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Hoarding Disorder and OCD in DSM V

PSYC 442 Concordia University

Alexandra Therond

on 5 November 2013

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Transcript of Hoarding Disorder and OCD in DSM V

Is hoarding disorder distinct from obsessive compulsive disorder and other psychopathology, as suggested in the DSM-5?
Obsessive Compulsive
Highlights of Changes from DSM-IV-TR to DSM-V
People diagnosed with OCD having hoarding tendencies
Removed from the anxiety disorders section and a specific section for OCD was established, that also includes other related disorders like hoarding, excoriation, hair-pulling.
Inclusion of the substance abuse clause: where some cases of the obsessive compulsive disorder are classified as “substance-induced”.

Poor Insight
Better Formulation of Specifier
Obsessions and compulsions to amass belongings and hold onto them even though some if not all have very minuscule value.
Which specifier(s) is/are a part of the new section on obsessive-compulsive disorders in DSM-V?
a) poor insight

b) fair insight

c) irrational insight

d) a and b

e) all of the above

Obsessions over these possessions and because of that have a lot of issues when are asked to get rid of them or even downsize them
DSM-V also emphasizes that hoarding tendencies are not seen exclusively in patients with obsessive-compulsive disorder:
Present in autism spectrum disorders
Cognitive impairment disorders

Hoarding Disorder
Hoarding is…
The acquisition of and failure to discard possessions that appear to be useless or of limited value.

Criterion A
Persistent difficulties discarding or parting with possessions regardless of actual value

Criterion B
The need to purposefully save their possessions and experience distress when faced with having to get rid of them.

The hoarding is not attributable to another medical condition.
The hoarding is not better explained by the symptoms of another mental disorder

Specify if…

. Excessive acquisition

Good or fair insight

Poor insight

Absent insight/delusional beliefs

Hoarding Disorder
and OCD
Hoarding disorder as a symptom of OCD?
Hoarding as a symptom of OCD
- Prevalence of hoarding criteria in OCD patients (16 – 20%)
o Cases of OCD with a clinically significant hoarding behavior (about 5%)

- Phenomenology of both have some similarities
o Avoidance and difficulties of discarding possessions driven by fear of losing items which might be important later on.
• Functionally similar to obsessions
o Avoidance of discarding, having urges to save items and some acquisition behaviors
• Functionally similar to compulsions
o Over lapping of symmetry-related obsessions in OCD

Hoarding disorder as a distinct entity?
- Growing body of evidence
o Different neural substrates involved
o Different cognitive processes

Hoarding aspect and beliefs
o Patients with a hoarding compulsion do not respond to evidence-based treatments of OCD
• Exposure
• Ritual prevention
• Serotonin reuptake inhibitors

Other Psychopathologies


• 92% of individuals with Hoarding Disorder have another Axis I or Axis II Disorder
Anxiety & Mood Disorders
75% comorbidity
Major Depressive Disorder (MDM)
• 26.7% - 53% comorbidity
• MDD more frequent in HD than OCD populations

Anxiety Disorders
• Social Phobia
o 23.5% - 33% comorbidity
o More common in men
o Social Phobia is diagnosed more frequently in HD than OCD populations
• Generalized Anxiety Disorder
o 13.3% - 24.4% comorbidity

Impulse Control Disorders
• 50-86% have excessive acquisition problem
• 78.2% of participants with hoarding disorder meet criteria for one or more acquisition-related impulse control disorder
o 42.1% meet criteria for two
o 6.1% meet criteria for three
• Impaired behavioral inhibition

Attention Deficit Hyperactivity Disorder
• Inattentive symptoms (impaired attention) predict hoarding severity
• Hoarders had high ADHD scores
• 20% diagnosed with hoarding disorder meet ADHD criteria, only 4% in OCD
• 27.8% comorbidity
• Information processing deficit underlies hoarding
Personality Disorders
• Obsessive Compulsive Personality Disorder
o In DSM-IV and DSM-5 one of eight diagnostic criteria
• “Inability to discard worn-out/worthless objects even when they have no sentimental value.”
• Not found in ICD-10
• No support for criteria addition
• “worthless” aspect counter to hoarding tendencies
• Other Personality Disorders
o Dependent
o Schizotypal
o Avoidant
o Paranoid
Alexandra Therond
Aurelie Fock
Tamraa Greenidge
Christina Deguire

Criterion C
Difficulty discarding possessions resulting in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities)
Criterion D
The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
Criterion E

Being unable to discard worn-out or worthless objects even when they have no sentimental value

Individuals diagnosed with hoarding disorder have difficulty discarding possessions but do not save them on purpose.


Hoarding Disorder distinct from OCD

· Treatments ineffective
· Emotional attachment absent in OCD
· Pleasurable in HD while distressful in OCD
· Addition in DSM-5

Less clear if Hoarding Disorder distinct from other psychopathology

· High comorbidity with mood, anxiety, impulse control, ADHD, and personality disorders

· Future research

o Methyphenidate
Individuals diagnosed with a hoarding disorder perceive their hoarding behavior as a pleasurable experience and even contribute to their sense of self.

True or False?

Concordia University
PSYC 442
Gillian Marta Acolado
Fall 2013

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