Hoarding disorder: a unique obsession

Many of us know a “pack rat” who has trouble throwing things away, but people with hoarding disorder take that tendency to extremes, sometimes filling their homes to the ceiling with possessions.

Long considered a subtype of obsessive-compulsive disorder (OCD), compulsive hoarding is being reconsidered as a possible standalone diagnosis in light of evidence that its brain abnormalities are distinct from those of OCD patients. A recent study led by David F. Tolin, Ph.D., adjunct associate professor of psychiatry, lends weight to that idea.

In the new research, healthy people, people with OCD, and people with hoarding disorder were asked to bring junk mail to the lab. In a functional magnetic resonance imaging scanner, subjects were presented with pictures of their own mail as well as mail not belonging to them, and were asked to decide to keep or shred each piece.

As reported in the August issue of Archives of General Psychiatry, compared with the control and OCD groups, the hoarders’ brains showed less activity in regions involved in emotional regulation, risk assessment, and decision-making when they considered others’ mail but were hyperactive while deciding about their own. The under-and over-activation patterns resembled those seen in autism and anxiety disorders, respectively, say the researchers.