Family Informants’ Perceptions of Insight in Compulsive Hoarding

Abstract

Existing psychological and pharmacological interventions for obsessive-compulsive disorder have not been particularly successful for compulsive hoarding, perhaps due in part to poor insight on the part of sufferers. Individuals with compulsive hoarding problems commonly display lack of awareness of the severity of their behavior, sometimes denying that they have a problem and often resisting intervention attempts and failing to follow through with therapeutic assignments. Using an internet-based survey, family and friends of individuals with reported hoarding problems (family/friend informants, N = 584) provided ratings of the hoarder's level of insight. They also made several ratings of the severity of the person's hoarding behavior, then rated the same items again with regard to how they thought the hoarder would respond to the items. Family/friend informants described the hoarder on average as having fair to poor insight. More than half were described as having ''poor insight'' or ''lacks insight/delusional,'' substantially worse insight than found in samples of OCD clinic patients using the same measure. Family/friend informants' ratings of hoarding severity were significantly greater than were their estimates of the hoarder's ratings. Hoarders described as showing less distress about the hoarding were described as showing poorer insight. These results suggest that compulsive hoarding is characterized by poor insight into the severity of the problem. Treatment development might need to emphasize strategies to bolster awareness, insight, and motivation.

Working with families of people who hoard: A harm reduction approach

“…In a recent study, 53% of family members described the person who hoards as having ''poor insight'' or ''lacks insight/delusional'' (Tolin, Fitch, Frost, & Steketee, 2010). A large majority (73%) of social service workers with elderly hoarding clients described their client as having severely impaired insight (Steketee et al, 2001).…”

Course of compulsive hoarding and its relationship to life events

“…[13] Furthermore, unlike most individuals with OCD, many individuals with compulsive hoarding exhibit little distress about or recognition of the problem. [14,15] The diagnostic placement of compulsive hoarding in DSM-V is currently being discussed, and many researchers are recommending its inclusion as a diagnostic entity separate from OCD.…”

Hoarding among patients seeking treatment for anxiety disorders

“…Structured and unstructured diagnostic interviews typically do not include an assessment of hoarding symptoms. Furthermore, individuals with hoarding often have poor insight into their problem (Christensen & Greist, 2001;Tolin, Fitch, Frost, & Steketee, 2010) and may be unlikely to spontaneously report these symptoms. Accordingly, assessment of hoarding symptoms in samples seeking treatment for other psychiatric disorders is necessary to help clarify the comorbidity of these problems.…”