Hostname: page-component-745bb68f8f-g4j75 Total loading time: 0 Render date: 2025-01-12T11:02:08.310Z Has data issue: false hasContentIssue false
  • English
  • Français

Neurobiology and Treatment of Compulsive Hoarding

Published online by Cambridge University Press:  07 November 2014

Sanjaya Saxena
Sanjaya Saxena*
Affiliation:
Dr. Saxena is professor of psychiatry and director of the Obsessive-Compulsive Disorders Program at the, University of California, San Diego
*
UCSD Department of Psychiatry, 8950 Villa La Jolla Drive, Suite C-207, La Jolla, CA 92037. Tel: (858) 642-3472; Fax:, (858) 642-6442; E-Mail:, [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Type
Research Article
Information
CNS Spectrums , Volume 13 , Issue S14 , 2008 , pp. 29 - 36
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Frost, RO, Gross, RC. The hoarding of possessions. Behav Res Ther. 1993;31:367–381.CrossRefGoogle ScholarPubMed
2.Samuels, JF, Bienvenu, OJ, Grados, MA, et al.Prevalence and correlates of hoarding behavior in a community-based sample. Behav Res Ther. 2008;46:836–844.CrossRefGoogle Scholar
3.Steketee, G, Frost, R. Compulsive hoarding: current status of the research. Clin Psychology Rev. 2003;23:905–927.CrossRefGoogle ScholarPubMed
4.Rasmussen, S, Eisen, JL. The epidemiology and clinical features of obsessive-compulsive disorder. Psychiatric Clin N Am. 1992;15:743–758.CrossRefGoogle ScholarPubMed
5.Samuels, JF, Bienvenu, OJ 3rd, Pinto, A, et al.Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. Behav Res Ther. 2007;45:673–686.CrossRefGoogle ScholarPubMed
6.Mataix-Cols, D, Nakatani, E, Micali, N, Heyman, I. Structure of obsessive-compulsive symptoms in pediatric OCD. J Am Acad Child Adolesc Psychiatry. 2008;47:773–778.CrossRefGoogle ScholarPubMed
7.Frost, R, Hartl, T. A cognitive-behavioral model of compulsive hoarding. Behav Res Ther. 1996;34:341–350.CrossRefGoogle ScholarPubMed
8.Saxena, S, Maidment, KM, Vapnik, T, et al.Obsessive-compulsive hoarding: symptom severity and response to multi-modal treatment. J Clin Psychiatry. 2002;63:21–27.CrossRefGoogle Scholar
9.Leckman, JF, Grice, DE, Boardman, J, et al.Symptoms of obsessive-compulsive disorder. Am J Psychiatry. 1997;154:911–917.Google ScholarPubMed
10.Mataix-Cols, D, Rosario-Campos, MC, Leckman, JF. A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry. 2005;162:228–238.CrossRefGoogle ScholarPubMed
11.Mataix-Cols, D, Rauch, SL, Manzo, PA, et al.Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 1999;156:1409–1416.CrossRefGoogle ScholarPubMed
12.Pinto, A, Eisen, JL, Mancebo, MC, et al.Taboo thoughts and doubt/checking: a refinement of the factor structure for obsessive-compulsive disorder symptoms. Psychiatry Res. 2007;151:255–258.CrossRefGoogle ScholarPubMed
13.Calamari, JE, Wiegartz, PS, Riemann, BC, et al.Obsessive-compulsive disorder subtypes: an attempted replication and extension of a symptom-based taxonomy. Behav Res Ther. 2004;42:647–670.CrossRefGoogle ScholarPubMed
14.Wu, KD, Watson, D. Hoarding and its relation to obsessive-compulsive disorder. Behav Res Ther. 2005;43(7):897–921.CrossRefGoogle ScholarPubMed
15.Olatunji, BO, Williams, BJ, Haslam, N, et al.The latent structure of obsessive-compulsive symptoms: a taxometric study. Depress Anxiety. 2007 Oct 17; [Epub ahead of print].Google Scholar
16.Pertusa, A, Fullana, MA, Singh, S, et al.Compulsive Hoarding: OCD symptom, distinct clinical syndrome, or both?Am J Psychiatry. 2008 May 15. [Epub ahead of print]Google Scholar
17.Saxena, S. Is compulsive hoarding a genetically and neurobiologically discrete syndrome? Implications for diagnostic classification. Am J Psychiatry. 2007;164:380–384.CrossRefGoogle ScholarPubMed
18.Frost, RO, Kim, HJ, Morris, C, et al.Hoarding, compulsive buying and reasons for saving. Behav Res Ther. 1998;36(7-8):657–664.CrossRefGoogle ScholarPubMed
19.Winsberg, M, Cassic, K, Koran, L. Hoarding in obsessive-compulsive disorder: a report of 20 cases. J Clin Psychiatry. 1999;60:591–597.CrossRefGoogle ScholarPubMed
20.Samuels, J, Bienvenu, OJ, Riddle, MA, et al.Hoarding in obsessive-compulsive disorder: results from a case-control study. Behav Res Ther. 2002;40:517–528.CrossRefGoogle ScholarPubMed
21.Hasler, G, Pinto, A, Greenberg, BD, et al.Familiality of factor analysis-derived YBOCS dimensions in OCD-affected sibling pairs from the OCD Collaborative Genetics Study. Biol Psychiatry. 2007;61:617–625.CrossRefGoogle ScholarPubMed
22.Zhang, H, Leckman, JF, Pauls, DL, et al, and the Tourette Syndrome Association International Consortium for Genetics. Genomewide scan of hoarding in sib pairs in which both sibs have Gilles de la Tourette Syndrome. Am J Hum Genet. 2002;70:896–904.CrossRefGoogle ScholarPubMed
23.Lochner, C, Kinnear, CJ, Hemmings, SM, et al.Hoarding in obsessive-compulsive disorder: clinical and genetic correlates. J Clin Psychiatry. 2005;66:1155–1160.CrossRefGoogle ScholarPubMed
24.Samuels, J, Shugart, YY, Grados, MA, et al.Significant linkage to compulsive hoarding on chromosome 14 in families with obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. Am J Psychiatry. 2007;164:493–499.CrossRefGoogle ScholarPubMed
25.Cohen, L, Angladette, L, Benoit, N, Pierrot-Deseilligny C. A man who borrowed cars. Lancet. 1999;353:34.CrossRefGoogle Scholar
26.Hahm, DS, Kang, Y, Cheong, SS, Na, DL. A compulsive collecting behavior following an A-com aneurysmal rupture. Neurology. 2001;56:398–400.CrossRefGoogle ScholarPubMed
27.Volle, E, Beato, R, Levy, R, Dubois, B. Forced collectionism after orbitofrontal damage. Neurology. 2002;58:488–490.CrossRefGoogle ScholarPubMed
28.Nakaaki, S, Murata, Y, Sato, J, et al.Impairment of decision-making cognition in a case of frontotemporal lobar degeneration (FTLD) presenting with pathologic gambling and hoarding as the initial symptoms. Cogn Behav Neurol. 2007;20:121–125.CrossRefGoogle Scholar
29.Mendez, MF, Shapira, JS. The spectrum of recurrent thoughts and behaviors in frontotemporal dementia. CNS Spectr. 2008;13(3):202–208.CrossRefGoogle ScholarPubMed
30.Anderson, SW, Damasio, H, Damasio, AR. A neural basis for collecting behaviour in humans. Brain. 2005;128:201–212.CrossRefGoogle ScholarPubMed
31.Lawrence, NS, Wooderson, S, Mataix-Cols, D, et al.Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder. Neuropsychology. 2006;20:409–419.CrossRefGoogle ScholarPubMed
32.Gilbert, AR, Mataix-Cols, D, Almeida, JR, et al.Brain structure and symptom dimension relationships in obsessive-compulsive disorder: A voxel-based morphometry study. J Affect Disord. 2008;109:117–126.CrossRefGoogle ScholarPubMed
33.Saxena, S, Brody, A, Maidment, KM, et al.Cerebral glucose metabolism in obsessive-compulsive hoarding. Am J Psychiatry. 2004;161:1038–1048.CrossRefGoogle ScholarPubMed
34.Saxena, S, Bota, RG, Brody, AL. Brain-behavior relationships in obsessive-compulsive disorder. Sem Clin Neuropsychiatry. 2001;6:82–101.CrossRefGoogle ScholarPubMed
35.Saxena, S, Maidment, KM, Baker, SK, et al.Anterior cingulate cortex dysfunction in compulsive hoarding. Presented at: Annual Meeting of the American College of Neuropsychopharmacology; December, 2007; Boca Raton, FL.Google Scholar
36.Vogt, BA, Vogt, L, Farber, NB, Bush, G. Architecture and neurocytology of monkey cingulate cortex. Neurology. 2005;485:218–239.Google Scholar
37.Awh, E, Gehring, WJ. The anterior cingulate lends a hand in response selection. Nat Neurosci. 1999;2:853–854.CrossRefGoogle Scholar
38.Krawczyk, DC. Contributions of the prefrontal cortex to the neural basis of decision making. Neurosci Biobehav Rev. 2002;26;631–664.CrossRefGoogle Scholar
39.Carter, CS, Braver, TS, Barch, DM, et al.Anterior cingulate cortex, error detection, and online monitoring of performance. Science. 1998;280:747–749.CrossRefGoogle ScholarPubMed
40.Paus, T. Primate anterior cingulate cortex: where motor control, drive, and cognition interface. Nat Rev: Neurosci. 2001;2:417–424.CrossRefGoogle ScholarPubMed
41.Walton, ME, Croxson, PL, Behrens, TE, et al.Adaptive decision making and value in the anterior cingulate cortex. Neuroimage. 2007;36(Suppl 2):T142–154.CrossRefGoogle ScholarPubMed
42.Grisham, JR, Brown, TA, Savage, CR, et al.Neuropsychological impairment associated with compulsive hoarding. Behav Res Ther. 2007;45:1471–1483.CrossRefGoogle ScholarPubMed
43.Lane, RD, Fink, GR, Chau, PM-L, Dolan, RJ. Neural activation during selective attention to subjective emotional responses. Neuroreport. 1997;8:3969–3972.CrossRefGoogle ScholarPubMed
44.Ochsner, K, Bunge, SA, Gross, JJ, Gabrieli, JDE. Rethinking feelings: An fMRI study of the cognitive regulation of emotion. J Cog Neurosci. 2002;14:1215–1229.CrossRefGoogle ScholarPubMed
45.Beauregard, M, Levesque, J, Bourgouin, P. Neural correlates of conscious self-regulation of emotion. J Neurosci. 2001;21:RC165.CrossRefGoogle ScholarPubMed
46.Phan, KL, Fitzgerald, DA, Nathan, PJ, et al.Neural substrates for voluntary suppression of negative affect: a functional magnetic resonance imaging study. Biol Psychiatry. 2005;57:210–219.CrossRefGoogle ScholarPubMed
47.Mega, MS, Dinov, ID, Porter, V, et al.Metabolic patterns associated with the clinical response to galantamine therapy: a fluorodeoxyglucose F18 positron emission tomographic study. Arch Neurol. 2005;62:721–728.CrossRefGoogle ScholarPubMed
48.de Bruijn, ER, Hulstijn, W, Verkes, RJ, et al.Drug-induced stimulation and suppression of action monitoring in healthy volunteers. Psychopharmacology. 2004;177:151–160.CrossRefGoogle ScholarPubMed
49.de Haes, JI, Maguire, RP, Jager, PL, et al.Methylphenidate-induced activation of the anterior cingulate but not the striatum: a [15O]H2O PET study in healthy volunteers. Hum Brain Mapp. 2007;28:625–635.CrossRefGoogle Scholar
50.Spence, SA, Green, RD, Wilkinson, ID, Hunter, MD. Modafinil modulates anterior cingulate function in chronic schizophrenia. Br J Psychiatry. 2005;187:55–61.CrossRefGoogle ScholarPubMed
51.Mataix-Cols, D, Wooderson, S, Lawrence, N, et al.Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Arch Gen Psychiatry. 2004;61:564–576.CrossRefGoogle ScholarPubMed
52.An, SK, Mataix-Cols, D, Lawrence, NS, et al.To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder. Mol Psychiatry. 2008 Jan 8; [Epub ahead of print].Google Scholar
53.Tolin, DF, Kiehl, KA, Worhunsky, P, et al.An exploratory study of the neural mechanisms of decision making in compulsive hoarding. Psychol Med. 2008 May 19:1–12. [Epub ahead of print]Google ScholarPubMed
54.Hartl, TL, Frost, RO, Allen, GJ, et al.Actual and perceived memory deficits in individuals with compulsive hoarding. Depress Anxiety. 2004;20(2):59–69.CrossRefGoogle ScholarPubMed
55.Wincze, JP, Steketee, G, Frost, RO. Categorization in compulsive hoarding. Behav Res Ther. 2007;45:63–72.CrossRefGoogle ScholarPubMed
56.Bechara, A, Damasio, AR, Damasio, H, Anderson, SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition. 1994;50:7–15.CrossRefGoogle ScholarPubMed
57.Goldman, BL, Martin, ED, Calamari, JE, et al.Implicit learning, thought-focused attention and obsessive-compulsive disorder: A replication and extension. Behav Res Ther. 2008;46:48–61.CrossRefGoogle ScholarPubMed
58.Saxena, S, Maidment, KM. Treatment of obsessive-compulsive hoarding. J Clin Psychology. 2004;60:1143–1154.CrossRefGoogle Scholar
59.Black, DW, Monahan, P, Gable, J, et al.Hoarding and treatment response in non-depressed subjects with obsessive-compulsive disorder. J Clin Psychiatry. 1998;59:420–425.CrossRefGoogle Scholar
60.Stein, DJ, Andersen, EW, Overo, KF. Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo. Rev Bras Psiquiatr. 2007;29:303–307.CrossRefGoogle ScholarPubMed
61.Stein, DJ, Carey, PD, Lochner, C, et al.Escitalopram in obsessive-compulsive disorder: response of symptom dimensions to pharmacotherapy. CNS Spectr. 2008;13:492–498.CrossRefGoogle ScholarPubMed
62.Alonso, P, Menchon, JM, Pifarre, J, et al.Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy. J Clin Psychiatry. 2001;62:535–540.CrossRefGoogle ScholarPubMed
63.Ferrao, YA, Shavitt, RG, Bedin, NR, et al.Clinical features associated to refractory obsessive-compulsive disorder. J Affect Disord. 2006;94:199–209.CrossRefGoogle ScholarPubMed
64.Erzegovesi, S, Cavallini, MC, Cavedini, P, et al.Clinical predictors of drug response in obsessive-compulsive disorder. J Clin Psychopharm. 2001;21:488–492.CrossRefGoogle ScholarPubMed
65.Shetti, CN, Reddy YCJ, Kandavel, T, et al.Clinical predictors of drug nonresponse in obsessive-compulsive disorder. J Clin Psychiatry. 2005;66:1517–1523.CrossRefGoogle ScholarPubMed
66.Flament, MF, Rapoport, JL, Berg, CJ, et al.Clomipramine treatment of childhood obsessive-compulsive disorder. A double-blind controlled study. Arch Gen Psychiatry. 1985;42:977–983.CrossRefGoogle ScholarPubMed
67.Leonard, HL, Swedo, SE, Rapoport, JL, et al.Treatment of obsessive-compulsive disorder with clomipramine and desipramine in children and adolescents. A double-blind crossover comparison. Arch Gen Psychiatry. 1989;46:1088–1092.CrossRefGoogle ScholarPubMed
68.Masi, G, Millepiedi, S, Mucci, M, et al.A naturalistic study of referred children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2005;44:673–681.CrossRefGoogle ScholarPubMed
69.Saxena, S, Brody, AL, Maidment, KM, Baxter, LR. Paroxetine treatment of compulsive hoarding. J Psychiatr Res. 2007;41:481–487.CrossRefGoogle ScholarPubMed
70.Kaplan, A, Hollander, E. Comorbidity in compulsive hoarding: a case report. CNS Spectr. 2004;9(1):71–73.CrossRefGoogle ScholarPubMed
71.Mataix-Cols, D, Marks, IM, Greist, JH, et al.Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: results from a controlled trial. Psychother Psychosom. 2002;71:255–262.CrossRefGoogle ScholarPubMed
72.Abramowitz, JS, Franklin, ME, Schwartz, SA, Furr, JM. Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. J Consult Clin Psychology. 2003;71:1049–1057.CrossRefGoogle ScholarPubMed
73.Rufer, M, Fricke, S, Moritz, S, Kloss, M, Hand, I. Symptom dimensions in obsessive-compulsive disorder: prediction of cognitive-behavior therapy outcome. Acta Psychiatr Scand. 2006;113:440–446.CrossRefGoogle ScholarPubMed
74.Storch, EA, Merlo, LJ, Larson, MJ, et al.Symptom dimensions and cognitive-behavioural therapy outcome for pediatric obsessive-compulsive disorder. Acta Psychiatr Scand. 2008;117:67–75.CrossRefGoogle ScholarPubMed
75.Hartl, TL, Frost, RO. Cognitive-behavioral treatment of compulsive hoarding: a multiple baseline experimental case study. Behav Res Ther. 1999;37(5):451–461.CrossRefGoogle ScholarPubMed
76.Steketee, G, Frost, R, Wincze, J, et al.Group and individual treatment of compulsive hoarding: A pilot study. Behav Cog Psychotherapy. 2000;28:259–268.CrossRefGoogle Scholar
77.Tolin, DF, Frost, RO, Steketee, G. An open trial of cognitive-behavioral therapy for compulsive hoarding. Behav Res Ther. 2007;45:1461–1470.CrossRefGoogle ScholarPubMed
78.Miller, WR. Motivational interviewing: research, practice, and puzzles. Addict Behav. 1996;21(6):835–842.CrossRefGoogle ScholarPubMed
79.Maltby, N, Tolin, DF. A brief motivational intervention for treatment-refusing OCD patients. Cogn Behav Ther. 2005;34(3):176–184.CrossRefGoogle ScholarPubMed
80.Wulfert, E, Blanchard, EB, Freidenberg, BM, Martell, RS. Retaining pathological gamblers in cognitive behavior therapy through motivational enhancement: A pilot study. Behav Modif. 2006;30(3):315–340.CrossRefGoogle ScholarPubMed