Sex-specific clinical correlates of hoarding in obsessive-compulsive disorder

Abstract

Little is known about whether the clinical correlates of hoarding behavior are different in men and women with obsessive-compulsive disorder (OCD). In the current study, we evaluated the association of hoarding with categories of obsessions and compulsions, psychiatric disorders, personality dimensions, and other clinical characteristics separately in 151 men and 358 women with OCD who were examined during the OCD Collaborative Genetics Study. We found that, among men but not women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In men, hoarding was associated with generalized anxiety disorder and tics whereas, among women, hoarding was associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking. In women but not men, hoarding was associated with schizotypal and dependent personality disorder dimensions, and with low conscientiousness. These findings indicate that specific clinical correlates of hoarding in OCD are different in men and women and may reflect sex-specific differences in the course, expression, and/or etiology of hoarding behavior in OCD. KeywordsObsessive-compulsive disorder; hoarding; comorbidity; personality disorders; personality; sex differences *Corresponding author: Jack Samuels, Ph.D., Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, 600 N. Wolfe Street, Meyer 4-181, Baltimore, MD 21287-7228. Phone: 410-614-4942; Fax: 410-614-8137, E-mail address: jacks@jhmi.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptHoarding 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 (Greenberg, Witztum & Levy, 1990;Frost & Gross, 1993). 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 et al., 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, as well as legal citations and evictions from home by public health authorities . Although hoarding behavior can occur in several psychiatric conditions, including dementia, mental retardation, schizophrenia, and eating disorders (Damecour & Charron, 1998), it appears to occur most frequently in the context of obsessive-compulsive disorder (OCD), presenting in 20-30% or more of patients with this condition (Rasmussen & Eisen, 1992; Frost, Krause, & Steketee, 1996).Over the past decade, considerable evidence has accumulated that OCD-affected individuals with hoarding behavior show clinical differences from those without hoarding behavior. These differences include greater severity of OCD, as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS) (Goo...

The Relationship of Hoarding Symptoms to Schizotypal Personality and Cognitive Schemas in an Obsessive-Compulsive Disorder Sample

“…The link between hoarding and SPT was consistent with past research showing an association between hoarding and SPT in OCD samples (Frost et al, 2000; Samuels, Bienvenu, Pinto, et al, 2008). However, the correlation between SPT and symmetry/ordering symptoms, but not other OCD symptoms more traditionally characterized by “magical thinking”, was somewhat unexpected.…”

“…Similar to findings from previous studies demonstrating an association between SPT and SPD and hoarding in OCD (Frost et al, 2000; Matsunaga et al, 2010; Samuels, Bienvenu, Pinto, et al, 2008), the relationship between hoarding symptoms and SPT on the PDQ-4 demonstrated a moderate correlation. In addition, the results from univariate regression showed symmetry/ordering symptoms predicted SPT.…”

“…Another study failed to find differences in the frequency of these obsessions for OCD patients with and without SPD (Poyurovsky et al, 2008). Interestingly, in several studies of OCD patients where hoarding was conceptualized as a symptom of OCD, hoarding was consistently associated with SPT (Frost, Steketee, Williams, & Warren, 2000) or SPD (Matsunaga, Hayashia, Kiriike, Nagata, & Stein, 2010; Samuels, Bienvenu, Pinto et al, 2008). In another study by Grisham, Brown, Savage, Steketee & Barlow (2007), patients recruited primarily for hoarding symptoms (but among whom 56.7% had at least one clinically significant non-hoarding OCD obsession or compulsion) had greater rates of SPT versus participants with anxiety disorders or community controls.…”

Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive–compulsive disorder as an example of overlapping clinical and genetic heterogeneity

“…Evaluation of phenotypic considerations, such as a focus on age of onset, gender, compulsive hoarding, and additional subgroups and sub-phenotypes, have shown influences of these variables on genome-wide linkage analyses [22,24,25]. These have primarily been the consequence of large-scale quantitative phenotypical variable assessment built into the rstb.royalsocietypublishing.org Phil Trans R Soc B 368: 20120435 second genome-wide study of OCD and other studies from this collaborative group [10,23,25,208,209,214,215], and also the recent GWAS by another consortium [28].…”

“…(iii) Consideration of a hoarding sub-phenotype It has increasingly been observed that there are key differences between individuals with primary hoarding symptoms and those with non-hoarding OCD on a constellation of features, including clinical and biological factors, as well as associations with gender and heritability estimates [5,10,[208][209][210][211][212][213]. Genetic evidence, as reviewed earlier, in addition to a series of clinical investigations, is beginning to provide support for hoarding as a discrete phenomenon [25,89,[214][215][216][217][218][219].…”