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Hoarding Symptoms in Obsessive-Compulsive Disorder Signify a Distinctive Subtype: Presented at APA

By Paula Moyer

SAN FRANCISCO, CA -- May 26, 2003 -- When patients with obsessive-compulsive disorder (OCD) have hoarding symptoms, they also differ from other OCD patients in several ways.

"It's important to determine whether an OCD patient is also a hoarder, because if so, their disorder may be more resistant to treatment than OCD without hoarding symptoms," said Leonardo F. Fontenelle, MD, a clinical instructor at the Anxiety and Depression Research Program, Institute of Psychiatry, at Federal University of Rio de Janeiro, in Brazil.

Dr. Fontenelle presented these findings here May 22^nd at the 2003 Annual Meeting of the American Psychiatric Association. He noted that hoarders tend to have a higher educational level and higher socioeconomic status than their nonhoarding counterparts.

Because hoarders have little insight regarding their behavior, he suggested that clinicians ask questions such as, "Do you have so much clutter that it impairs your function?" Also, he suggested that family members be asked about the extent of the patient's clutter, since they may have been affected adversely by the hoarding.

It is important to know whether an OCD patient is a hoarder so that the clinician can plan the treatment realistically, he said. In this study, hoarded items ranged from newspapers and books to inherited family items to fingernail clippings.

He and his colleagues assessed 96 patients with OCD with several evaluation instruments. These included a sociodemographic questionnaire, the Structured Clinical Interview for Diagnostic and Statistical Manual IV Axis I Disorders, Patient Edition (SCID-I/P); the Yale-Brown Obsessive Compulsive Rating Scale (Y-BOCS); the Beck Depression Inventory; the Hamilton Rating Scale for Depression; and the Global Assessment of Functioning.

The investigators then compared patients who reported hoarding symptoms in the Y-BOCS checklist with patients who lacked those symptoms. They made statistical analyses using the Mann-Whitney U test for continuous variables and the Pearson's goodness of fit chi-square test for categorical variables. They also used Fisher's exact test when it was appropriate.

Among these patients, 14.9% of the total sample were classified as hoarders, they had higher education levels (chi=7.49; degrees of freedom [df]=2; P=0.02), and an earlier age at onset (Z=-2.9; P=0.004).

Dr. Fontenelle pointed out that the hoarders had a pattern of predominant obsessive thoughts that differed from that of the nonhoarders. Hoarders had significantly higher rates of obsessions with symmetry and ordering, as well as compulsions that were more likely to involve repetition rituals (P=0.01 for all). Hoarders were also more likely to have had previous major depressive episodes (chi=7.80; df=1; P=0.005).

Future research may elucidate why these features are more associated with hoarding than with nonhoarding, Dr. Fontenelle said. One speculation regarding the educational difference is that hoarders may be more likely to read, because many hoarded items included newspapers and books, and that hoarding of those items may facilitate academic performance.

The socioeconomic relationship may be due to the fact that many hoarded items must be purchased, he said.


[Study title: Patients With OCD And Hoarding Symptoms: A Distinctive Subtype? Abstract NR794]

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