Neurobiology and Treatment of Compulsive Hoarding

Abstract

Compulsive hoarding is a common and often disabling neuropsychiatric disorder. This article reviews the phenomenology, etiology, neurobiology, and treatment of compulsive hoarding. Compulsive hoarding is part of a discrete clinical syndrome that includes difficulty discarding, urges to save, clutter, excessive acquisition, indecisiveness, perfectionism, procrastination, disorganization, and avoidance. Epidemiological and taxometric studies indicate that compulsive hoarding is a separate but related obsessive-compulsive spectrum disorder that is frequently comorbid with obsessive-compulsive disorder (OCD). Compulsive hoarding is a genetically discrete, strongly heritable phenotype. Neuroimaging and neuropsychological studies indicate that compulsive hoarding is neurobiologically distinct from OCD and implicate dysfunction of the anterior cingulate cortex and other ventral and medial prefrontal cortical areas that mediate decision-making, attention, and emotional regulation. Effective treatments for compulsive hoarding include pharmacotherapy and cognitive-behavioral therapy. More research will be required to determine the etiology and pathophysiology of compulsive hoarding, and to develop better treatments for this disorder.

Hoarding disorder: a new diagnosis for DSM-V?

“…[5,7,[18][19][20][21][22][23][24][25][26][27] Several clinician and self-administered measures also have been developed to reflect these criteria and are now widely used in the field, including the Saving InventoryRevised, [28] the Hoarding Rating Scale, [29] and the UCLA Hoarding Severity Scale. [30] In light of recent developments and cumulative knowledge gained over the last decade, the original criteria by Frost and Hartl [17] have now been further refined and are listed below: These proposed diagnostic criteria would be accompanied with additional text for clarification.…”

“…A detailed review of this literature is beyond the scope of this article and can be found elsewhere. [5][6][7] Briefly, preliminary evidence suggests that hoarding symptoms may have a distinct neural substrate to that of OCD. Compulsive hoarding shows a unique pattern of abnormal resting state brain function that does not overlap with that of nonhoarding OCD.…”

“…[5,23] Whereas OCD symptoms are mediated by elevated activity in specific orbitofronto-striatalpallidal-thalamic circuits, [67] compulsive hoarding symptoms seem to be mediated by partially distinct fronto-limbic circuits involving the cingulate cortex, ventromedial prefrontal cortex, and limbic structures. [5,18,23,25] Similar results were obtained in com-pulsive hoarding samples with [18] and primarily without [25] OCD, but more research is needed before firm conclusions can be drawn. Interestingly, these preliminary results are consistent with the animal and human lesion literature, which also implicate the ventromedial prefrontal cortex and subcortical limbic structures in hoarding behavior.…”

Obsessive-Compulsive Disorders or Not: Differential Diagnosis of Repetitive Behaviors Among Individuals with Intellectual and Developmental Disorders

“…These studies also note the relationship between intrusive aggressive, sexual or asocial urges and impulses and tic disorders. These studies also link hoarding with tic disorders and ASD (Kana et al 2007;Pallanti et al 2008, Saxena, 2008). Many individuals with IDD/ASD and severe sensory abnormalities also engage in stereotypic behaviors that function as an escape from overstimulation (Sayers et al, 2011).…”

“…Recent factor analytic studies report four major subgroups of obsessive and compulsive symptoms. These are pure obsessions, obsessions with compulsions such as anxiety about contamination leading to cleaning rituals; uncertainties about the completeness of actions contributing to doubting and checking; increased urge to arrange and order, organize and seeking balance in symmetry of thought and action; and hoarding ( DeMathis et al , 2006;Mataix-Cols et al, 2008;Saxena, 2008). In addition to OCD, there are two subsets of OC-like symptoms, hoarding, and arranging, symmetry, counting and ordering rituals that are currently classified as Obsessive-compulsive Spectrum Disorder (OCSD).…”