Hoarding: a community health problem

Compulsive hoarding is a little studied phenomenon within the research literature. The information available on compulsive hoarding is diverse and not well integrated. In the present article we propose a tentative cognitive-behavioral model of compulsive hoarding. The purpose of such a model is to provide a framework for the development and testing of hypotheses about compulsive hoarding. In this model hoarding is conceptualized as a multifaceted problem stemming from: (1) information processing deficits; (2) problems in forming emotional attachments; (3) behavioral avoidance; and (4) erroneous beliefs about the nature of possessions. Specific hypotheses about each of these are discussed.

Three studies of nonfood hoarding are reported. Findings support the reliability and validity of a Hoarding Scale. Furthermore, the findings indicate a number of features of hoarding behavior. Hoarding was associated with indecisiveness, perfectionism (especially maladaptive evaluative concern) and obsessive compulsive symptoms among college students and community volunteers. Hoarders tended to buy extra things in order not to be caught without a needed item, and they carried more 'just-in-case' items in purses, pockets and cars. Onset of hoarding was childhood and adolescence. Hoarders had more first degree relatives who engaged in excessive saving than nonhoarders, and hoarders were less likely to be married. There was no evidence to suggest that hoarding was related to material deprivation. A model was suggested which conceptualizes hoarding as an avoidance behavior tied to indecisiveness and perfectionism. Saving allows the hoarder to avoid the decision required to throw something away, and the worry which accompanies that decision (worry that a mistake has been made). Also, it allows hoarders to avoid emotional reactions which accompany parting with cherished possessions, and results in increased perception of control.

Recent reviews and meta-analytic studies have provided an encouraging account of the effectiveness of behavioral interventions for obsessive-compulsive disorder (OCD). One question regarding these estimates concerns their degree of generalizability to the range of OCD subtypes encountered in clinical settings. The purpose of the present study was to provide a quantitative description of the prevalence of various OCD subtypes (i.e. type of compulsions) within the behavioral treatment literature. We examined 65 studies that permitted classification of patients according to symptom subtype. Patients with primarily cleaning and/or checking compulsions predominated, accounting for 75% of the treatment population. On the other hand, patients with multiple compulsions or other compulsions, such as exactness, counting, hoarding, or slowness rituals were underrepresented, comprising only 12% of the population, which is markedly less than clinical epidemiological estimates. Rates of improvements in patients with OCD are most applicable to patients with cleaning and checking compulsions, but may not yet be generalizable to patients with other symptoms. These findings encourage studies of the efficacy of existing and novel interventions for patients with counting, repeating, symmetry, hoarding, or multiple compulsions in order to broaden the clinical application of OCD behavioral treatment.