587235 research-article2015
APY0010.1177/1039856215587235Australasian PsychiatryV Brakoulias and D Milicevic
Australasian
Psychiatry
Anxiety
Assessment and treatment of hoarding disorder
Australasian Psychiatry 2015, Vol 23(4) 358–360 © The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856215587235 apy.sagepub.com
Vlasios Brakoulias Senior Lecturer, Psychiatry, Sydney Medical School, University of Sydney, and; Psychiatrist, Department of Psychiatry, Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia Denise Milicevic Senior Clinical Psychologist and Clinic Co-ordinator, Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Penrith NSW, Australia This paper was presented at the International Anxiety Disorders Society Conference which was held in Melbourne in November 2014.
Abstract Objectives: To provide a brief selective review of the current literature regarding Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Hoarding Disorder, with an emphasis on its associated risks, assessment and management approaches. Conclusions: Hoarding disorder is defined by clear diagnostic criteria. It can be a severe and disabling disorder that can pose significant safety risks to the individual and to others. Management is often challenging, due to the poor level of insight that people with hoarding disorder often have. Psychological approaches tend to adapt cognitivebehavioural approaches, in order to specifically target areas such as impaired decision-making and motivation. Several trials of pharmacological agents have been conducted, but the limitations of these studies call for further research. Keywords: diagnosis, hoarding disorder, obsessive-compulsive disorder, review, treatment
E
xcessive hoarding behaviour has been recognised since antiquity; however, the recent introduction of the diagnosis ‘hoarding disorder’ into the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)1 by the American Psychiatric Association (APA) has shed new light onto the disorder. DSM-5 defines hoarding as the persistent difficulty in discarding or parting with possessions, regardless of their actual value. The difficulty is due to a perceived need to save the items and to distress associated with discarding them. In order to meet criteria for the DSM-5 hoarding disorder, the subsequent accumulation of possessions needs to congest active living areas to the extent that their use is substantially compromised. The hoarding should also cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. For example, clutter is so prominent in the kitchen area that the person cannot cook. Hoarding disorder is thought to be present in 1.5% of the population, with this figure increasing in older adults.2 Males tend to be overrepresented in community samples and females tend to be overrepresented in clinical samples. The course of hoarding tends to be chronic and progressive, with symptoms starting in the teens and severity increasing with age.3
The assessment of hoarding Sufferers of hoarding disorder are unlikely to self-present for treatment, as > 50% are suspected of having poor or absent insight.3 More often, sufferers are coerced to seek help by concerned relatives, police or welfare officers, or local government orders. Sufferers may also present due to co-occurring mood or anxiety disorders that are thought to be present in 75% of people with hoarding disorder.4,5 Hoarding also has high rates of co-occurrence with obsessive-compulsive disorder (OCD)6 and attention deficit hyperactivity disorder (ADHD).7 Screening for hoarding disorder is recommended, but hoarding is likely to be more accurately assessed via collateral history or home visits. Hoarding should not be diagnosed if attributable to another medical condition, or if it is better explained by another mental disorder. Organic causes should be suspected when accumulation arises later in life or is Corresponding author: Vlasios Brakoulias, Department of Psychiatry, Nepean Hospital, Level 5 South Block, PO Box 63, Penrith, NSW 2751, Australia. Email: [email protected]
358 Downloaded from apy.sagepub.com at CORNELL UNIV on September 30, 2016
Brakoulias and Milicevic
associated with new cognitive or functional deficits. Common organic causes include brain injuries, dementia and alcohol-related brain damage. Accumulation due to organic causes or other mental disorders, such as schizophrenia, is usually characterised by filth and disorganisation. The term collecting is preferred when only a few types of items are accumulated in an organised manner and the items occupy no more than one room of the house.8 Most individuals with hoarding disorder excessively acquire objects that are not needed or for which there is no available space. Together with ‘good or fair insight’, ‘poor insight’ and ‘absent insight/delusional beliefs’, excessive acquisition is a specifier for hoarding disorder in DSM-5. When asked to discard objects, patients with hoarding disorder can move objects from one pile to another, in a process commonly known as ‘churning’. They can also be very talkative or over-inclusive in their speech. More specialised neuropsychological testing reveals a relationship between hoarding disorder and impaired decision-making,9 reduced attention10 and reduced memory confidence.11 The greatest concerns arising from hoarding disorder are its associated risks. People with hoarding disorder, and their partners, have been found dead weeks after being trapped by falling items in what has been termed a ‘clutter avalanche’. Clutter poses significant tripping hazards for elderly people; and the difficulty cleaning cluttered areas can lead to insect and rodent infestations and associated health hazards. Clutter is also thought to pose a significant fire hazard; with Melbourne fire fighters estimating that hoarding was a factor in 25% of fires that were deemed preventable.12
The treatment of hoarding disorder The low levels of insight, ambivalence regarding de-cluttering and indecisiveness associated with hoarding increase the challenges associated with hoarding disorder. A recent meta-analysis of behavioural and pharmacological approaches to treating hoarding symptoms (within a sample of patients with OCD) showed that hoarding symptoms were 50% less likely to respond to treatment than other symptoms of OCD.13 A multimodal approach is commonly used and often comprises a combination of cognitive-behavioural strategies, serotonin-reuptake inhibitors, assistance from willing family members, support workers and local authorities. The mental health act is used when there is co-occurring major mental illness and associated risks. There have been no studies to ascertain whether psychological or pharmacological treatment gains have been maintained for longer than six months.
Psychological management approaches Cognitive-behavioural approaches have been the most widely studied for hoarding disorder. These approaches tend to target the unique cognitions, patterns of avoidance and neuropsychological deficits associated with hoarding disorder. Cognitive therapy attempts to address the overvaluation of the aesthetics, utility, uniqueness and sentimental importance of possessions.14 Behavioural therapy involves goal setting, practice in sorting and discarding objects, resisting acquisition and graded exposure to discarding objects (this can occur in session, by asking
Table 1. Trials of pharmacotherapy for hoarding disorder Treatment
Sample
Sample Study length size (in weeks)
Venlafaxine XR (Avg. 204 mg)22 Paroxetine (Avg. 40 mg)23 Sertraline (50 mg)24
DSM-5 hoarding disorder 23
OCD with predominant hoarding OCD with predominant hoarding Quetiapine (200 mg) Resistant OCD with preaugmentation25 dominant hoarding Methylphenidate XR DSM-5 hoarding disorder (Avg. 50 mg)26 Minocycline (100 mg OCD with predominant bd) augmentation27 hoarding
12 wks
32 of 79 Avg. 11 wks 20
8–12 wks
9 of 30 8 wks 4
4 wks
2 of 9
12 wks
Outcome measures
Outcome
Y-BOCS, SI-R, UHSS, HARS Y-BOCS, HDRS, HARS Y-BOCS
Avg. 32% reduction in SI-R; 8-point reduction, Y-BOCS 6-point reduction in Y-BOCS 47% mean Y-BOCS reduction
Y-BOCS
8-point reduction in Y-BOCS, in a single responder SI-R 32% and 50% reduction in SI-R in the responders Y-BOCS, HDRS, 1 and 13- point decrease in HARS Y-BOCS
Avg.: average; bd: twice daily; CGI: Clinical Global Impression Index; HARS: Hamilton Anxiety Rating Scale; HDRS: Hamilton Depression Rating Scale; mg: milligrams; OCD: obsessive-compulsive disorder; SI-R: Savings Inventory – Revised; UHSS: University of California Hoarding Severity Scale; wks: weeks; Y-BOCS: Yale-Brown Obsessive-Compulsive Scale.
359 Downloaded from apy.sagepub.com at CORNELL UNIV on September 30, 2016
Brakoulias and Milicevic
Australasian Psychiatry 23(4)
the patient to bring in a box of items). It is thought that the risk of wrongly discarding an object is avoided, due to a high sensitivity to punishment, high harm avoidance and reduced novelty seeking.15 There is also a high emotional attachment to inanimate objects.16 Motivational interviewing techniques, strategies to address attachment issues, information processing for decision-making deficits and monthly home visits have been incorporated into both individual and group cognitive-behavioural therapies for hoarding disorder.17 Hoarding symptoms tend to reduce by about one-third over 20–26 weekly sessions.18,19
Pharmacological management approaches Antidepressants such as paroxetine and venlafaxine tend to be used to reduce hoarding behaviour.20 These appear to have a similar efficacy to the cognitive-behavioural approaches;21 however, the studies have many limitations. There are a limited number of studies that assess the effectiveness of pharmacotherapeutic approaches to treating hoarding disorder and the studies that have been conducted, have had small samples, have been open label and often used samples of patients with OCD, where the outcome measure was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). As obsessions and compulsions are not the prominent phenomena in hoarding disorder, the Y-BOCS is not a particularly useful tool to measure hoarding severity. Trials of pharmacotherapeutic agents for hoarding disorder are summarised in Table 1.22–27
Conclusions Hoarding disorder has a chronic, progressive course and can be associated with significant risks. Its prevalence rate and its rate of co-occurrence with mood and anxiety disorders indicate that screening may play a role in early detection of the disorder. The limited level of insight and unwillingness of patients with hoarding disorder to reduce their clutter pose a significant challenge for clinicians; however, tailored psychological approaches to treatment have shown some success. Also, there are pharmacotherapeutic approaches that appear promising, but the studies need to be replicated, using larger samples of subjects with hoarding disorder and more focussed outcome measures. Disclosure The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper. The first author V.B. is the Editor of Australasian Psychiatry. This article was blinded to reviewers and reviewers were chosen by his deputy Editor Michael Robertson whose Editorial decisions were made independently.
References 1. American Psychiatric Association. The Diagnostic and statistical manual of mental disorders, 5th edition. Washington, DC: American Psychiatric Association, 2013.
2. Nordsletten AE, Reichenberg A, Hatch SL, et al. Epidemiology of hoarding disorder. Brit J Psychiatry 2013; 203: 445–452. 3. Tolin DF, Meunier SA, Frost RO, et al. Course of compulsive hoarding and its relationship to life events. Depress Anxiety 2010; 27: 829–838. 4. Mataix-Cols D. Clinical practice. Hoarding disorder. New Engl J Med 2014; 370: 2023–2030. 5. Frost RO, Steketee G and Tolin DF. Comorbidity in hoarding disorder. Depress Anxiety 2011; 28: 876–884. 6. Pertusa A, Fullana MA, Singh S, et al. Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both? Am J Psychiatry 2008; 165: 1289–1298. 7. Hartl TL, Duffany SR, Allen GJ, et al. Relationships among compulsive hoarding, trauma and attention-deficit/hyperactivity disorder. Behav Res Ther 2005; 43: 269–276. 8. Nordsletten AE and Mataix-Cols D. Hoarding versus collecting: Where does pathology diverge from play? Clin Psychol Rev 2012; 32: 165–176. 9. Samuels JF, Bienvenu O, Pinto A, et al. Hoarding in obsessive-compulsive disorder: Results from the OCD Collaborative Genetics Study. Behav Res Ther 2007; 45: 673–686. 10. Grisham JR, Brown TA, Savage CR, et al. Neuropsychological impairment associated with compulsive hoarding. Behav Res Ther 2007; 45: 1471–1483. 11. Hartl TL, Frost RO, Allen GJ, et al. Actual and perceived memory deficits in individuals with compulsive hoarding. Depress Anxiety 2004; 20:59–69. 12. Harris J. Household hoarding and residential fires. In: International Congress of Applied Psychology, Melbourne, Australia. July 2010. 13. Bloch M, Bartley C, Zipperer L, et al. Meta-analysis: Hoarding symptoms associated with poor treatment outcome in obsessive-compulsive disorder. Molecular Psychiatry 2014; 19: 1025–1030. 14. Steketee G, Frost RO and Kyrios M. Cognitive aspects of compulsive hoarding. Cognitive Ther Res 2003; 27: 463–479. 15. Fullana MA, Mataix-Cols D, Caseras X, et al. High sensitivity to punishment and low impulsivity in obsessive-compulsive patients with hoarding symptoms. Psychiatry Res 2004; 129: 21–27. 16. Nedelisky A and Steele M. Attachment to people and to objects in obsessive-compulsive disorder: An exploratory comparison of hoarders and non-hoarders. Attachment Human Developm 2009; 11: 365–383. 17. Steketee G, Frost RO, Wincze J, et al. Group and individual treatment of compulsive hoarding: A pilot study. Behav Cognitive Psychother 2000; 28: 259–268. 18. Steketee G, Frost RO, Tolin DF, et al. Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder. Depress Anxiety 2010; 27: 476–484. 19. Tolin DF, Frost RO and Steketee G. An open trial of cognitive-behavioral therapy for compulsive hoarding. Behav Res Ther 2007; 45: 1461–1470. 20. Saxena S. Pharmacotherapy of compulsive hoarding. J Clin Psychol 2011; 67: 477–484. 21. Tolin DF. Challenges and advances in treating hoarding. J Clin Psychol 2011; 67: 451–455. 22. Saxena S and Sumner J. Venlafaxine extended-release treatment of hoarding disorder. Int Clin Psychopharmacol 2014; 29: 266–273. 23. Saxena S, Brody AL, Maidment KM, et al. Paroxetine treatment of compulsive hoarding. J Psychiatr Res 2007; 41: 481–487. 24. Winsberg ME, Cassic KS and Koran LM. Hoarding in obsessive-compulsive disorder: A report of 20 cases. J Clin Psychiatry 1999; 60: 591–597. 25. Bogan AM, Koran LM, Chuong HW, et al. Quetiapine augmentation in obsessive-compulsive disorder resistant to serotonin reuptake inhibitors: An open-label study. J Clin Psychiatry 2005; 66: 73–79. 26. Rodriguez CI, Bender J, Morrison S Jr, et al. Does extended release methylphenidate help adults with hoarding disorder? A case series. J Clin Psychopharmacol 2013; 33: 444–447. 27. Rodriguez CI, Bender J Jr, Marcus SM, et al. Minocycline augmentation of pharmacotherapy in obsessive-compulsive disorder: An open-label trial. J Clin Psychiatry 2010; 71: 1247–1249.
360 Downloaded from apy.sagepub.com at CORNELL UNIV on September 30, 2016
APY0010.1177/1039856215587235Australasian PsychiatryV Brakoulias and D Milicevic
Australasian
Psychiatry
Anxiety
Assessment and treatment of hoarding disorder
Australasian Psychiatry 2015, Vol 23(4) 358–360 © The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856215587235 apy.sagepub.com
Vlasios Brakoulias Senior Lecturer, Psychiatry, Sydney Medical School, University of Sydney, and; Psychiatrist, Department of Psychiatry, Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia Denise Milicevic Senior Clinical Psychologist and Clinic Co-ordinator, Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Penrith NSW, Australia This paper was presented at the International Anxiety Disorders Society Conference which was held in Melbourne in November 2014.
Abstract Objectives: To provide a brief selective review of the current literature regarding Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Hoarding Disorder, with an emphasis on its associated risks, assessment and management approaches. Conclusions: Hoarding disorder is defined by clear diagnostic criteria. It can be a severe and disabling disorder that can pose significant safety risks to the individual and to others. Management is often challenging, due to the poor level of insight that people with hoarding disorder often have. Psychological approaches tend to adapt cognitivebehavioural approaches, in order to specifically target areas such as impaired decision-making and motivation. Several trials of pharmacological agents have been conducted, but the limitations of these studies call for further research. Keywords: diagnosis, hoarding disorder, obsessive-compulsive disorder, review, treatment
E
xcessive hoarding behaviour has been recognised since antiquity; however, the recent introduction of the diagnosis ‘hoarding disorder’ into the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)1 by the American Psychiatric Association (APA) has shed new light onto the disorder. DSM-5 defines hoarding as the persistent difficulty in discarding or parting with possessions, regardless of their actual value. The difficulty is due to a perceived need to save the items and to distress associated with discarding them. In order to meet criteria for the DSM-5 hoarding disorder, the subsequent accumulation of possessions needs to congest active living areas to the extent that their use is substantially compromised. The hoarding should also cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. For example, clutter is so prominent in the kitchen area that the person cannot cook. Hoarding disorder is thought to be present in 1.5% of the population, with this figure increasing in older adults.2 Males tend to be overrepresented in community samples and females tend to be overrepresented in clinical samples. The course of hoarding tends to be chronic and progressive, with symptoms starting in the teens and severity increasing with age.3
The assessment of hoarding Sufferers of hoarding disorder are unlikely to self-present for treatment, as > 50% are suspected of having poor or absent insight.3 More often, sufferers are coerced to seek help by concerned relatives, police or welfare officers, or local government orders. Sufferers may also present due to co-occurring mood or anxiety disorders that are thought to be present in 75% of people with hoarding disorder.4,5 Hoarding also has high rates of co-occurrence with obsessive-compulsive disorder (OCD)6 and attention deficit hyperactivity disorder (ADHD).7 Screening for hoarding disorder is recommended, but hoarding is likely to be more accurately assessed via collateral history or home visits. Hoarding should not be diagnosed if attributable to another medical condition, or if it is better explained by another mental disorder. Organic causes should be suspected when accumulation arises later in life or is Corresponding author: Vlasios Brakoulias, Department of Psychiatry, Nepean Hospital, Level 5 South Block, PO Box 63, Penrith, NSW 2751, Australia. Email: [email protected]
358 Downloaded from apy.sagepub.com at CORNELL UNIV on September 30, 2016
Brakoulias and Milicevic
associated with new cognitive or functional deficits. Common organic causes include brain injuries, dementia and alcohol-related brain damage. Accumulation due to organic causes or other mental disorders, such as schizophrenia, is usually characterised by filth and disorganisation. The term collecting is preferred when only a few types of items are accumulated in an organised manner and the items occupy no more than one room of the house.8 Most individuals with hoarding disorder excessively acquire objects that are not needed or for which there is no available space. Together with ‘good or fair insight’, ‘poor insight’ and ‘absent insight/delusional beliefs’, excessive acquisition is a specifier for hoarding disorder in DSM-5. When asked to discard objects, patients with hoarding disorder can move objects from one pile to another, in a process commonly known as ‘churning’. They can also be very talkative or over-inclusive in their speech. More specialised neuropsychological testing reveals a relationship between hoarding disorder and impaired decision-making,9 reduced attention10 and reduced memory confidence.11 The greatest concerns arising from hoarding disorder are its associated risks. People with hoarding disorder, and their partners, have been found dead weeks after being trapped by falling items in what has been termed a ‘clutter avalanche’. Clutter poses significant tripping hazards for elderly people; and the difficulty cleaning cluttered areas can lead to insect and rodent infestations and associated health hazards. Clutter is also thought to pose a significant fire hazard; with Melbourne fire fighters estimating that hoarding was a factor in 25% of fires that were deemed preventable.12
The treatment of hoarding disorder The low levels of insight, ambivalence regarding de-cluttering and indecisiveness associated with hoarding increase the challenges associated with hoarding disorder. A recent meta-analysis of behavioural and pharmacological approaches to treating hoarding symptoms (within a sample of patients with OCD) showed that hoarding symptoms were 50% less likely to respond to treatment than other symptoms of OCD.13 A multimodal approach is commonly used and often comprises a combination of cognitive-behavioural strategies, serotonin-reuptake inhibitors, assistance from willing family members, support workers and local authorities. The mental health act is used when there is co-occurring major mental illness and associated risks. There have been no studies to ascertain whether psychological or pharmacological treatment gains have been maintained for longer than six months.
Psychological management approaches Cognitive-behavioural approaches have been the most widely studied for hoarding disorder. These approaches tend to target the unique cognitions, patterns of avoidance and neuropsychological deficits associated with hoarding disorder. Cognitive therapy attempts to address the overvaluation of the aesthetics, utility, uniqueness and sentimental importance of possessions.14 Behavioural therapy involves goal setting, practice in sorting and discarding objects, resisting acquisition and graded exposure to discarding objects (this can occur in session, by asking
Table 1. Trials of pharmacotherapy for hoarding disorder Treatment
Sample
Sample Study length size (in weeks)
Venlafaxine XR (Avg. 204 mg)22 Paroxetine (Avg. 40 mg)23 Sertraline (50 mg)24
DSM-5 hoarding disorder 23
OCD with predominant hoarding OCD with predominant hoarding Quetiapine (200 mg) Resistant OCD with preaugmentation25 dominant hoarding Methylphenidate XR DSM-5 hoarding disorder (Avg. 50 mg)26 Minocycline (100 mg OCD with predominant bd) augmentation27 hoarding
12 wks
32 of 79 Avg. 11 wks 20
8–12 wks
9 of 30 8 wks 4
4 wks
2 of 9
12 wks
Outcome measures
Outcome
Y-BOCS, SI-R, UHSS, HARS Y-BOCS, HDRS, HARS Y-BOCS
Avg. 32% reduction in SI-R; 8-point reduction, Y-BOCS 6-point reduction in Y-BOCS 47% mean Y-BOCS reduction
Y-BOCS
8-point reduction in Y-BOCS, in a single responder SI-R 32% and 50% reduction in SI-R in the responders Y-BOCS, HDRS, 1 and 13- point decrease in HARS Y-BOCS
Avg.: average; bd: twice daily; CGI: Clinical Global Impression Index; HARS: Hamilton Anxiety Rating Scale; HDRS: Hamilton Depression Rating Scale; mg: milligrams; OCD: obsessive-compulsive disorder; SI-R: Savings Inventory – Revised; UHSS: University of California Hoarding Severity Scale; wks: weeks; Y-BOCS: Yale-Brown Obsessive-Compulsive Scale.
359 Downloaded from apy.sagepub.com at CORNELL UNIV on September 30, 2016
Brakoulias and Milicevic
Australasian Psychiatry 23(4)
the patient to bring in a box of items). It is thought that the risk of wrongly discarding an object is avoided, due to a high sensitivity to punishment, high harm avoidance and reduced novelty seeking.15 There is also a high emotional attachment to inanimate objects.16 Motivational interviewing techniques, strategies to address attachment issues, information processing for decision-making deficits and monthly home visits have been incorporated into both individual and group cognitive-behavioural therapies for hoarding disorder.17 Hoarding symptoms tend to reduce by about one-third over 20–26 weekly sessions.18,19
Pharmacological management approaches Antidepressants such as paroxetine and venlafaxine tend to be used to reduce hoarding behaviour.20 These appear to have a similar efficacy to the cognitive-behavioural approaches;21 however, the studies have many limitations. There are a limited number of studies that assess the effectiveness of pharmacotherapeutic approaches to treating hoarding disorder and the studies that have been conducted, have had small samples, have been open label and often used samples of patients with OCD, where the outcome measure was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). As obsessions and compulsions are not the prominent phenomena in hoarding disorder, the Y-BOCS is not a particularly useful tool to measure hoarding severity. Trials of pharmacotherapeutic agents for hoarding disorder are summarised in Table 1.22–27
Conclusions Hoarding disorder has a chronic, progressive course and can be associated with significant risks. Its prevalence rate and its rate of co-occurrence with mood and anxiety disorders indicate that screening may play a role in early detection of the disorder. The limited level of insight and unwillingness of patients with hoarding disorder to reduce their clutter pose a significant challenge for clinicians; however, tailored psychological approaches to treatment have shown some success. Also, there are pharmacotherapeutic approaches that appear promising, but the studies need to be replicated, using larger samples of subjects with hoarding disorder and more focussed outcome measures. Disclosure The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper. The first author V.B. is the Editor of Australasian Psychiatry. This article was blinded to reviewers and reviewers were chosen by his deputy Editor Michael Robertson whose Editorial decisions were made independently.
References 1. American Psychiatric Association. The Diagnostic and statistical manual of mental disorders, 5th edition. Washington, DC: American Psychiatric Association, 2013.
2. Nordsletten AE, Reichenberg A, Hatch SL, et al. Epidemiology of hoarding disorder. Brit J Psychiatry 2013; 203: 445–452. 3. Tolin DF, Meunier SA, Frost RO, et al. Course of compulsive hoarding and its relationship to life events. Depress Anxiety 2010; 27: 829–838. 4. Mataix-Cols D. Clinical practice. Hoarding disorder. New Engl J Med 2014; 370: 2023–2030. 5. Frost RO, Steketee G and Tolin DF. Comorbidity in hoarding disorder. Depress Anxiety 2011; 28: 876–884. 6. Pertusa A, Fullana MA, Singh S, et al. Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both? Am J Psychiatry 2008; 165: 1289–1298. 7. Hartl TL, Duffany SR, Allen GJ, et al. Relationships among compulsive hoarding, trauma and attention-deficit/hyperactivity disorder. Behav Res Ther 2005; 43: 269–276. 8. Nordsletten AE and Mataix-Cols D. Hoarding versus collecting: Where does pathology diverge from play? Clin Psychol Rev 2012; 32: 165–176. 9. Samuels JF, Bienvenu O, Pinto A, et al. Hoarding in obsessive-compulsive disorder: Results from the OCD Collaborative Genetics Study. Behav Res Ther 2007; 45: 673–686. 10. Grisham JR, Brown TA, Savage CR, et al. Neuropsychological impairment associated with compulsive hoarding. Behav Res Ther 2007; 45: 1471–1483. 11. Hartl TL, Frost RO, Allen GJ, et al. Actual and perceived memory deficits in individuals with compulsive hoarding. Depress Anxiety 2004; 20:59–69. 12. Harris J. Household hoarding and residential fires. In: International Congress of Applied Psychology, Melbourne, Australia. July 2010. 13. Bloch M, Bartley C, Zipperer L, et al. Meta-analysis: Hoarding symptoms associated with poor treatment outcome in obsessive-compulsive disorder. Molecular Psychiatry 2014; 19: 1025–1030. 14. Steketee G, Frost RO and Kyrios M. Cognitive aspects of compulsive hoarding. Cognitive Ther Res 2003; 27: 463–479. 15. Fullana MA, Mataix-Cols D, Caseras X, et al. High sensitivity to punishment and low impulsivity in obsessive-compulsive patients with hoarding symptoms. Psychiatry Res 2004; 129: 21–27. 16. Nedelisky A and Steele M. Attachment to people and to objects in obsessive-compulsive disorder: An exploratory comparison of hoarders and non-hoarders. Attachment Human Developm 2009; 11: 365–383. 17. Steketee G, Frost RO, Wincze J, et al. Group and individual treatment of compulsive hoarding: A pilot study. Behav Cognitive Psychother 2000; 28: 259–268. 18. Steketee G, Frost RO, Tolin DF, et al. Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder. Depress Anxiety 2010; 27: 476–484. 19. Tolin DF, Frost RO and Steketee G. An open trial of cognitive-behavioral therapy for compulsive hoarding. Behav Res Ther 2007; 45: 1461–1470. 20. Saxena S. Pharmacotherapy of compulsive hoarding. J Clin Psychol 2011; 67: 477–484. 21. Tolin DF. Challenges and advances in treating hoarding. J Clin Psychol 2011; 67: 451–455. 22. Saxena S and Sumner J. Venlafaxine extended-release treatment of hoarding disorder. Int Clin Psychopharmacol 2014; 29: 266–273. 23. Saxena S, Brody AL, Maidment KM, et al. Paroxetine treatment of compulsive hoarding. J Psychiatr Res 2007; 41: 481–487. 24. Winsberg ME, Cassic KS and Koran LM. Hoarding in obsessive-compulsive disorder: A report of 20 cases. J Clin Psychiatry 1999; 60: 591–597. 25. Bogan AM, Koran LM, Chuong HW, et al. Quetiapine augmentation in obsessive-compulsive disorder resistant to serotonin reuptake inhibitors: An open-label study. J Clin Psychiatry 2005; 66: 73–79. 26. Rodriguez CI, Bender J, Morrison S Jr, et al. Does extended release methylphenidate help adults with hoarding disorder? A case series. J Clin Psychopharmacol 2013; 33: 444–447. 27. Rodriguez CI, Bender J Jr, Marcus SM, et al. Minocycline augmentation of pharmacotherapy in obsessive-compulsive disorder: An open-label trial. J Clin Psychiatry 2010; 71: 1247–1249.
360 Downloaded from apy.sagepub.com at CORNELL UNIV on September 30, 2016
