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Hoarding in obsessive compulsive disorder: results from a case-control study
J Samuels1, O Joseph Bienvenu, M A Riddle
1Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore 21287, USA. jacks@jhmi.edu
Insights
Hoarding is common in obsessive-compulsive disorder (OCD), affecting nearly 30% of patients. Hoarding symptoms in OCD are linked to earlier onset, greater severity, and co-occurring conditions, complicating treatment.
Area of Science:
- Psychiatry
- Clinical Psychology
- Behavioral Science
Background:
- Hoarding is a frequent symptom in obsessive-compulsive disorder (OCD).
- Patients with hoarding symptoms often exhibit more severe OCD and poorer treatment response.
- Understanding hoarding within OCD is crucial for effective clinical management.
Purpose of the Study:
- To investigate the prevalence and characteristics of hoarding symptoms in a cohort of OCD patients.
- To compare clinical features and co-occurring conditions between OCD patients with and without hoarding symptoms.
- To explore the familial transmission patterns of hoarding in OCD.
Main Methods:
- A cross-sectional study involving 126 subjects diagnosed with OCD.
- Assessment of hoarding symptoms using standardized diagnostic criteria.
- Comparison of demographic, clinical, and familial data between hoarding and non-hoarding groups.
Main Results:
- Nearly 30% of OCD subjects presented with hoarding symptoms, with a 2:1 male-to-female ratio.
- Hoarding was associated with earlier age at onset, increased OCD symptom severity, and specific symptom subtypes (symmetry obsessions, counting/ordering compulsions).
- Hoarders showed higher rates of social phobia, personality disorders, pathological grooming, and a family history of hoarding and tics.
Conclusions:
- Hoarding symptoms in OCD may indicate a distinct clinical subgroup with more severe illness and comorbid conditions.
- The presence of hoarding complicates OCD treatment due to increased symptom severity and co-occurring disorders.
- Hoarding appears to have a familial component in some OCD-affected families, suggesting potential genetic or shared environmental influences.
Abstract:
Hoarding occurs relatively frequently in obsessive-compulsive disorder (OCD), and there is evidence that patients with hoarding symptoms have more severe OCD and are less responsive to treatment. In the present study, we investigated hoarding symptoms in 126 subjects with OCD. Nearly 30% of the subjects had hoarding symptoms; hoarding was twice as prevalent in males than females. Compared to the 90 non-hoarding subjects, the 36 hoarding individuals had an earlier age at onset of, and more severe, obsessive-compulsive symptoms. Hoarders had greater prevalences of symmetry obsessions, counting compulsions, and ordering compulsions. Hoarders also had greater prevalences of social phobia, personality disorders, and pathological grooming behaviors (skin picking, nail biting, and trichotillomania). Hoarding and tics were more frequent in first-degree relatives of hoarding than non-hoarding probands. The findings suggest that the treatment of OCD patients with hoarding symptoms may be complicated by more severe OCD and the presence of co-occurring disorders. Hoarding appears to be transmitted in some OCD families and may differentiate a clinical subgroup of OCD.