What is underneath all that stuff? A Q-methodological exploration of profiles of beliefs and vulnerabilities in hoarding disorder

Abstract

Background: Hoarding disorder (HD) can be understood through the cognitive behavioural model in the context of vulnerability factors (for example, personality traits, co-morbidities, traumatic life events) and beliefs about possessions (for example, identity, emotional attachment, memory, utility). Less is known about the strength of these hypothesised beliefs, or how they interact within the hoarding population, with researchers suggesting that specifying beliefs would improve treatment outcomes. Aim: The current study explored beliefs in HD, utilising Q-methodology to explore both categories of beliefs and the interactions between these. Moreover, Q-methodology allowed for comparison of the individuals endorsing specific categories of beliefs. Method: A comprehensive list of beliefs about possessions was developed. Thirty-two adults with clinically significant levels of HD completed a Q-sort task, alongside measures of proposed vulnerabilities, including co-morbidity, trauma and attachment style. Results: Q-factor analysis produced four profiles consisting of groups of participants who endorsed the same beliefs and had shared characteristics: (1) ‘Expression of identity’, (2) ‘Responsibility and morality’, (3) ‘Stability and predictability’, and (4) ‘Objects as emotional and meaningful beings’. Discussion: The profiles were distinguished by different categories of beliefs and co-morbid symptoms, suggesting that more targeted assessment tools and interventions would be beneficial to account for this heterogeneity within the clinical population. In particular, beliefs about identity and self-concept formed the largest profile, and beliefs about stability and predictability introduce a novel category of beliefs.

‘A more human approach … I haven’t found that really’: experiences of hoarding difficulties and seeking help

“…The variation in preferences for treatment has been noted elsewhere (Robertson et al, 2020;Rodriguez et al, 2016). A recent exploration of beliefs around hoarding behaviours led to the authors concluding that the current models of understanding hoarding are not sufficiently complex (Tinlin et al, 2022). This seems pertinent given that if an individual can overcome the internal and external barriers identified, there is little offer of choice or flexibility in relation to interventions provisioned.…”

“…Cognitive behavioural therapy (CBT) is the most recognised approach to the presentation. Treatment aims to enhance motivation to discard objects, develop skills in organising and problem solving, reduce acquisition, enable discarding and promote relapse prevention (Steketee and Frost, 2014). A meta-analysis of CBT interventions reported pre-to post-treatment effect sizes of 0.82 and 0.70 for hoarding severity and clutter, respectively (Tolin et al, 2015) and a more recent meta-analysis (Rodgers et al, 2021) found larger effect sizes with some evidence of maintenance of improvement.…”