Unbending mind: Individuals with hoarding disorder do not modify decision strategy in response to feedback under risk

Abstract

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.

Cognitive impairment in hoarding disorder: a systematic review

“…Studies differed in terms of controls used for comparison with HD patients: 9 included controls, 11 , 53 , 61 , 62 , 65 - 67 , 69 , 71 6 included controls and OCD patients, 52 , 55 , 59 , 60 , 64 , 72 3 employed controls and patients with major depression or anxiety disorders, 54 , 56 , 57 2 used OCD patients and comorbid OCD and HD, 68 , 70 1 included patients with anxiety disorders, 63 and 1 included late life depression patients 58 (Table 2).…”

“…Sixteen out of 22 studies evaluated executive functions in patients with HD in comparison with controls. 54,55,[57][58][59][60][61]63,64,[66][67][68][69][70][71][72] Working memory Six out of 22 studies evaluated working memory in patients with HD. 54,58,61,[67][68][69] The neuropsychological instruments employed in these studies were subtests of the Wechsler adult intelligence scale (WAIS): digit span (DS), 54,58,61,67 letter number sequencing (LNS), 58,61,67 and visual memory span (VMS) 54 ; the NeuroTrax (NT) verbal and non-verbal memory tests 68 ; and the object alternation task (OAT).…”

“…All seven studies that evaluated decision-making in patients with HD demonstrated that they do not differ from controls 54,57,60,64,67,70,71 or from patients with mood or anxiety disorders. 54,57 The main neuropsychological instruments employed to assess decision-making were the Iowa gambling task (IGT) 54,60,67,71 and the Cambridge gambling task (CGT). 57,64 Inhibitory control Nine out of 22 studies evaluated inhibitory control in patients with HD.…”

Assessing the validity of three tasks of risk‐taking propensity

“…Çek, Shaw, & Timpano, 2016), so we added two psychiatric measures to further explore the relationship between the behavioral tasks and psychiatric disorders like Obsessive-Compulsive Disorder (OCD) and Hoarding Disorder (HD). Research has found that individuals with HD tend to follow a simple, deliberative, and risk-neutral strategy in risktaking decisions whereas the healthy individuals tend to explore more strategies and then stick to a more complicated strategy (Pushkarskaya, Tolin, Henick, Levy, & Pittenger, 2018). Therefore, we hypothesized that participants with more serious hoarding problems would explore less in the games and thus use strategies farther away from the true optimal strategy, resulting in worse performances as represented by lower adjusted scores.…”

Clinical characteristics of hoarding disorder in Japanese patients

“…Recent studies have also reported the possibility of cognitive impairment in HD (Grisham and Baldwin, 2015;Woody et al, 2014), such as information processing problems in hoarding patients (Blom et al, 2011;Frost and Hartl, 1996;Grisham et al, 2010;Mackin et al, 2011;Mackin et al, 2016;Pushkarskaya et al, 2018;Raines et al, 2014;Steketee and Frost, 2003;Wincze et al, 2007) and the impairment of attention, memory, and executive function in HD (Ayers et al, 2016;Ayers et al, 2013;Steketee and Frost, 2003;Tolin et al, 2018;.…”