Faculty Bibliography

BACKGROUND:A new diagnostic category, hoarding disorder (HD), has been proposed for inclusion in DSM-5. This study field-tested the validity, reliability and perceived acceptability of the proposed diagnostic criteria for HD. Method Fifty unselected individuals with prominent hoarding behavior and 20 unselected, self-defined 'collectors' participated in thorough psychiatric assessments, involving home visits whenever possible. A semi-structured interview based on the proposed diagnostic criteria for HD was administered and scored by two independent raters. 'True' diagnoses were made by consensus according to the best-estimate diagnosis procedure. The percentage of true positive HD cases (sensitivity) and true negative HD cases (specificity) was calculated, along with inter-rater reliability for the diagnosis and each criterion. Participants were asked about their perceptions of the acceptability, utility and stigma associated with the new diagnosis. RESULTS:Twenty-nine (58%) of the hoarding individuals and none of the collectors fulfilled diagnostic criteria for HD. The sensitivity, specificity and inter-rater reliability of the diagnosis, and of each individual criterion and the specifiers, were excellent. Most participants with HD (96%) felt that creating a new disorder would be very or somewhat acceptable, useful (96%) and not too stigmatizing (59%). CONCLUSIONS:The proposed HD criteria are valid, reliable and perceived as acceptable and useful by the sufferers. Crucially, they seem to be sufficiently conservative and unlikely to overpathologize normative behavior. Minor changes in the wording of the criteria are suggested.

OBJECTIVE:A new diagnostic category called Hoarding Disorder (HD) has been proposed for inclusion in DSM-5. It is paramount that this addition does not result in an over-pathologization of normative behavior. Collectors constitute a valid population within which to test the diagnostic boundaries of HD. The current study explored the features that differentiate pathological hoarding from normative collecting. METHODS:Participants were 29 individuals with a diagnosis of HD and 20 individuals who self-identified as collectors who enrolled in the London Field Trial for HD. A series of semi-structured interviews (often in the participants' homes) were conducted, including a detailed assessment of the typical elements of the collecting process. Participants also completed a battery of self-report questionnaires. RESULTS:Collectors were more likely than those with HD to be male, partnered, and free of psychiatric conditions or medication. Like those with HD, collectors reported the acquisition of, attachment to, and reluctance to discarding objects. However, the resulting clutter and impairment were minimal in this group and ultimately insufficient to garner an HD diagnosis. Collectors were, additionally, more focused in their acquisitions (e.g., confining their accumulations to a narrow range of items), more selective (e.g., planning and purchasing only pre-determined items), more likely to organize their possessions and less likely to accumulate in an excessive manner. CONCLUSIONS:There are important quantitative and qualitative differences between HD and normative collecting. For this reason, collectors are unlikely to be inappropriately pathologized by the introduction of HD.

BACKGROUND:Clutter impeding the normal use of living spaces is a landmark feature of hoarding disorder (HD) but can also be present in other conditions. The assessment of clutter ideally requires home visits, although such assessments are sometimes not feasible. This study examined whether photographs from patients' homes can assist in the diagnostic process. METHODS:Thirty-two professionals with experience with hoarding cases were shown pictures from the inside of 10 houses and asked to decide whether the house belonged to a person with HD, a person with obsessive compulsive disorder (OCD), or a healthy collector. Participants also rated different features of the room appearing in each picture (overall amount of possessions, tidiness, functionality, number of different classes of items, and cleanliness). RESULTS:Sensitivity for the HD and collectors' pictures was high, whereas sensitivity for the OCD pictures was substantially lower. Specificity was high for all groups. Rooms belonging to HD individuals were rated as significantly more cluttered, more untidy, less functional, containing a higher number of different classes of items, and being less clean than the rooms from the remaining groups. CONCLUSIONS:Photographs may be used to assist clinicians in determining the presence of clinically significant levels of clutter in the event a home visit is not feasible. Although differential diagnosis will usually not be possible from photographs alone, examination of certain characteristics of the environment might provide useful diagnostic clues. Combined with a thorough psychopathological interview, the use of photographs may increase the clinician's confidence in the diagnosis of HD.

The present study investigated the consequences of different forms of emotion regulation. Eighty nine healthy participants viewed a distressing video of the aftermath of road traffic accidents under either suppression (of both felt and expressed affect), acceptance, or no-regulation control instructions and the immediate and longer-term consequences on emotion, mood, and memory were examined. Suppression (relative to control) led to reduced subjective experience of fear when viewing the video, but did not alter electrodermal (EDA) or heart rate (HR) response. Subsequently, suppression led to a less marked subjective emotional reaction to positive but not negative emotional images, reduced free recall memory of the video, and a greater likelihood of experiencing zero intrusions of the video's content. Acceptance (relative to control) had no impact when viewing the video, was associated with a less marked increase in EDA activity in the 5 min period immediately after viewing the video, a more marked HR deceleration and EDA response to both positive and negative images, and elevated negative affect at one week follow-up. These findings suggest, contrary to the current clinical zeitgeist, that emotion suppression can successfully lead to an ongoing down-regulation of emotion and memory, whereas acceptance may elevate subsequent emotionality.