Prevalence and correlates of hoarding behavior in a community-based sample
Introduction
Hoarding behavior has been called ‘pathological collecting’ and is characterized by the acquisition of, and unwillingness or inability to discard, large quantities of seemingly useless objects (Frost & Gross, 1993; Greenberg, Witzum, & Levy, 1990). The behavior can lead to significantly cluttered living space in the home and can cause considerable distress and impairment in functioning for individuals and their family members (Tolin, Frost, Steketee, & Fitch, 2008). The clutter may interfere with the normal use of space for basic household activities and increase the risk of injuries due to fire and falling, and illnesses due to poor sanitation (Frost, Steketee, & Williams, 2000; Steketee, Frost, & Kim, 2001).
To date, hoarding behavior has been studied primarily in samples of individuals who were not selected from the community, such as respondents to advertisements for hoarding research studies, participants in hoarding self-help groups, individuals referred to clinics specializing in the treatment of obsessive–compulsive disorder, and individuals participating in family studies of obsessive–compulsive disorder. Results from these studies suggest that individuals with hoarding behavior have more symptoms of anxiety and depression, a greater prevalence of anxiety disorders, especially generalized anxiety disorder and social phobia, and poorer functioning (Frost, Steketee, Williams, & Warren 2000; Samuels, Bienvenu et al., 2002; Samuels, Eaton et al., 2002). Moreover, individuals with hoarding behavior are more likely to exhibit obsessive–compulsive, dependent, avoidant, and schizotypal personality traits (Samuels, Bienvenu, et al., 2007; Samuels, Shugart, et al.,2007).
However, little is known about the prevalence, and sociodemographic and clinical correlates, of hoarding behavior in community samples. Given that compulsive hoarding occurs in approximately 30% of individuals with obsessive–compulsive disorder (OCD) in clinical and family samples (Rasmussen & Eisen, 1992; Samuels, Bienvenu et al., 2002; Samuels, Eaton et al., 2002), and that the population prevalence of OCD is estimated to be about 1–2% (Karno, Golding, Sorenson, & Burnam, 1988), based on population-based surveys, the population prevalence of compulsive hoarding behavior has been estimated to be approximately 0.4%; however, since hoarding behavior can occur in individuals without OCD, this may be an underestimate (Steketee & Frost, 2003). Furthermore, knowledge about the demographic and clinical characteristics of individuals with hoarding behavior is restricted to these particular samples of individuals, who may not reflect the wider range of hoarding behavior in the community.
A biological basis for the development of hoarding behavior has been suggested from case reports of hoarding emerging after traumatic brain lesions (Anderson, Damasio, & Damasio, 2005), and from functional imaging studies identifying differential activation of specific brain regions in OCD patients with and without hoarding behavior (Saxena et al., 2004). A genetic etiology for hoarding behavior is supported by the occurrence of hoarding behavior in known genetic syndromes (e.g., Prader-Willi syndrome and velocardiofacial syndrome) (Dykens & Shah, 2003; Gothelf et al., 2004), aggregation of hoarding behavior in OCD families (Samuels, Bienvenu, et al., 2007), and genetic linkage of hoarding behavior to specific chromosomal regions in families with OCD (Samuels, Shugart, et al., 2007). However, in most cases, precipitating factors for the development of hoarding behavior have not been identified.
Although early material deprivation has been hypothesized as a risk factor for hoarding behavior (Steketee & Frost, 2007), this was not supported by the only study to evaluate it empirically (Frost & Gross, 1993). More recently, two studies found that traumatic life events are associated with hoarding behavior. Hartl, Duggany, Allen, Steketee, and Frost (2005) found that, compared with controls, participants with hoarding reported having experienced greater frequency and greater number of different types of traumatic events, especially having had something taken by force, being physically handled roughly in childhood or adulthood, and being forced to engage in sexual activity in childhood or adulthood. Cromer, Schmidt, and Murphy (2007) reported that, in patients admitted to an adult OCD clinic, those with hoarding reported significantly more traumatic life events, and that the number of traumatic events experienced was significantly related to hoarding severity, even when controlling for current age, age at onset of OCD, and symptoms of depression and anxiety.
Little is known about gender-specific differences between individuals with and without hoarding behavior. Wheaton, Cromer, LaSalle-Ricci, and Murphy (2008) reported that, among female patients in an OCD clinic, those with hoarding behavior had earlier age at onset of OCD, greater severity of OCD symptoms, and greater prevalence of bipolar disorder, panic disorder, binge-eating disorder, and alcohol and substance use disorders; in contrast, among men, the only difference was a greater prevalence of social phobia in those who hoard. To our knowledge, no studies have evaluated correlates of hoarding behavior separately in men and women in a community sample.
In the current study, we investigated hoarding behavior in a community sample of adults who participated in an epidemiologic study of personality and personality disorders. The aims of the study were: (1) to estimate the prevalence of hoarding, overall and by sociodemographic characteristics, in this community sample; (2) to investigate the association between hoarding behavior and potential clinical correlates (personality disorder and personality dimensions; history of psychiatric disorders; and current functioning); (3) to investigate the association between hoarding behavior and specific self-reported childhood adversities, including parental psychopathology and specific childhood traumas; and (4) to determine if the relationships between hoarding and specific correlates are different in men and women.
Section snippets
Participants
As described previously (Samuels, Bienvenu et al., 2002; Samuels, Eaton et al., 2002), participants in the Hopkins Epidemiology of Personality Disorder Study were sampled from the Baltimore Epidemiologic Catchment Area (ECA) Follow-up survey (Eaton et al., 1997). In brief, 3481 adult household residents of east Baltimore were sampled probabilistically and were interviewed in 1981–1982, using the Diagnostic Interview Schedule (DIS); 810 of these individuals also were examined by psychiatrists as
Prevalence and description of hoarding behavior
Of 735 participants with information on the hoarding trait, 27 (3.7%) were rated as having ‘pathological’ hoarding. The weighted prevalence of hoarding was 5.3%.
The individuals with hoarding described substantial difficulties due to this behavior. For example, one participant, a 49-year-old man, said that “My room is like a bomb hit it. I’ve got books and papers, stuff in the corner there. I don’t want to throw nothing away. Old suits in my closet, I know I’ll never wear again in my life. Old
Strengths and limitations
Strengths of the current study include its investigation of hoarding in a community sample; assessment of personality disorder features and specific childhood adversities by psychologists; and evaluation of Axis I disorders, social functioning, and psychosocial stressors by psychiatrists.
However, several potential limitations of the study must be acknowledged. First, whereas the 1981 ECA study involved a probabilistic sample of household residents of the eastern Baltimore community, the sample
Implications
This study provides evidence that hoarding behavior is more prevalent in the community than previously thought. The prevalence is greater in older individuals, and those with limited household income, and these demographic characteristics should be considered in focusing community interventions. Clinicians and social welfare professionals also should be aware that alcohol dependence and paranoid, avoidant, and obsessive–compulsive personality disorder features may complicate the treatment of,
Acknowledgments
This research was supported by National Institute of Mental Health Grants R01- MH47447, R01-MH50616, and K23-MH64543. The authors thank the many individuals participating in the study; Ms. Gail Bendit, Ms. Stacie Johnson, Ms. Carolyn Newcomb, and Ms. Valerie Wadja-Johnson for conducting personality assessments; Dr. Leigh Ellison, Dr. David Gotlib, and Dr. William Howard for conducting clinical evaluations; Dr. Armand Loranger and Dr. Alan Romanoski for consultation on the study; and Ms.
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