Distinguishing variability in hoarding symptom course across time

Area of Science:

• Psychiatry
• Clinical Psychology
• Longitudinal Studies

Background:

• Hoarding disorder (HD) is often viewed as chronic and progressive.
• Little is known about the longitudinal course and factors influencing HD symptom progression, maintenance, or remission.
• This is the first prospective study examining hoarding symptom trajectories in a large adult sample.

Purpose of the Study:

• To identify and characterize patterns of hoarding symptom chronicity.
• To investigate the longitudinal course of hoarding symptoms over 5 years.
• To explore demographic and clinical factors associated with different symptom trajectories.

Main Methods:

• 1,275 adults with clinically significant hoarding symptoms were recruited from the internet-based Brain Health Registry.
• Online self-report measures of hoarding symptom severity were collected at 6-month intervals for 5 years.
• Latent class mixed modeling (LCMM) identified symptom trajectories, which were compared to theory-driven models.

Main Results:

• Three distinct trajectories emerged: persistent severe (15.9%), persistent mild/subclinical (74.9%), and rapidly improving (9.2%).
• The "improving" group showed sustained remission within 18 months, characterized by later onset and higher PTSD prevalence.
• Heterogeneity was observed within "mild" and "severe" groups; childhood-onset hoarding with ADHD predicted worsening symptoms in the "severe" class.

Conclusions:

• Individuals with hoarding disorder exhibit significant variability in their longitudinal symptom course.
• A distinct subgroup experiences rapid improvement, with unique clinical and demographic profiles.
• Findings emphasize monitoring intraindividual change and may inform early intervention strategies for hoarding disorder.