Hoarding Disorder Data Suggest It's Not OCD Subtype

Is compulsive hoarding a component of obsessive-compulsive disorder (OCD) or something else entirely? That's one of the questions being considered by DSM-5 Task Force members as they move toward publication of the manual's next edition in May 2013.

The DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group conducted a focused review of the literature on compulsive hoarding (published in the June 2010 Depression and Anxiety) and recommended the classification of hoarding disorder (HD) as a separate entity, although the group is still examining the evidence as to whether inclusion is merited in the main manual or in the "Appendix for Further Research." Their publication includes working diagnostic criteria for compulsive hoarding and mentions several clinician and self-administered measures that have been developed to reflect these criteria and are widely used in the field. They include the Saving Inventory-Revised, the Hoarding Rating Scale, and the UCLA Hoarding Severity Scale.

Randy Frost, Ph.D., a professor of psychology at Smith College in Northampton, Mass., and colleagues have recently characterized HD by examining comorbidities associated with the disorder, making HD appear even less as simply a subtype of OCD or even of obsessive-compulsive personality disorder.

Frost and colleagues recruited participants with "a large amount of clutter, trouble using rooms in the home, or difficulty throwing things away" from health and mental health clinic settings, newspaper and information Web sites, and investigator media appearances. They then evaluated psychiatric comorbidity in a sample of 217 people who met the diagnostic criteria for HD outlined by the work group and compared that cohort with data for 96 participants meeting criteria for OCD without HD.

Relatively few HD-diagnosed participants were diagnosed with OCD. Other disorders, including major depressive disorder (MDD), generalized anxiety disorder, and social phobia were more frequent among HD subjects than were OCD cases. MDD was the most frequent comorbid condition among HD patients, with more than half the sample receiving that diagnosis. Inattentive attention-deficit/hyperactivity disorder was significantly more frequent in HD than in OCD, evident in nearly 30 percent of HD participants.