AN EXPLORATION OF COMORBID SYMPTOMS AND CLINICAL CORRELATES OF CLINICALLY SIGNIFICANT HOARDING SYMPTOMS
Corresponding Author
Brian J. Hall Ph.D.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Correspondence to: Brian J. Hall, Ph.D., Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD 21205.
E-mail: [email protected]
Search for more papers by this authorDavid F. Tolin Ph.D.
Institute of Living, Hartford Connecticcut
Search for more papers by this authorGail Steketee Ph.D.
Boston University, Chestnut Hill, Massachusetts
Search for more papers by this authorCorresponding Author
Brian J. Hall Ph.D.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Correspondence to: Brian J. Hall, Ph.D., Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD 21205.
E-mail: [email protected]
Search for more papers by this authorDavid F. Tolin Ph.D.
Institute of Living, Hartford Connecticcut
Search for more papers by this authorGail Steketee Ph.D.
Boston University, Chestnut Hill, Massachusetts
Search for more papers by this authorAbstract
Background
Hoarding disorder (HD) is currently being considered for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), yet remains poorly understood. Consensus is building that hoarding may constitute a separate disorder, although comorbidity remains high and complicates the diagnostic picture. The purpose of this investigation was to explore patterns of comorbidity among people who engage in hoarding behavior in order to better understand its clinical presentation and phenomenology.
Methods
Data were collected from a large internet sample (N = 363) of people who self-identified as having hoarding problems, met criteria for clinically significant hoarding, and completed all measures for this study. Participants self-reported their symptoms of disorders commonly co-occurring with hoarding (obsessive-compulsive disorder [OCD], depression, and attention deficit hyperactivity disorder [ADHD]), along with other clinical problems.
Results
Latent class analysis results indicated that the participants were grouped into three classes: “non-comorbid” hoarding (42%), hoarding with depression (42%), and hoarding with depression and inattention (16%).
Conclusions
Depression symptoms were the most commonly co-occurring symptom in this sample. Contrary to previous theory relating to hoarding etiology, OCD symptoms were not significantly co-occurring and a large percentage of the study participants were free from comorbid symptoms of OCD, depression, and ADHD. This suggests that HD is not primarily the consequence of other psychiatric conditions. Implications for DSM-5, clinical treatment, and future research directions are discussed.
REFERENCES
- 1 American Psychiatric Association. Hoarding Disorder 2012; http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=398.
- 2Iervolino AC, Perroud N, Fullana MA, et al. Prevalence and heritability of compulsive hoarding: a twin study. Am J Psychiatry 2009; 166(10): 1156–1161.
- 3Samuels JF, Bienvenu OJ, Grados MA, et al. Prevalence and correlates of hoarding behavior in a community-based sample. Behav Res Ther 2008; 46(7): 836–844.
- 4Tolin DF, Frost RO, Steketee G, Gray KD, Fitch KE. The economic and social burden of compulsive hoarding. Psychiat Res 2008; 160: 200–211.
- 5Steketee G, Frost RO, Kim HJ. Hoarding by elderly people. Health Soc Work 2001; 26(3): 176–184.
- 6Frost RO, Steketee G, Tolin DF. Comorbidity in hoarding disorder. Depress Anxiety 2011; 28: 876–884.
- 7Samuels JF, Bienvenu OJ, Riddle MA, et al. Hoarding in obsessive compulsive disorder: results from a case-control study. Behav Res Ther 2002; 40(5): 517–528.
- 8Frost RO, Krause MS, Steketee G. Hoarding and obsessive-compulsive symptoms. Behav Modif 1996; 20: 116–132.
- 9Rasmussen SA, Eisen JL. Clinical features and phenomenology of obsessive compulsive disorder. Psychiatr Ann 1989; 19: 67–73.
- 10Sobin C, Blundell ML, Weiller F, Gavigan C, Haiman C, Karayiorgou M. Evidence of a schizotypy subtype in OCD. J Psychiatr Res 2000; 34: 15–24.
- 11Saxena S, Maidment KM, Vapnik T, et al. Obsessive-compulsive hoarding: symptom severity and response to multimodal treatment. J Clin Psychiatry 2002; 63(1): 21–27.
- 12Pertusa A, Fullana MA, Singh S, Alonso P, Menchon JM, Mataix-Cols D. Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both? Am J Psychiatry 2008; 165(10): 1289–1298.
- 13Tolin DF, Meunier SA, Frost RO, Steketee G. Hoarding among patients seeking treatment for anxiety disorders. J Anxiety Disord 2011; 25: 43–48.
- 14Pertusa A, Frost RO, Mataix-Cols D. When hoarding is a symptom of OCD: a case series and implications for DSM-V. Behav Res Ther 2010; 48(10): 1012–1020.
- 15Pertusa A, Mataix-Cols D. Structured Interview for Hoarding Disorder (SIHD). London: King's College; 2010.
- 16Samuels JF, Shugart YY, Grados MA, et al. Significant linkage to compulsive hoarding on chromosome 14 in families with obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. Am J Psychiatry 2007; 164(3): 493–499.
- 17Wheaton M, Timpano KR, Lasalle-Ricci VH, Murphy D. Characterizing the hoarding phenotype in individuals with OCD: associations with comorbidity, severity and gender. J Anxiety Disord 2008; 22(2): 243–252.
- 18Pertusa A, Frost RO, Fullana MA, et al. Refining the diagnostic boundaries of compulsive hoarding: a critical review. Clin Psychol Rev 2010; 30(4): 371–386.
- 19Frost RO, Gross R. The hoarding of possessions. Behav Res Ther 1993; 31: 367–382.
- 20Frost RO, Novara C, Rhéaume J. Perfectionism in obsessive compulsive disorder. In: RO Frost, G Steketee, editors. Cognitive Approaches to Obsessions and Compulsions: Theory, Assessment, and Treatment. New York: Pergamon Press; 2002: 91–105.
10.1016/B978-008043410-0/50007-6 Google Scholar
- 21Hartl TL, Duffany SR, Allen GJ, Steketee G, Frost RO. Relationships among compulsive hoarding, trauma, and attention-deficit/hyperactivity disorder. Behav Res Ther 2005; 43(2): 269–276.
- 22Tolin DF, Abramowitz JS, Brigidi BD, Amir N, Street GP, Foa EB. Memory and memory confidence in obsessive-compulsive disorder. Behav Res Ther 2001; 39(8): 913–927.
- 23van den Hout M, Kindt M. Repeated checking causes memory distrust. Behav Res Ther 2003; 41(3): 301–316.
- 24Frost RO, Steketee G, Tolin DF. Comorbidity in hoarding disorder. Depression and Anxiety 2011; 28(10): 876–884.
- 25Wu KD, Watson D. Hoarding and its relation to obsessive-compulsive disorder. Behav Res Ther 2005; 43(7): 897–921.
- 26Frost RO, Hartl TL. A cognitive-behavioral model of compulsive hoarding. Behav Res Ther 1996; 34(4): 341–350.
- 27Frost RO, Steketee G, Grisham J. Measurement of compulsive hoarding: Saving Inventory-Revised. Behav Res Ther 2004; 42(10): 1163–1182.
- 28Steketee G, Frost RO, Tolin DF, Rasmussen J, Brown TA. Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder. Depress Anxiety 2010; 27(5): 476–484.
- 29Grisham JR, Brown TA, Savage CR, Steketee G, Barlow DH. Neuropsychological impairment associated with compulsive hoarding. Behav Res Ther 2007; 45: 1471–1483.
- 30Tolin DF, Kurtz MM, Meunier SA, Carlson SE. Neuropsychological Impairment in Compulsive Hoarding. Paper presented at Annual Meeting of the Association of Behavioral and Cognitive Therapies; November 2009; New York.
- 31Hartl TL, Frost RO, Allen GJ, et al. Actual and perceived memory deficits in individuals with compulsive hoarding. Depress Anxiety 2004; 20(2): 59–69.
- 32Sheppard B, Chavira D, Azzam A, et al. ADHD prevalence and association with hoarding behaviors in childhood-onset OCD. Depress Anxiety 2010; 27(7): 667–674.
- 33Steketee G, Frost RO. Compulsive hoarding: current status of the research. Clin Psychol Rev 2003; 23: 905–927.
- 34Grisham JR, Brown TA, Liverant GI, Campbell-Sills L. The distinctiveness of compulsive hoarding from obsessive-compulsive disorder. J Anxiety Disord 2005; 19(7): 767–779.
- 35Mataix-Cols D, Billotti D, Fernandez de la Cruz L, Nordsletten AE. The London field trial for hoarding disorder. Psychol Med 2012; 10: 1–11.
- 36Kraut R, Olson J, Banaji M, Bruckman A, Cohen J, Couper M. Psychological research online: report of Board of Scientific Affairs’ Advisory Group on the conduct of research on the Internet. Am Psychol 2004; 59(2): 105–117.
- 37Tolin DF, Frost RO, Steketee G. An open trial of cognitive-behavioral therapy for compulsive hoarding. Behav Res Ther 2007; 45: 1461–1470.
- 38Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. Sydney: The Psychology Foundation of Australia; 1995.
- 39Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005; 44: 227–239.
- 40Barkley RA, Murphy KR. Attention-Deficit Hyperactivity Disorder: A Clinical Workbook. 2nd ed. New York: Guilford Press; 1998.
10.1038/scientificamerican0998-66 Google Scholar
- 41Foa EB, Huppert JD, Leiberg S, et al. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess 2002; 14: 485–496.
- 42Frost RO, Shows DL. The nature and measurement of compulsive indecisiveness. Behav Res Ther 1993; 31(7): 683–692.
- 43Janeck AS, Calamari JE, Riemann BC, Heffelfinger SK. Too much thinking about thinking? Metacognitive differences in obsessive-compulsive disorder. J Anxiety Disord 2003; 17(2): 181–195.
- 44Broadbent DE, Cooper PF, FitzGerald P, Parkes KR. The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol 1982; 21(Pt 1): 1–16.
- 45Nedeljkovic M, Kyrios M. Metamemory beliefs in obsessive-compulsive disorder. Behav Res Ther 2007; 45: 2899–2914.
- 46 Obsessive Compulsive Cognitions Working Group. Development and initial validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory. Behav Res Ther 2001; 39(8): 987–1006.
- 47Tangney JP, Baumeister RF, Boone AL. High self-control predicts good adjustment, less pathology, better grades, and interpersonal success. J Pers 2004; 72(2): 271–324.
- 48Nock MK, Wedig MM, Holmberg EB, Hooley JM. The emotion reactivity scale: development, evaluation, and relation to self-injurious thoughts and behaviors. Behav Ther 2008; 39(2): 107–116.
- 49Frost RO, Hristova V, Steketee G, Tolin DF. Activities of Daily Living in hoarding disorder (ADL-H). Psychological Assessment 2012.
- 50Rasmussen J, Steketee G, Frost RO, Tolin DF, Brown TA. Assessing squalor in hoarding: The Home Environment Index. 2012.
- 51Tabachnick BG, Fidell LS. Using Multivariate Statistics. 3rd ed. New York: HarperCollins; 1996.
- 52Horn JL. A rationale and test for the number of factors in factor analysis. Psychometrika 1965; 30: 179–185.
- 53Zwick WR, Velicer WF. Comparison of five rules for determining the number of components to retain. Psychol Bull 1986; 99: 432–442.
- 54McCutcheon AC. Latent Class Analysis. Beverly Hills, CA: Sage; 1987.
10.4135/9781412984713 Google Scholar
- 55Nylund KL, Asparouhov T, Muthen BO. Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Modeling 2007; 14: 535–569.
- 56Lo Y, Mendell N, Rubin D. Testing the number of components in a normal mixture. Biometrika 2001; 88: 767–778.
- 57Muthén L, Muthén B. Mplus User's Guide. 6th ed. Los Angeles, CA: Muthén & Muthén; 1998–2010.
- 58 PASW. PASW User's Guide for Windows (Version 18). Armonk, NY: IBM; 2009.
- 59Ratchford E, Frost RO, Steketee G, Tolin DF. ADHH in hoarders, OCD patients, and community controls. Paper presented at: Association of Behavioral and Cognitive Therapies; November, 2009;New York.
- 60Kyrios M, Frost RO, Steketee G. Cognitions in compulsive buying and acquisition. Cognitive Therapy and Research 2004; 28: 241–258.
- 61Cohen RJ, Calamari JE. Thought-focused attention and obsessive-compulsive symptoms: An evaluation of cognitive self-consciousness in a nonclinical sample. Cognitive Therapy and Research 2004; 28(4): 457–471.
- 62Wallace JC, Kass SJ, Stanny CJ. The Cognitive Failures Questionnaire revisited: Dimensions and correlates. Journal of General Psychology 2002; 129: 238–256.
- 63Crawford JR & Henry JD. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005; 44: 227–239.
- 64Samuels JF, Bienvenu OJ, Pinto A, et al. Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. Behav Res Ther 2007; 45: 673–686.
- 65Baumeister RF. Yielding to temptation: self-control failure, impulsive purchasing, and consumer behavior. J Consum Res 2002; 28: 670–676.
- 66Mick DG, DeMoss M. Self-gifts: phenomenological insights from four contexts. J Consum Res 1990; 17: 322–332.
- 67Sheppard B, Chavira D, Azzam A, et al. ADHD prevalence and association with hoarding behaviors in childhood-onset OCD. Depress Anxiety 2010; 27(7): 667–674.
- 68Wincze JP, Steketee G, Frost RO. Categorization in compulsive hoarding. Behav Res Ther 2007; 45(1): 63–72.
- 69Tolin DF, Stevens MC, Villavicencio AL, et al. Neural mechanisms of decision-making in hoarding disorder. Arch Gen Psychiatry 2012; 69(8): 832–841.
- 70Grisham JR, Norberg MM, Williams AD, Certoma SP, Kadib R. Categorization and cognitive deficits in compulsive hoarding. Behav Res Ther 2010; 48(9): 866–872.
- 71Woods SP, Lovejoy DW, Ball JD. Neuropsychological characteristics of adults with ADHD: a comprehensive review of initial studies. Clin Neuropsychol 2002; 16(1): 12–34.
- 72Fabricant L, Frost RO, Tolin DF, Steketee G. The role of homework in the treatment of compulsive hoarding. Paper Presented at Annual Meeting of the Association of Behavioral and Cognitive Therapies; November 2007; Philadelphia, PA.
- 73Winsberg ME, Cassic KS, Koran LM. Hoarding in obsessive-compulsive disorder: a report of 20 cases. J Clin Psychiatry 1999; 60(9): 591–597.