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Catherine R Ayers - One of the best experts on this subject based on the ideXlab platform.
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a description of 17 animal Hoarding case files from animal control and a humane society
Psychiatry Research-neuroimaging, 2019Co-Authors: Mary E Dozier, Christiana Bratiotis, Dominique V Broadnax, Catherine R AyersAbstract:Abstract This study describes 17 publicly available cases of animal Hoarding, a special manifestation of Hoarding disorder. The cases, which included court documents, animal service documents, photographs, and newspaper clippings, were reviewed by Masters-level clinicians and a veterinarian in private practice. The veterinarian rated the animals in the case files for possible neglect. Over half of the homes had signs of object Hoarding. The most commonly hoarded animals were cats, dogs, and rabbits. The majority of animals in the cases reviewed required veterinary care. Individuals with animal Hoarding often lack insight about the condition of their animals and require community intervention.
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group cognitive rehabilitation and exposure sorting therapy a pilot program
Cognitive Therapy and Research, 2018Co-Authors: Catherine R Ayers, Mary E Dozier, Charles T Taylor, Tina L Mayes, James O E Pittman, Elizabeth W TwamleyAbstract:While cognitive-behavioral therapy for Hoarding disorder (HD) has resulted in significant reductions in symptoms, most individuals continue to have significant Hoarding symptoms following treatment. This investigation sought to extend the literature on the behavioral treatments for Hoarding by examining (1) group cognitive rehabilitation and exposure/sorting therapy (CREST) and (2) group exposure therapy (ET) for Hoarding. Participants in both studies reported significant decreases in Hoarding symptom severity from baseline to post-treatment on all primary outcome measures using mixed-effects linear regression models with the intent to treat sample. Participants who received group CREST reported statistically significant reductions in anxiety, depression, and overall severity at post-treatment, while participants who received group ET did not. Results provide preliminary evidence for both group CREST and group ET as effective treatments for Hoarding disorder.
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Hoarding severity predicts disability in late life Hoarding disorder patients
Hawai'i journal of medicine & public health, 2014Co-Authors: Princeton Ly, Catherine R Ayers, Taryn L Mayes, Ben Porter, Ian Howard, Yasmeen IqbalAbstract:Objective: Late-life Hoarding is a serious psychiatric condition with significant implications in health and functioning. Geriatric Hoarding patients show greater impairment in activities of daily living and have a greater number of medical conditions compared to same-aged non-hoarders. This study examined the relationship between geriatric Hoarding severity and disability severity.
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Hoarding severity predicts functional disability in late life Hoarding disorder patients
International Journal of Geriatric Psychiatry, 2014Co-Authors: Catherine R Ayers, Princeton Ly, Taryn L Mayes, Ben Porter, Ian Howard, Yasmeen IqbalAbstract:Objective Late-life Hoarding is a serious psychiatric condition with significant implications in health and functioning. Geriatric Hoarding patients show greater impairment in activities of daily living and have a greater number of medical conditions compared with same-aged nonhoarders. This study examined the relationship between geriatric Hoarding severity and functional disability severity. Methods Sixty-five subjects age 60 or older with Hoarding disorder (HD) participated in the current study. Participants were assessed with measures of Hoarding severity, psychiatric symptoms, and general disability. Hierarchical regression was used to test the unique association of Hoarding symptoms with functional disability beyond the effects of demographic factors, anxiety, and depression. Results When controlling for demographics (age and gender) and psychiatric symptoms (anxiety and depression), Hoarding severity predicts functional disability severity. Analyses also show that clinician-administered measures of Hoarding are stronger predictors of disability than patient self-report measures. Conclusions When treating older adults with HD, clinicians must consider symptom impact on daily life. A multidisciplinary team must be utilized to address the wide-ranging consequences of Hoarding symptoms. Future work should examine how psychiatric treatment of HD affects functional disability. Copyright © 2013 John Wiley & Sons, Ltd.
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novel treatment for geriatric Hoarding disorder an open trial of cognitive rehabilitation paired with behavior therapy
American Journal of Geriatric Psychiatry, 2014Co-Authors: Catherine R Ayers, Sanjaya Saxena, Emmanuel P Espejo, Elizabeth W Twamley, Eric Granholm, Julie Loebach WetherellAbstract:Objectives To investigate the feasibility of an age-adapted, manualized behavioral treatment for geriatric Hoarding. Methods Participants were 11 older adults (mean age: 66 years) with Hoarding disorder. Treatment encompassed 24 individual sessions of psychotherapy that included both cognitive rehabilitation targeting executive functioning and exposure to discarding/not acquiring. Hoarding severity was assessed at baseline, mid-treatment, and posttreatment. Results Results demonstrated clinically and statistically significant changes in Hoarding severity at posttreatment. No participants dropped out of treatment. Eight participants were classified as treatment responders, and three as partial responders. Partial responders reported severe/extreme Hoarding and psychiatric comorbidities at baseline. Conclusions The combination of cognitive rehabilitation and exposure therapy is a promising approach in the treatment of geriatric Hoarding. Targeting neurocognitive deficits in behavioral therapy for these geriatric patients with Hoarding disorder doubled response rates relative to our previous trial of cognitive behavior therapy alone.
Gail Steketee - One of the best experts on this subject based on the ideXlab platform.
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Hoarding and emotional reactivity the link between negative emotional reactions and Hoarding symptomatology
Journal of Psychiatric Research, 2015Co-Authors: Ashley M Shaw, Kiara R Timpano, Gail Steketee, David F Tolin, Randy O FrostAbstract:Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD's etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater Hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious Hoarding difficulties to examine how Hoarding symptoms related to both general and Hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified Hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess Hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict Hoarding symptoms. These findings provide support for cognitive-behavioral models of Hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for Hoarding.
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assessing squalor in Hoarding the home environment index
Community Mental Health Journal, 2014Co-Authors: Jessica Rasmussen, Randy O Frost, Gail Steketee, David F Tolin, Timothy A BrownAbstract:The current study examined a new measure of squalor associated with Hoarding, the Home Environment Index (HEI). Participants (N = 793) were recruited from a large database of individuals who sought information about Hoarding following national media appearances and consented to an internet study. Participants completed measures of Hoarding and related psychopathology, including the HEI. The HEI showed good internal consistency and construct validity and reflected a single factor of home squalor (15 items). The HEI correlated positively with measures of Hoarding and mood psychopathology. Recommendations for future modifications and further study are provided.
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a multitrait multimethod matrix investigation of Hoarding
Journal of Obsessive-Compulsive and Related Disorders, 2013Co-Authors: Joseph F Meyer, Randy O Frost, Timothy A Brown, Gail Steketee, David F TolinAbstract:Hoarding is a serious and potentially life-threatening mental health problem that, until recently, was considered a subtype of OCD. However, recent research suggests it is distinct and more prevalent than OCD. Three key defining features have emerged in factor analytic studies of Hoarding scales: excessive acquisition, difficulty discarding, and excessive clutter. Covariation among these defining features has received limited attention. The primary aim of the current study was to examine the role of the three key features in defining Hoarding disorder. Convergent and discriminant validity of the three Hoarding factors were examined in a multitrait-multimethod matrix. A secondary aim was to examine the extent to which each Hoarding feature distinguished individuals meeting criteria for Hoarding from those with OCD and community controls. Although the three-factor model provided an adequate fit for the data and convergent validities were high, the Hoarding factors evidenced poor discriminant validity across measures. The findings provide preliminary support for a more parsimonious merging of the clutter, acquisition, and discarding subscales versus parsing out subscale scores. Specifically, the active acquisition of items, buildup of clutter, and difficulty discarding accumulated possessions co-occurred strongly enough to be considered a unidimensional construct. Thus, these symptoms were less attributable to separate phenomena and better conceived as part of a cohesive Hoarding phenotype. Each of the three factors discriminated Hoarding participants from OCD patients and community controls, but did not discriminate the latter two groups. The findings have implications for treating acquisition as a specifier in DSM-5.
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activities of daily living scale in Hoarding disorder
Journal of Obsessive-Compulsive and Related Disorders, 2013Co-Authors: Randy O Frost, Gail Steketee, Veselina Hristova, David F TolinAbstract:Abstract Research on Hoarding over the last two decades has shown that Hoarding disorder appears to be a distinct disorder that burdens the individual, the community and the families of people who hoard. Although Hoarding clearly interferes with the daily functioning, especially in the context of extensive clutter, no validated measures of this interference have been developed. The present research examined the psychometric properties of the Activities of Daily Living in Hoarding scale (ADL-H) in two large samples of individuals with significant Hoarding problems, one identified through the internet (n=363) and a second through clinical diagnostic interviews (n=202). The ADL-H scale test–retest (1–12 weeks), interrater and internal reliabilities ranged from .79 to .96. Convergent and discriminant validity were established through analyses of correlational data collected for measures of Hoarding severity and non-Hoarding psychopathology (obsessive–compulsive disorder [OCD], moodstate, attention deficit, and perfectionism/uncertainty), as well as through comparisons of scores among individuals with Hoarding, Hoarding plus OCD, OCD without Hoarding, and community controls. The ADL-H scale appears to have strong psychometric properties and to be useful in clinical and research settings. Suggestions are made for expansion of the scale, and study limitations are noted.
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group cognitive and behavioral therapy and bibliotherapy for Hoarding a pilot trial
Depression and Anxiety, 2012Co-Authors: Jordana Muroff, Gail Steketee, Christiana Bratiotis, Abigail M RossAbstract:Background Group cognitive behavioral treatments (GCBTs) for Hoarding have produced modest benefits. The current study examined whether the outcomes of a specialized GCBT improve upon bibliotherapy (BIB) for Hoarding, as part of a stepped care model. We also explored whether additional home assistance enhanced GCBT outcomes. Methods Hoarding patients (n = 38) were randomized and completed one of three conditions: (1) GCBT with nonclinician home assistants (GCBT+HA; N = 11), (2) GCBT without HA (CGBT; N = 14), and (3) BIB (N = 13). All GCBT participants received 20 weekly group sessions and four home visits by a group co-therapist. GCBT+HA groups received four additional visits by a nonclinician coach. BIB participants were assigned a self-help book describing specific skills to reduce Hoarding over the 20-week period. All participants were assessed by self-report at baseline, mid-treatment, and posttreatment. The sample averaged 57 years old and was mainly female, White, highly educated, employed, and living alone. Results GCBT+HA and GCBT participants showed significant reductions on Hoarding and depression symptoms, whereas BIB did not. GCBT+HA and GCBT benefited substantially and similarly on the saving inventory-revised (reductions of 29.9 and 23.3%, respectively) and SI-R (Saving Inventory-Revised) (reductions of 26.5 and 25.4%), whereas BIB participants showed very limited improvement (9% reduction) on both measures. Conclusion This study provides support for the efficacy of GCBT for Hoarding. The effect of adding nonclinician home assistance was not significant in this small sample. BIB was not sufficient to improve Hoarding symptoms. The findings have implications for a stepped care model for treating Hoarding (e.g., the benefits of psycho-education via BIB, added benefits of extra in-home visits) and suggest the need to further examine the role of in-home Hoarding coaches.
Randy O Frost - One of the best experts on this subject based on the ideXlab platform.
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Hoarding and emotional reactivity the link between negative emotional reactions and Hoarding symptomatology
Journal of Psychiatric Research, 2015Co-Authors: Ashley M Shaw, Kiara R Timpano, Gail Steketee, David F Tolin, Randy O FrostAbstract:Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD's etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater Hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious Hoarding difficulties to examine how Hoarding symptoms related to both general and Hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified Hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess Hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict Hoarding symptoms. These findings provide support for cognitive-behavioral models of Hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for Hoarding.
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assessing squalor in Hoarding the home environment index
Community Mental Health Journal, 2014Co-Authors: Jessica Rasmussen, Randy O Frost, Gail Steketee, David F Tolin, Timothy A BrownAbstract:The current study examined a new measure of squalor associated with Hoarding, the Home Environment Index (HEI). Participants (N = 793) were recruited from a large database of individuals who sought information about Hoarding following national media appearances and consented to an internet study. Participants completed measures of Hoarding and related psychopathology, including the HEI. The HEI showed good internal consistency and construct validity and reflected a single factor of home squalor (15 items). The HEI correlated positively with measures of Hoarding and mood psychopathology. Recommendations for future modifications and further study are provided.
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a multitrait multimethod matrix investigation of Hoarding
Journal of Obsessive-Compulsive and Related Disorders, 2013Co-Authors: Joseph F Meyer, Randy O Frost, Timothy A Brown, Gail Steketee, David F TolinAbstract:Hoarding is a serious and potentially life-threatening mental health problem that, until recently, was considered a subtype of OCD. However, recent research suggests it is distinct and more prevalent than OCD. Three key defining features have emerged in factor analytic studies of Hoarding scales: excessive acquisition, difficulty discarding, and excessive clutter. Covariation among these defining features has received limited attention. The primary aim of the current study was to examine the role of the three key features in defining Hoarding disorder. Convergent and discriminant validity of the three Hoarding factors were examined in a multitrait-multimethod matrix. A secondary aim was to examine the extent to which each Hoarding feature distinguished individuals meeting criteria for Hoarding from those with OCD and community controls. Although the three-factor model provided an adequate fit for the data and convergent validities were high, the Hoarding factors evidenced poor discriminant validity across measures. The findings provide preliminary support for a more parsimonious merging of the clutter, acquisition, and discarding subscales versus parsing out subscale scores. Specifically, the active acquisition of items, buildup of clutter, and difficulty discarding accumulated possessions co-occurred strongly enough to be considered a unidimensional construct. Thus, these symptoms were less attributable to separate phenomena and better conceived as part of a cohesive Hoarding phenotype. Each of the three factors discriminated Hoarding participants from OCD patients and community controls, but did not discriminate the latter two groups. The findings have implications for treating acquisition as a specifier in DSM-5.
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activities of daily living scale in Hoarding disorder
Journal of Obsessive-Compulsive and Related Disorders, 2013Co-Authors: Randy O Frost, Gail Steketee, Veselina Hristova, David F TolinAbstract:Abstract Research on Hoarding over the last two decades has shown that Hoarding disorder appears to be a distinct disorder that burdens the individual, the community and the families of people who hoard. Although Hoarding clearly interferes with the daily functioning, especially in the context of extensive clutter, no validated measures of this interference have been developed. The present research examined the psychometric properties of the Activities of Daily Living in Hoarding scale (ADL-H) in two large samples of individuals with significant Hoarding problems, one identified through the internet (n=363) and a second through clinical diagnostic interviews (n=202). The ADL-H scale test–retest (1–12 weeks), interrater and internal reliabilities ranged from .79 to .96. Convergent and discriminant validity were established through analyses of correlational data collected for measures of Hoarding severity and non-Hoarding psychopathology (obsessive–compulsive disorder [OCD], moodstate, attention deficit, and perfectionism/uncertainty), as well as through comparisons of scores among individuals with Hoarding, Hoarding plus OCD, OCD without Hoarding, and community controls. The ADL-H scale appears to have strong psychometric properties and to be useful in clinical and research settings. Suggestions are made for expansion of the scale, and study limitations are noted.
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Hoarding among patients seeking treatment for anxiety disorders
Journal of Anxiety Disorders, 2011Co-Authors: Randy O Frost, David F Tolin, Suzanne A Meunier, Gail SteketeeAbstract:The aim of the present study was to examine the prevalence of Hoarding symptoms among individuals presenting for treatment of anxiety symptoms. Participants included 130 adults who were seeking treatment at an outpatient anxiety disorders clinic between January 2004 and February 2006. During their initial assessment, participants (31 with panic disorder, 15 specific phobia, 27 social phobia, 36 obsessive-compulsive disorder, 21 generalized anxiety disorder, mean age 37 years, 57% female, 88% White) completed the Saving Inventory-Revised, a self-report measure of Hoarding symptoms, and several measures of anxiety symptoms, depressive symptoms, and functional impairment. Approximately 12-25% of anxious patients reported significant Hoarding symptoms. Patients diagnosed with generalized anxiety disorder and obsessive-compulsive disorder were more likely to report significant Hoarding symptoms than were those with panic disorder or specific phobia. Hoarding symptoms were positively correlated with trait anxiety, depressive symptoms, and functional impairment. These findings suggest that Hoarding symptoms may be associated with anxiety disorders other than obsessive-compulsive disorder. The findings further suggest that Hoarding symptoms may be underreported by anxious populations since typical intake assessments do not include specific questions about Hoarding and individuals with Hoarding symptoms may be unlikely to spontaneously report them.
David F Tolin - One of the best experts on this subject based on the ideXlab platform.
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unbending mind individuals with Hoarding disorder do not modify decision strategy in response to feedback under risk
Psychiatry Research-neuroimaging, 2018Co-Authors: Helen Pushkarskaya, David F Tolin, Daniel Henick, Ifat Levy, Christopher PittengerAbstract:Cognitive-behavioral models of Hoarding disorder emphasize impairments in information processing and decision making in the genesis of Hoarding symptomology. We propose and test the novel hypothesis that individuals with Hoarding are maladaptively biased towards a deliberative decision style. While deliberative strategies are often considered normative, they are not always adaptable to the limitations imposed by many real-world decision contexts. We examined decision-making patterns in 19 individuals with Hoarding and 19 healthy controls, using a behavioral task that quantifies selection of decision strategies in a novel environment with known probabilities (risk) in response to feedback. Consistent with prior literature, we found that healthy individuals tend to explore different decision strategies in the beginning of the experiment, but later, in response to feedback, they shift towards a compound strategy that balances expected values and risks. In contrast, individuals with Hoarding follow a simple, deliberative, risk-neutral, value-based strategy from the beginning to the end of the task, irrespective of the feedback. This seemingly rational approach was not ecologically rational: individuals with Hoarding and healthy individuals earned about the same amount of money, but it took individuals with Hoarding a lot longer to do it: additional cognitive costs did not lead to additional benefits.
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Hoarding and emotional reactivity the link between negative emotional reactions and Hoarding symptomatology
Journal of Psychiatric Research, 2015Co-Authors: Ashley M Shaw, Kiara R Timpano, Gail Steketee, David F Tolin, Randy O FrostAbstract:Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD's etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater Hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious Hoarding difficulties to examine how Hoarding symptoms related to both general and Hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified Hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess Hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict Hoarding symptoms. These findings provide support for cognitive-behavioral models of Hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for Hoarding.
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assessing squalor in Hoarding the home environment index
Community Mental Health Journal, 2014Co-Authors: Jessica Rasmussen, Randy O Frost, Gail Steketee, David F Tolin, Timothy A BrownAbstract:The current study examined a new measure of squalor associated with Hoarding, the Home Environment Index (HEI). Participants (N = 793) were recruited from a large database of individuals who sought information about Hoarding following national media appearances and consented to an internet study. Participants completed measures of Hoarding and related psychopathology, including the HEI. The HEI showed good internal consistency and construct validity and reflected a single factor of home squalor (15 items). The HEI correlated positively with measures of Hoarding and mood psychopathology. Recommendations for future modifications and further study are provided.
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a multitrait multimethod matrix investigation of Hoarding
Journal of Obsessive-Compulsive and Related Disorders, 2013Co-Authors: Joseph F Meyer, Randy O Frost, Timothy A Brown, Gail Steketee, David F TolinAbstract:Hoarding is a serious and potentially life-threatening mental health problem that, until recently, was considered a subtype of OCD. However, recent research suggests it is distinct and more prevalent than OCD. Three key defining features have emerged in factor analytic studies of Hoarding scales: excessive acquisition, difficulty discarding, and excessive clutter. Covariation among these defining features has received limited attention. The primary aim of the current study was to examine the role of the three key features in defining Hoarding disorder. Convergent and discriminant validity of the three Hoarding factors were examined in a multitrait-multimethod matrix. A secondary aim was to examine the extent to which each Hoarding feature distinguished individuals meeting criteria for Hoarding from those with OCD and community controls. Although the three-factor model provided an adequate fit for the data and convergent validities were high, the Hoarding factors evidenced poor discriminant validity across measures. The findings provide preliminary support for a more parsimonious merging of the clutter, acquisition, and discarding subscales versus parsing out subscale scores. Specifically, the active acquisition of items, buildup of clutter, and difficulty discarding accumulated possessions co-occurred strongly enough to be considered a unidimensional construct. Thus, these symptoms were less attributable to separate phenomena and better conceived as part of a cohesive Hoarding phenotype. Each of the three factors discriminated Hoarding participants from OCD patients and community controls, but did not discriminate the latter two groups. The findings have implications for treating acquisition as a specifier in DSM-5.
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activities of daily living scale in Hoarding disorder
Journal of Obsessive-Compulsive and Related Disorders, 2013Co-Authors: Randy O Frost, Gail Steketee, Veselina Hristova, David F TolinAbstract:Abstract Research on Hoarding over the last two decades has shown that Hoarding disorder appears to be a distinct disorder that burdens the individual, the community and the families of people who hoard. Although Hoarding clearly interferes with the daily functioning, especially in the context of extensive clutter, no validated measures of this interference have been developed. The present research examined the psychometric properties of the Activities of Daily Living in Hoarding scale (ADL-H) in two large samples of individuals with significant Hoarding problems, one identified through the internet (n=363) and a second through clinical diagnostic interviews (n=202). The ADL-H scale test–retest (1–12 weeks), interrater and internal reliabilities ranged from .79 to .96. Convergent and discriminant validity were established through analyses of correlational data collected for measures of Hoarding severity and non-Hoarding psychopathology (obsessive–compulsive disorder [OCD], moodstate, attention deficit, and perfectionism/uncertainty), as well as through comparisons of scores among individuals with Hoarding, Hoarding plus OCD, OCD without Hoarding, and community controls. The ADL-H scale appears to have strong psychometric properties and to be useful in clinical and research settings. Suggestions are made for expansion of the scale, and study limitations are noted.
Sanjaya Saxena - One of the best experts on this subject based on the ideXlab platform.
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novel treatment for geriatric Hoarding disorder an open trial of cognitive rehabilitation paired with behavior therapy
American Journal of Geriatric Psychiatry, 2014Co-Authors: Catherine R Ayers, Sanjaya Saxena, Emmanuel P Espejo, Elizabeth W Twamley, Eric Granholm, Julie Loebach WetherellAbstract:Objectives To investigate the feasibility of an age-adapted, manualized behavioral treatment for geriatric Hoarding. Methods Participants were 11 older adults (mean age: 66 years) with Hoarding disorder. Treatment encompassed 24 individual sessions of psychotherapy that included both cognitive rehabilitation targeting executive functioning and exposure to discarding/not acquiring. Hoarding severity was assessed at baseline, mid-treatment, and posttreatment. Results Results demonstrated clinically and statistically significant changes in Hoarding severity at posttreatment. No participants dropped out of treatment. Eight participants were classified as treatment responders, and three as partial responders. Partial responders reported severe/extreme Hoarding and psychiatric comorbidities at baseline. Conclusions The combination of cognitive rehabilitation and exposure therapy is a promising approach in the treatment of geriatric Hoarding. Targeting neurocognitive deficits in behavioral therapy for these geriatric patients with Hoarding disorder doubled response rates relative to our previous trial of cognitive behavior therapy alone.
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quality of life and functional impairment in compulsive Hoarding
Journal of Psychiatric Research, 2011Co-Authors: Sanjaya Saxena, Catherine R Ayers, Julie Loebach Wetherell, Karron M Maidment, Tanya Vapnik, Alexander BystritskyAbstract:Compulsive Hoarding patients have been found in previous studies to have substantial disability and functional impairment. However, no prior study has examined subjective and objective quality of life (QOL) in patients with compulsive Hoarding. This present study compared compulsive hoarders and non-Hoarding OCD patients across a variety of QOL domains. Subjects were 171 consecutive adult patients (34 compulsive hoarders, 137 non-Hoarding patients with DSM-IV OCD) treated openly between 1998 and 2004 in the UCLA OCD Partial Hospitalization Program (OCD PHP), a specialized, intensive, multi-modal treatment program for treatment-refractory patients. Scores on the Quality of Life Scale and other symptom severity measures on admission were compared between compulsive hoarders and non-Hoarding OCD patients. Compulsive hoarders were older and had lower global functioning than non-Hoarding OCD patients. Both groups had low overall QOL scores across multiple domains. Compulsive hoarders had significantly lower levels of satisfaction with their safety than non-Hoarding OCD patients, were more often the victims of both violent and non-violent crime, felt less safe in their neighborhoods, and felt less protected against attack. Compulsive hoarders were also much less satisfied with their living arrangements than non-Hoarding OCD patients. No differences were found on financial variables, but the vast majority of patients in both groups were unemployed. Compulsive hoarders have lower QOL than non-Hoarding OCD patients in the domains of safety and living situation. Psychosocial rehabilitation that focuses on problems with victimization, safety, employment, and financial areas may be a beneficial augmentation to treatment for compulsive Hoarding.
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Cognitive-behavioral therapy for geriatric compulsive Hoarding
Behaviour Research and Therapy, 2011Co-Authors: Catherine R Ayers, Shahrokh Golshan, Julie Loebach Wetherell, Sanjaya SaxenaAbstract:This investigation examined response to a manualized cognitive-behavioral therapy (CBT) protocol for compulsive Hoarding (Steketee & Frost, 2007) in a sample of 12 adults over age 65. All participants were cognitively intact, not engaging in any other psychotherapy, and had compulsive Hoarding as their primary problem. All received 26 sessions of individual CBT over the course of 17 weeks. The primary outcome measures were the Savings Inventory-Revised and UCLA Hoarding Severity Scale, which were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up. Other outcomes included Clinical Global Impression (CGI) scores, depression, anxiety, disability, and clutter image ratings. Results demonstrated statistically significant changes on Hoarding severity and depression. However, only three of the twelve participants were classified as treatment responders at post-treatment, and their gains were not maintained at 6-month follow-up. CGI, anxiety, disability, and clutter ratings were unchanged at post-treatment and follow-up. No participants dropped out, but homework compliance was variable and correlated with decreases in Hoarding severity. Findings suggest that older adults with compulsive Hoarding may require an enhanced or alternative treatment. © 2011.
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refining the diagnostic boundaries of compulsive Hoarding a critical review
Clinical Psychology Review, 2010Co-Authors: Alberto Pertusa, Sanjaya Saxena, Miquel A. Fullana, Randy O Frost, Gail Steketee, Jack Samuels, James F Leckman, David F Tolin, David MataixcolsAbstract:Abstract Like most human behaviors, saving and collecting possessions can range from totally normal and adaptive to excessive or pathological. Hoarding, or compulsive Hoarding, are some of the more commonly used terms to refer to this excessive form of collectionism. Hoarding is highly prevalent and, when severe, it is associated with substantial functional disability and represents a great burden for the sufferers, their families, and society in general. It is generally considered difficult to treat. Hoarding can occur in the context of a variety of neurological and psychiatric conditions. Although it has frequently been considered a symptom (or symptom dimension) of obsessive–compulsive disorder, and is listed as one of the diagnostic criteria for obsessive–compulsive personality disorder, its diagnostic boundaries are still a matter of debate. Recent data suggest that compulsive Hoarding can also be a standalone problem. Growing evidence from epidemiological, phenomenological, neurobiological, and treatment studies suggests that compulsive Hoarding may be best classified as a discrete disorder with its own diagnostic criteria.
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age at onset and clinical features of late life compulsive Hoarding
International Journal of Geriatric Psychiatry, 2010Co-Authors: Catherine R Ayers, Shahrokh Golshan, Sanjaya Saxena, Julie Loebach WetherellAbstract:Objectives Compulsive Hoarding is a debilitating, chronic disorder, yet we know little about its onset, clinical features, or course throughout the life span. Hoarding symptoms often come to clinical attention when patients are in late life, and case reports of elderly hoarders abound. Yet no prior study has examined whether elderly compulsive hoarders have early or late onset of Hoarding symptoms, whether their Hoarding symptoms are idiopathic or secondary to other conditions, or whether their symptoms are similar to compulsive Hoarding symptoms seen in younger and middle-aged populations. The objectives of this study were to determine the onset and illustrate the course and clinical features of late life compulsive Hoarding, including psychiatric and medical comorbitities. Methods Participants were 18 older adults (≥60) with clinically significant compulsive Hoarding. They were assessed using structured interviews, including the Mini International Neuropsychiatric Interview (MINI), Structured Clinical Interview for DSM-IV (SCID I), Yale–Brown Obsessive Compulsive Scale (YBOCS), and UCLA Hoarding Severity Scale (UHSS). Self-report Measures Included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Sheehan Disability Scale (SDS), and Savings Inventory-Revised (SI-R). Psychosocial and medical histories were also obtained. To determine age at onset, participants were asked to rate their Hoarding symptoms and describe major life events that occurred during each decade of their lives. Results Results show that (1) onset of compulsive Hoarding symptoms was initially reported as being in mid-life but actually found to be in childhood or adolescence. No subjects reported late onset compulsive Hoarding. (2) Compulsive Hoarding severity increased with each decade of life. (3) Comorbid mood and anxiety disorders were common, but only 16% of patients met criteria for OCD if Hoarding symptoms were not counted toward the diagnosis. (4) The vast majority of patients had never received treatment for Hoarding. (5) Older adults with compulsive Hoarding were usually socially impaired and living alone. Conclusions Compulsive Hoarding is a progressive and chronic condition that begins early in life. Left untreated, its severity increases with age. Compulsive Hoarding should be considered a distinct clinical syndrome, separate from OCD. Unfortunately, compulsive Hoarding is largely unrecognized and untreated in older adults. Copyright © 2009 John Wiley & Sons, Ltd.
