Neziroglu Hoarding Presentation - Part 2

Jun 10, 2015 | Author: Bio Behavioral Institute

7. 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

8. 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

9. 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)

10. 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”

11. 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)

12. 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

13. 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

14. 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

15. Hoarding vs. OCD: Neuroanatomy (Saxena, 2007)


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


         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.

16. 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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