Classification of hoarding and comorbid neuropsychiatric symptoms

Psychiatric comorbidity and self-reported cognitive dysfunction are common among individuals with hoarding disorder (HD). However, common patterns of co-occurring neuropsychiatric symptoms, and their potential impact on the clinical manifestation of hoarding, including functional impairment, are not well-established.

Latent class analysis (LCA) was used to identify and characterize distinct neuropsychiatric symptom subgroups among 7606 adult internet-based research participants who reported experiencing social impairment due to household clutter. An additional 1129 participants who screened negative but had evidence of hoarding on additional assessment ("false negative") were identified and compared to the LCA-identified classes. Demographic and clinical characteristics associated with class membership were assessed.

The best fitting model yielded five subgroups, including three subgroups characterizing individuals with hoarding symptoms: "hoarding only" (12.1 %), hoarding with depressive symptoms ("depressed + hoarding"; 11.8 %), and hoarding with depressive symptoms, inattention, and subjective memory decline ("multisymptomatic"; 14.6 %). These subgroups fell along a continuum of increasing neuropsychiatric burden, with individuals in the "multisymptomatic" class experiencing the greatest deficits to general functional ability and cognitive functioning, as well as elevated rates of comorbid neuropsychiatric diagnoses. The "false negative" group was similar to the "hoarding only" class, although comprised of a significantly higher proportion of male participants and married individuals.

Neuropsychiatric symptom patterns among individuals with hoarding are heterogenous in nature and uniquely associated with clinical features and functional outcomes. These findings may inform the development of targeted interventions for HD that include assessment and management of depressive symptoms, inattention, and memory.