Hoarding and emotional reactivity: The link between negative emotional reactions and hoarding symptomatology

Abstract

Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD’s etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious hoarding difficulties to examine how hoarding symptoms related to both general and hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict hoarding symptoms. These findings provide support for cognitive-behavioral models of hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for hoarding.

Behavioral and emotional consequences of thought listing versus cognitive restructuring during discarding decisions in hoarding disorder

“…Extending prior research on emotional prediction and intensity in HD (Shaw et al, 2015; Timpano et al, 2014), we predicted that:…”

“…Preliminary research suggests that student volunteers with hoarding symptoms exhibit ER-related problems such as greater intensity of NA and decreased emotion tolerance (Timpano, Shaw, Cougle, & Fitch, 2014). On self-report measures, individuals with HD report difficulty engaging in goal-directed behavior when distressed and difficulty accessing to strategies for regulating emotions (Fernandez de la Cruz et al, 2013), and report anticipating a higher level of NA when discarding (Shaw, Timpano, Steketee, Tolin, & Frost, 2015). …”

Etiological Models of Hoarding Disorder

“…Beliefs about the nature of possessions and beliefs about the necessity of maintaining control over possessions, beliefs about responsibility for possessions, and beliefs about the necessity of perfection. Many experimental and observational studies corroborate the observations provided in the Frost and Hartl model of HD and emotional reactivity [13], intolerance of uncertainty [14], anxiety sensitivity [15] and impulsivity [16]. The model has become a basis for classical cognitive-behavioral therapy (CBT) for HD, whose efficacy has been established in clinical trials [17].…”

The Etiology of Hoarding Disorder: A Review

“…Emotional reactivity describes the intensity and duration of emotions an individual experiences following exposure to emotional stimuli [33] and it has been postulated as a possible vulnerability factor for HD. An internet study of individuals who self-reported hoarding symptoms found that individuals with higher levels of emotional reactivity also reported higher levels of hoarding symptom severity [33] .…”

“…An internet study of individuals who self-reported hoarding symptoms found that individuals with higher levels of emotional reactivity also reported higher levels of hoarding symptom severity [33] . The association was strongest in the context of higher levels of fear of making an incorrect decision and lower levels of confidence in the individual's ability to remember information [33] .…”