Comparison of Object and Animal Hoarding

Recent research has highlighted the prevalence and harmful consequences of hoarding,1 and investigators have proposed inclusion of hoarding disorder in DSM-5.2 An unanswered question about the proposed disorder is whether people who hoard animals would meet diagnostic criteria for it. This article discusses the similarities and differences between object and animal hoarding. People who hoard animals appear to meet the basic diagnostic criteria for hoarding disorder. Their homes are cluttered, disorganized, and dysfunctional. They have great difficulty relinquishing animals to people who can more adequately care for them, and they form intense attachments (urges to save) that result in significant impairment. However, they differ from people who hoard objects in several ways. These differences are significant enough to warrant comment in the text description accompanying the diagnostic criteria and consideration as a subtype of hoarding disorder. More research is necessary to determine the exact relationship between object and animal hoarding. © 2011 Wiley-Liss, Inc

A Brief Interview for Assessing Compulsive Hoarding: The Hoarding Rating Scale-Interview

This article describes the development and validation of the Hoarding Rating Scale-Interview (HRS-I), a brief (5-10 min) five-item semi-structured interview that assesses the features of compulsive hoarding (clutter, difficulty discarding, acquisition, distress and impairment). Trained interviewers administered the HRS-I to 136 adults (73 compulsive hoarding, 19 OCD, 44 non-clinical controls) along with a battery of self-report measures. An initial assessment was conducted in the clinic, and a second assessment was conducted in participants\u27 homes. The HRS-I showed high internal consistency and reliability across time and context. The HRS-I clearly differentiated hoarding and non-hoarding participants, and was strongly associated with other measures of hoarding. It is concluded that the HRS-I is a promising measure for determining the presence and severity of compulsive hoarding

A comparison of cognitive restructuring and thought listing for excessive acquiring in hoarding disorder

Excessive acquiring is a common symptom of hoarding disorder (HD). Little is known about subjective distress associated with acquiring in HD. The present study examined acquiring- related distress and reactions to cognitive restructuring (CR) in 92 individuals with HD and 66 community control (CC) participants. All participants identified an item of interest at a high-risk acquiring location and then decided whether or not to acquire the item. HD participants completed the acquiring task while receiving a CR-based intervention or a thought-listing (TL) control condition. Results showed that HD participants reported more severe distress and greater urges to acquire the item of interest than did CC participants. Nevertheless, subjective distress decreased in both groups following the acquiring task. There were no differences in acquiring- related distress between the CR and TL conditions. The findings indicate that subjective distress may decrease after relatively short periods of time in individuals with HD, but that a single session of CR may not alleviate acquiring-related distress in HD participants.R01 MH068007 - NIMH NIH HHS; R01 MH068008 - NIMH NIH HHSAccepted manuscrip

Development and Validation of the Frost Multidimensional Perfectionism Scale–Brief

Twenty-five years ago, one of the first empirically validated measures of perfectionism, the Frost et al. Multidimensional Perfectionism Scale (F-MPS) was published. Since that time, psychometric studies of the original F-MPS have provided a plethora of evidence to support the potential development of a shorter yet still psychometrically robust version of the measure. Using confirmatory factor analyses across community and clinical samples, the current study identifies an eight-item F-MPS-Brief with two dimensions (i.e., striving and evaluative concerns) that evidences good internal consistency, measurement equivalence across ethnicities, and concurrent and convergent validity. This new, short version of the F-MPS captures well the bidimensional model of perfectionism that has emerged across studies over the past two decades and is suggested for use when a short yet high-performing assessment tool for this model is desired

Indecisiveness And Hoarding

Hoarding behavior and the problems associated with it have been the subject of an increasing amount of research. Early theorizing has suggested that problems with decision-making constitute a core feature, yet relatively few studies have examined this in depth. In the present study, indecisiveness was examined in large samples of adults who self-identified as having significant hoarding problems (n = 887), adult children of such individuals (n = 295), and spouses of such individuals (n = 120). People with hoarding problems reported more decision-making problems than children or spouses, and considerably more than community controls from other studies. Adult children of people with hoarding reported more indecisiveness than spouses, suggesting that this characteristic runs in families. Among the hoarding group, decision-making problems were correlated with all three core features of hoarding (excessive acquisition, difficulty discarding, clutter/disorganization), and the associations were independent of depression, anxiety, and obsessive-compulsive (OC) symptoms. Higher indecisiveness scores were also associated with earlier age of onset of hoarding independent of hoarding severity. Depression was associated mainly with the negative consequences of hoarding, while OC symptoms were related to the excessive acquisition of free things. Indecisiveness may be an important marker or nonhoarding endophenotype for hoarding and deserves closer examination

Activities of Daily Living Scale in Hoarding Disorder

Research on hoarding over the last two decades has shown that hoarding disorder appears to be a distinct disorder that burdens the individual, the community and the families of people who hoard. Although hoarding clearly interferes with the daily functioning, especially in the context of extensive clutter, no validated measures of this interference have been developed. The present research examined the psychometric properties of the Activities of Daily Living in Hoarding scale (ADL-H) in two large samples of individuals with significant hoarding problems, one identified through the internet (n=363) and a second through clinical diagnostic interviews (n=202). The ADL-H scale test-retest (1-12 weeks), interrater and internal reliabilities ranged from .79 to .96. Convergent and discriminant validity were established through analyses of correlational data collected for measures of hoarding severity and non-hoarding psychopathology (obsessive-compulsive disorder [OCD], moodstate, attention deficit, and perfectionism/uncertainty), as well as through comparisons of scores among individuals with hoarding, hoarding plus OCD, OCD without hoarding, and community controls. The ADL-H scale appears to have strong psychometric properties and to be useful in clinical and research settings. Suggestions are made for expansion of the scale, and study limitations are noted

Group And Individual Treatment of Compulsive Hoarding: a Pilot Study

Treatment of compulsive hoarding has rarely been described in the literature, apart from standard treatments for obsessive compulsive disorder of which hoarding is thought to be a subset. This paper presents preliminary findings from seven patients treated with cognitive and behavioral interventions derived from Frost and Hartl\u27s (1996) theoretical model of hoarding. Six clients attended 15 group treatment sessions over 20 weeks plus individual home treatment sessions and one client received 20 weekly-sessions of individual treatment only. After 20 weeks, treatment resulted in noticeable improvement in several hoarding symptoms for five of the seven patients, especially reduction in excessive acquisition of possessions, although problems with clutter persisted. Three of four clients who continued in treatment for approximately 1 year showed substantial further improvement, although none felt entirely recovered. Findings are discussed in light of the model of hoarding and possible modifications to treatment to enhance motivation and benefits

Investigation of the Phenomenological and Psychopathological Features of Trichotillomania in an Italian Sample

Trichotillomania (TTM) is still a scarcely known and often inadequately treated disorder in Italian clinical settings, despite growing evidence about its severe and disabling consequences. The current study investigated the phenomenology of TTM in Italian individuals; in addition, we sought to examine patterns of self-esteem, anxiety, depression, and OCD-related symptoms in individuals with TTM compared to healthy participants. The current study represents the first attempt to investigate the phenomenological and psychopathological features of TTM in Italian hair pullers. One hundred and twenty-two individuals with TTM were enrolled: 24 were assessed face-to-face (face-to-face group) and 98 were recruited online (online group). An additional group of 22 face-to-face assessed healthy controls (HC group) was included in the study. The overall female to male ratio was 14:1, which is slightly higher favoring female than findings reported in literature. Main results revealed that a higher percentage of individuals in the online group reported pulling from the pubic region than did face-to-face participants; furthermore, the former engaged in examining the bulb and running the hair across the lips and reported pulling while lying in bed at higher frequencies than the latter. Interestingly, the online TTM group showed greater functional and psychological impairment, as well as more severe psychopathological characteristics (self-esteem, physiological and social anxiety, perfectionism, overestimation of threat, and control of thoughts), than the face-to-face one. Differences between the two TTM groups may be explained by the anonymity nature of the online group, which may have led to successful recruitment of more serious TTM cases, or fostered more open answers to questions. Overall, results revealed that many of the phenomenological features of Italian TTM participants matched those found in U.S. clinical settings, even though some notable differences were observed; therefore, cross-cultural invariance might represent a characteristic of OCD-related disorders

Waitlist-Controlled Trial of Cognitive Behavior Therapy for Hoarding Disorder

Objective: This study investigated a multicomponent cognitive behavioral treatment (CBT) for hoarding based on a model proposed by Frost and colleagues and manualized in Steketee and Frost (2007). Method: Participants with clinically significant hoarding were recruited from the community and a university-based anxiety clinic. Of the 46 patients randomly assigned to CBT or waitlist (WL), 40 completed the 12-week assessment and 36 completed 26 sessions. Treatment included education and case formulation, motivational interviewing, skills training for organizing and problem solving, direct exposure to nonacquiring and discarding, and cognitive therapy. Measures included the Saving Inventory-Revised (self-report), Hoarding Rating Scale-Interview, and measures of clinical global improvement. Between group repeated measures analyses using general linear modeling examined the effect of CBT versus WL on hoarding symptoms and moodstate after 12 weeks. Within group analyses examined pre-post effects for all CBT participants combined after 26 sessions. Results: After 12 weeks, CBT participants benefited significantly more than WL patients on hoarding severity and mood with moderate effect sizes. After 26 sessions of CBT, participants showed significant reductions in hoarding symptoms with large effect sizes for most measures. At session 26, 71% of patients were considered improved on therapist clinical global improvement ratings and 81% of patients rated themselves improved; 41% of completers were clinically significantly improved. Conclusions: Multicomponent CBT was effective in treating hoarding. However, treatment refusal and compliance remain a concern, and further research with independent assessors is needed to establish treatment benefits and durability of gains