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Compulsive Hoarding may be a separate syndrome from OCD

OCTOBER 01, 2008

New research conducted at the Institute of Psychiatry has shown that, in most cases, compulsive hoarding is not related to an underlying OCD (obsessive-compulsive disorder).

Compulsive hoarding, the acquisition of and inability to discard a large number of possessions that appear to be useless and have no apparent value is a frequent (2-4% of the population) and serious problem for the sufferers and their families. In severe cases, it can lead to homelessness and even death from collapsing piles of clutter. Unfortunately, compulsive hoarders respond poorly to conventional treatments including medications and psychotherapy. Clarifying the diagnostic boundaries of compulsive hoarding is an important first step towards developing better treatments for this problem.

Hoarding behaviour has been described in a wide range of neurological and psychiatric disorders such as brain damage, dementia, autism or Prader-Willi syndrome to name a few, but has most often been associated with OCD. However, clinicians and researchers have long suspected that a large proportion of compulsive hoarders do not meet criteria for any organic or psychiatric disorder.

Researchers from the Institute of Psychiatry, led by Dr David Mataix-Cols (Psychobiology of Anxiety and Obsessive-Compulsive Disorders Group), interviewed 52 severe hoarders with no known organic or neurological disorder and found that approximately half did not meet diagnostic criteria for OCD. Crucially, even in those cases where severe hoarding coexisted with OCD, their hoarding behaviour was unrelated to traditional obsessional themes, such as fears of something bad happening. Most hoarders (regardless of whether they have OCD or not) said they find it difficult to discard their possessions because of their intrinsic value (‘I may need it one day’), they feel emotionally attached to the possessions or they feel safe around their possessions.

Interestingly, the study also identified a small group of hoarders (approx 10% of all studied hoarders) whose hoarding is clearly OCD-related and, characterized by the presence of specific OCD-like obsessions (e.g. ‘If I throw this object away, my father will die’) and the hoarding of unusual items (e.g. rubbish, body products).

These results suggest that, in most but not all cases, compulsive hoarding is a separate syndrome from OCD and may explain these patients’ poor response to existing anti-obsessional treatments. The findings also have implications for the classification of OCD and compulsive hoarding in the DSM-V.

The paper ‘Compulsive Hoarding: OCD Symptom, Distinct Clinical Syndrome, or Both?’ (Pertusa A., Fullana M.A., Singh S., Alonso P., Menchón J.M., Mataix-Cols D.) has been published online ahead of print by the American Journal of Psychiatry and is scheduled to appear in the October print edition of the Journal.

The study was supported in part by a grant from the University of London Central Fund awarded to Dr. Mataix-Cols.
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