Neziroglu Hoarding Presentation – Part 2

  1. Hoarding Behavior vs. Normal Behavior

Process of Hoarding

  • Acquire item
  • Use the item
  • Consider discarding the item: evaluate its use
  • Obsessional Thoughts
  • Anxiety
  • Save the item
  • Anxiety Relief

Normal Pattern of Use for Disposable Objects

  • Acquire item
  • Use the item
  • Consider discarding the item: evaluate use
  • Discard or save the item
  1. Comorbidity
  • 75% of individuals with hoarding disorder have a comorbid mood or anxiety disorder
  • Most common: major depressive disorder, social anxiety disorder (social phobia), and generalized anxiety disorder
  • 20% of individuals with hoarding disorder also have symptoms that meet diagnostic criteria for OCD
  1. Hoarding Disorder and OCD
  • DSM-5 identifies hoarding disorder as distinct from OCD.
  • Hoarders do not respond to the same CBT treatment approaches as OCD
  • Bloch et al. (2014)
  1. Obsessional Thoughts in Hoarding
  • Obsessional thoughts related to:
  • Emotional Attachment including feelings of comfort, distress, loss, and identity)

o       Without this possession, I will be vulnerable.”

o       “Throwing this away means losing a part of my life”

o       “I might never be able to find this again”

  • Responsibility

o       “I am responsible for finding a use for this possession.”

o       “I am responsible for saving this for someone who might need it.”

o       “I am ashamed when I don’t have something when I need it.”

  • Memory

o       “Saving this means I don’t have to rely on my memory”

o       If I don’t leave this in sight, I’ll forget it”

o       I must remember something about this

  • Control

o       “No one has the right to touch my possessions”

o       “I like to maintain sole control over my possesions”

  1. OCD vs. Hoarding Neziroglu, Peterson & Weissman (2006)
  • OCD has

o       Has identifiable obsessions

o       Report much distress associated with OCD

o       Responds well to ERP and cognitive therapy

o       Responds well to SSRI’s

  • Hoarding

o       More cognitive distortions, less actual obsessions

o       Report less distress

o       More difficult to engage and treat

o       High levels of overvalued ideation

o       No medications proven effective, including SSRI’s

o       More likely to have family friction

  • Individuals with compulsive hoarding are more likely to display:

o       Symmetry Obsessions

o       Counting, ordering, and repeating compulsions

o       Greater illness severity

o       Difficulty  completing tasks

o       Problems with decision making

o       (Sameuls, Bienvenu et. al, 2007)

  1. Hoarding vs. OCD: Obsessions
  • Thoughts triggered by objects and efforts to discard
    • Example: “I might need this; I don’t want to lose an opportunity; I can’t waste this.”
  • Not always distressing Example:
    • “This is beautiful/ sentimental. I’ll keep it.”
  • Impulses to acquire
  • Images of using item in future, but rarely distressing
  1. Hoarding vs. OCD: Rituals and Avoidance Behaviors
  • Doubting, checking, reassurance seeking are common before discarding and reflect negative emotions like anxiety and guilt
  • Efforts to control distress result in avoidance of discarding (saving) objects
  • Acquiring behaviors appear to be motivated by impulsive urges and are commonly accompanied by positive feelings
  1. Hoarding vs. OCD: Insight, Distress, and Interference
  • Insight can be very poor, ambivalence about treatment is common
  • Distress not always present, even in severe cases
  • Interference with functioning is typical
  1. Hoarding vs. OCD: Neuroanatomy (Saxena, 2007)
  • OCD:

▫         Deficits in the pre-frontal cortex and basal ganglia (Stein, 2000)

  • Hoarding:

▫         Low activity along the cingulate cortex, which is involved in decision making and motivation.

▫          Implications: The low activity may account for the disorganization and lack of motivation often seen in the difficulty of treating hoarders.

  1. Differences between Hoarding and OCD Neziroglu, Peterson & Weissman (2006)
  • Hoarders report less distress
  • Hoarders are less depressed
  • Hoarders usually have less insight: higher OVI
  • They are harder to engage in treatment
  • Hoarding more likely to cause family friction

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