HOARDING DISORDER: HOLD YOUR HORSES! A NEURODIVERGENT AND SOCIALLY MEDIATED CONDITION REQUIRING RETHINK AND REFORM

Area of Science:

• Psychiatry
• Neuroscience
• Sociology

Background:

• Hoarding disorder (HD) is recognized as a distinct, multifactorial condition.
• Emerging research in neuroimaging, psychopathology, and social context challenges its traditional link to obsessive-compulsive disorder.

Purpose of the Study:

• To synthesize recent clinical, neurobiological, and sociocultural literature on hoarding disorder.
• To explore cognitive dysfunction, comorbidities, suicidality, stigma, and environmental factors in HD.

Main Methods:

• Narrative review of clinical, neurobiological, and sociocultural studies.
• Inclusion of latent class analysis and resting-state fMRI findings.
• Synthesis of data on cognitive function, comorbidities, suicidality, stigma, and social context.

Main Results:

• HD is associated with impaired executive functioning and high comorbidity with ADHD and compulsive buying-shopping disorder.
• Latent class analysis reveals complex, multisymptomatic HD presentations.
• High rates of suicidality, social exclusion, and stigma are noted, particularly in individuals hoarding purchased items.

Conclusions:

• Hoarding disorder should be viewed through a neurodivergent and socially mediated lens.
• Treatment and policy must address neurocognitive deficits, emotional regulation, social determinants, and stigma.
• Interdisciplinary, person-centered interventions are crucial for effective management of HD.