. CONCLUSION: Hoarding is more common than family physicians realize. If hoarding is identified, local resources should be sought to assist in management. Assessment and treatment of underlying causes should be initiated when secondary causes are found. It is expected that primary hoarding will be a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

[Hoarding disorder, symptom or separate disorder? Case report]. / Syllogomanie, symptômes ou syndrome? A propos d'un cas clinique.

Hoarding or compulsive hoarding, a severe form of collectionism, is currently described in various psychiatric disorders, including the famous Diogenes syndrome. The lack of remission despite a correct treatment in a patient that we have followed in the brief therapy center in Geneva, has led us to carry out an extensive Medline review, which revealed several interesting points. It seems that excessive hoarding, with a prevalence of 2,3 to 4,6%, has received increasing interest and there is an actual debate of distinguishing hoarding from other disorders. Thus, this field requires further attention to better understand its phenomenology. This case report describes an excessive hoarding disorder confirming the complexity of this trouble and the possibility to consider it as an independent diagnosis.