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Family Informants’ Perceptions of Insight in Compulsive Hoarding

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Abstract

Existing psychological and pharmacological interventions for obsessive-compulsive disorder have not been particularly successful for compulsive hoarding, perhaps due in part to poor insight on the part of sufferers. Individuals with compulsive hoarding problems commonly display lack of awareness of the severity of their behavior, sometimes denying that they have a problem and often resisting intervention attempts and failing to follow through with therapeutic assignments. Using an internet-based survey, family and friends of individuals with reported hoarding problems (family/friend informants, N = 584) provided ratings of the hoarder’s level of insight. They also made several ratings of the severity of the person’s hoarding behavior, then rated the same items again with regard to how they thought the hoarder would respond to the items. Family/friend informants described the hoarder on average as having fair to poor insight. More than half were described as having “poor insight” or “lacks insight/delusional,” substantially worse insight than found in samples of OCD clinic patients using the same measure. Family/friend informants’ ratings of hoarding severity were significantly greater than were their estimates of the hoarder’s ratings. Hoarders described as showing less distress about the hoarding were described as showing poorer insight. These results suggest that compulsive hoarding is characterized by poor insight into the severity of the problem. Treatment development might need to emphasize strategies to bolster awareness, insight, and motivation.

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Notes

  1. Although all participants described themselves as non-hoarding friends or family members of a hoarder, analysis of the 434 participants who completed the HRS-SR in reference to themselves indicated that 45 (10.4%) in fact met our research criteria for compulsive hoarding. These participants were included in the analyses. Comparisons between hoarding and non-hoarding respondents indicated that their ratings of family members did not differ from each other on the HRS-SR (t = 0.62, P = .53) or Y-BOCS insight item (t = 0.82, P = .41).

References

  • Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71, 1049–1057. doi:10.1037/0022-006X.71.6.1049.

    Article  PubMed  Google Scholar 

  • Amador, X. F., Strauss, D. H., Yale, S. A., Flaum, M. M., Endicott, J., & Gorman, J. M. (1993). Assessment of insight in psychosis. The American Journal of Psychiatry, 150, 873–879.

    CAS  PubMed  Google Scholar 

  • Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Calamari, J. E., Wiegartz, P. S., Riemann, B. C., Cohen, R. J., Greer, A., Jacobi, D. M., et al. (2004). Obsessive-compulsive disorder subtypes: An attempted replication and extension of a symptom-based taxonomy. Behaviour Research and Therapy, 42, 647–670. doi:10.1016/S0005-7967(03)00173-6.

    Article  PubMed  Google Scholar 

  • Carlbring, P., Brunt, S., Bohman, S., Austin, D., Richards, J., Ost, L. G., et al. (2007). Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Computers in Human Behavior, 23, 1421–1434. doi:10.1016/j.chb.2005.05.002.

    Article  Google Scholar 

  • Coles, M. E., Cook, L. M., & Blake, T. R. (2007). Assessing obsessive compulsive symptoms and cognitions on the internet: Evidence for the comparability of paper and Internet administration. Behaviour Research and Therapy, 45, 2232–2240. doi:10.1016/j.brat.2006.12.009.

    Article  PubMed  Google Scholar 

  • De Berardis, D., Campanella, D., Gambi, F., Sepede, G., Salini, G., Carano, A., et al. (2005). Insight and alexithymia in adult outpatients with obsessive-compulsive disorder. European Archives of Psychiatry and Clinical Neuroscience, 255, 350–358. doi:10.1007/s00406-005-0573-y.

    Article  PubMed  Google Scholar 

  • Eisen, J. L., Phillips, K. A., Baer, L., Beer, D. A., Atala, K. D., & Rasmussen, S. A. (1998). The Brown Assessment of Beliefs Scale: Reliability and validity. The American Journal of Psychiatry, 155, 102–108.

    CAS  PubMed  Google Scholar 

  • Foa, E. B. (1979). Failure in treating obsessive-compulsives. Behaviour Research and Therapy, 17, 169–176. doi:10.1016/0005-7967(79)90031-7.

    Article  CAS  PubMed  Google Scholar 

  • Foa, E. B., Grayson, J. B., Steketee, G. S., Doppelt, H. G., Turner, R. M., & Latimer, P. R. (1983). Success and failure in the behavioral treatment of obsessive-compulsives. Journal of Consulting and Clinical Psychology, 51, 287–297. doi:10.1037/0022-006X.51.2.287.

    Article  CAS  PubMed  Google Scholar 

  • Foa, E. B., Kozak, M. J., Goodman, W. K., Hollander, E., Jenike, M. A., & Rasmussen, S. A. (1995). DSM-IV field trial: Obsessive-compulsive disorder. The American Journal of Psychiatry, 152, 90–96.

    CAS  PubMed  Google Scholar 

  • Frost, R. O., & Gross, R. (1993). The hoarding of possessions. Behaviour Research and Therapy, 31, 367–382. doi:10.1016/0005-7967(93)90094-B.

    Article  CAS  PubMed  Google Scholar 

  • Frost, R. O., & Hartl, T. L. (1996). A cognitive-behavioral model of compulsive hoarding. Behaviour Research and Therapy, 34, 341–350. doi:10.1016/0005-7967(95)00071-2.

    Article  CAS  PubMed  Google Scholar 

  • Frost, R. O., Krause, M. S., & Steketee, G. (1996). Hoarding and obsessive-compulsive symptoms. Behavior Modification, 20, 116–132. doi:10.1177/01454455960201006.

    Article  CAS  PubMed  Google Scholar 

  • Frost, R.O., & Steketee, G. (2003, July). Community response to hoarding problems. Paper presented at the Annual Meeting of the Obsessive-Compulsive Foundation, Nashville, TN.

  • Frost, R. O., Steketee, G., Tolin, D. F., & Brown, T. A. (2006, March). Comorbidity and diagnostic issues in compulsive hoarding. Paper presented at the Annual Meeting of the Anxiety Disorders Association of America, Miami, Florida.

  • Frost, R. O., Steketee, G., Tolin, D. F., & Renaud, S. (2008). Development and validation of the Clutter Image Rating. Journal of Psychopathology and Behavioral Assessment, 32, 401–417.

    Google Scholar 

  • Frost, R. O., Steketee, G., & Williams, L. (2000). Hoarding: A community health problem. Health & Social Care in the Community, 8, 229–234. doi:10.1046/j.1365-2524.2000.00245.x.

    Article  Google Scholar 

  • Frost, R. O., Steketee, G., Youngren, V. R., & Mallya, G. K. (1999). The threat of the housing inspector: A case of hoarding. Harvard Review of Psychiatry, 6, 270–278. doi:10.3109/10673229909000339.

    Article  CAS  PubMed  Google Scholar 

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.

    CAS  PubMed  Google Scholar 

  • Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. The American Psychologist, 59, 93–104. doi:10.1037/0003-066X.59.2.93.

    Article  PubMed  Google Scholar 

  • Greenberg, D. (1987). Compulsive hoarding. American Journal of Psychotherapy, 41, 409–416.

    CAS  PubMed  Google Scholar 

  • Grisham, J. R., Frost, R. O., Steketee, G., Kim, H. J., & Hood, S. (2006). Age of onset of compulsive hoarding. Journal of Anxiety Disorders, 20, 675–686. doi:10.1016/j.janxdis.2005.07.004.

    Article  PubMed  Google Scholar 

  • Hollander, E., Baldini Rossi, N., Sood, E., & Pallanti, S. (2003). Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: A double-blind, placebo-controlled study. The International Journal of Neuropsychopharmacology, 6, 397–401. doi:10.1017/S1461145703003730.

    Article  CAS  PubMed  Google Scholar 

  • Hoogduin, C. A., & Duivenvoorden, H. J. (1988). A decision model in the treatment of obsessive-compulsive neuroses. The British Journal of Psychiatry, 152, 516–521. doi:10.1192/bjp.152.4.516.

    Article  CAS  PubMed  Google Scholar 

  • Insel, T. R., & Akiskal, H. S. (1986). Obsessive-compulsive disorder with psychotic features: A phenomenologic analysis. The American Journal of Psychiatry, 143, 1527–1533.

    CAS  PubMed  Google Scholar 

  • Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19.

    CAS  PubMed  Google Scholar 

  • Kozak, M. J., & Foa, E. B. (1994). Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder. Behaviour Research and Therapy, 32, 343–353. doi:10.1016/0005-7967(94)90132-5.

    Article  CAS  PubMed  Google Scholar 

  • Kraut, R., Olson, J., Banaji, M., Bruckman, A., Cohen, J., & Couper, M. (2004). Psychological research online: Report of Board of Scientific Affairs’ Advisory Group on the Conduct of Research on the Internet. The American Psychologist, 59, 105–117. doi:10.1037/0003-066X.59.2.105.

    Article  PubMed  Google Scholar 

  • Marazziti, D., Dell’Osso, L., Di Nasso, E., Pfanner, C., Presta, S., Mungai, F., et al. (2002). Insight in obsessive-compulsive disorder: A study of an Italian sample. European Psychiatry, 17, 407–410. doi:10.1016/S0924-9338(02)00697-1.

    Article  PubMed  Google Scholar 

  • Mataix-Cols, D., Marks, I. M., Greist, J. H., Kobak, K. A., & Baer, L. (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from a controlled trial. Psychotherapy and Psychosomatics, 71, 255–262. doi:10.1159/000064812.

    Article  PubMed  Google Scholar 

  • Mataix-Cols, D., Rauch, S. L., Manzo, P. A., Jenike, M. A., & Baer, L. (1999). Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. The American Journal of Psychiatry, 156, 1409–1416.

    CAS  PubMed  Google Scholar 

  • Matsunaga, H., Kiriike, N., Matsui, T., Oya, K., Iwasaki, Y., Koshimune, K., et al. (2002). Obsessive-compulsive disorder with poor insight. Comprehensive Psychiatry, 43, 150–157. doi:10.1053/comp.2002.30798.

    Article  CAS  PubMed  Google Scholar 

  • McGlynn, S. M., & Schacter, D. L. (1989). Unawareness of deficits in neuropsychological syndromes. Journal of Clinical and Experimental Neuropsychology, 11, 143–205. doi:10.1080/01688638908400882.

    Article  CAS  PubMed  Google Scholar 

  • Meunier, S. A., Tolin, D. F., Frost, R. O., Steketee, G., & Brady, R. E. (2006, March). Prevalence of hoarding symptoms across the anxiety disorders. Paper presented at the Annual Meeting of the Anxiety Disorders Association of America, Miami, FL.

  • Neziroglu, F., McKay, D., Yaryura-Tobias, J. A., Stevens, K. P., & Todaro, J. (1999a). The Overvalued Ideas Scale: Development, reliability and validity in obsessive-compulsive disorder. Behaviour Research and Therapy, 37, 881–902. doi:10.1016/S0005-7967(98)00191-0.

    Article  CAS  PubMed  Google Scholar 

  • Neziroglu, F., Stevens, K., & Yaryura-Tobias, J. A. (1999b). Overvalued ideas and their impact on treatment outcome. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil), 21, 209–214. doi:10.1590/S1516-44461999000400009.

    Google Scholar 

  • O’Connor, K. P., Aardema, F., Bouthillier, D., Fournier, S., Guay, S., Robillard, S., et al. (2005). Evaluation of an inference-based approach to treating obsessive-compulsive disorder. Cognitive Behaviour Therapy, 34, 148–163. doi:10.1080/16506070510041211.

    Article  PubMed  Google Scholar 

  • Okasha, A., Saad, A., Khalil, A. H., el Dawla, A. S., & Yehia, N. (1994). Phenomenology of obsessive-compulsive disorder: A transcultural study. Comprehensive Psychiatry, 35, 191–197. doi:10.1016/0010-440X(94)90191-0.

    Article  CAS  PubMed  Google Scholar 

  • Olatunji, B. O., Williams, B. J., Haslam, N., Abramowitz, J. S., & Tolin, D. F. The latent structure of obsessive-compulsive symptoms: A taxometric study. Depression and Anxiety (in press).

  • Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrated model of change. Psychotherapy Theory, Research, and Practice, 19, 276–288. doi:10.1037/h0088437.

    Article  Google Scholar 

  • Rimel, R. W., Giordani, B., Barth, J. T., Boll, T. J., & Jane, J. A. (1981). Disability caused by minor head injury. Neurosurgery, 9, 221–228. doi:10.1097/00006123-198109000-00001.

    Article  CAS  PubMed  Google Scholar 

  • Samuels, J. F., Bienvenu, O. J., Pinto, A., Fyer, A. J., McCracken, J. T., Rauch, S. L., et al. (2007). Hoarding in obsessive-compulsive disorder: Results from the OCD Collaborative Genetics Study. Behaviour Research and Therapy, 45, 673–686. doi:10.1016/j.brat.2006.05.008.

    Article  PubMed  Google Scholar 

  • Schacter, D. L., Glisky, E. L., & McGlynn, S. M. (1990). Impact of memory disorder on everyday life: Awareness of deficits and return to work. In K. Cicerone (Ed.), The neuropsychology of everyday life: Assessment and basic competencies (pp. 231–258). Norwell, MA: Kluwer.

    Google Scholar 

  • Skitka, L. J., & Sargis, E. G. (2006). The internet as psychological laboratory. Annual Review of Psychology, 57, 529–555. doi:10.1146/annurev.psych.57.102904.190048.

    Article  PubMed  Google Scholar 

  • Steketee, G., & Frost, R. O. (2003). Compulsive hoarding: Current status of the research. Clinical Psychology Review, 23, 905–927. doi:10.1016/j.cpr.2003.08.002.

    Article  PubMed  Google Scholar 

  • Steketee, G., Frost, R., & Bogart, K. (1996). The Yale-Brown Obsessive Compulsive Scale: Interview versus self-report. Behaviour Research and Therapy, 34, 675–684. doi:10.1016/0005-7967(96)00036-8.

    Article  CAS  PubMed  Google Scholar 

  • Steketee, G., Frost, R. O., & Kim, H. J. (2001). Hoarding by elderly people. Health and Social Work, 26, 176–184.

    PubMed  Google Scholar 

  • Storch, E. A., Lack, C. W., Merlo, L. J., Geffken, G. R., Jacob, M. L., Murphy, T. K., et al. (2007). Clinical features of children and adolescents with obsessive-compulsive disorder and hoarding symptoms. Comprehensive Psychiatry, 48, 313–318. doi:10.1016/j.comppsych.2007.03.001.

    Article  PubMed  Google Scholar 

  • Tolin, D. F., Frost, R. O., & Steketee, G. (2007a). A brief interview for assessing compulsive hoarding: The Hoarding Rating Scale-Interview (submitted for publication).

  • Tolin, D. F., Frost, R. O., & Steketee, G. (2007b). An open trial of cognitive-behavioral therapy for compulsive hoarding. Behaviour Research and Therapy, 45, 1461–1470. doi:10.1016/j.brat.2007.01.001.

    Article  PubMed  Google Scholar 

  • Tolin, D. F., Frost, R. O., Steketee, G., & Fitch, K. E. (2008a). Family burden of compulsive hoarding: Results of an internet survey. Behaviour Research and Therapy, 46, 334–344. doi:10.1016/j.brat.2007.12.008.

    Article  PubMed  Google Scholar 

  • Tolin, D. F., Frost, R. O., Steketee, G., Gray, K. D., & Fitch, K. E. (2008b). The economic and social burden of compulsive hoarding. Psychiatry Research, 160, 200–211. doi:10.1016/j.psychres.2007.08.008.

    Article  PubMed  Google Scholar 

  • Weinstein, E. A., & Kahn, R. L. (1950). The syndrome of anosognosia. A.M.A. Archives of Neurology and Psychiatry, 64, 772–791.

    CAS  PubMed  Google Scholar 

  • Wu, K. D., & Watson, D. (2005). Hoarding and its relation to obsessive-compulsive disorder. Behaviour Research and Therapy, 43, 897–921. doi:10.1016/j.brat.2004.06.013.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by National Institute of Mental Health grants R01 MH074934 (Tolin), R01 MH068008 and MH068007 (Frost and Steketee), and R21 MH068539 (Steketee). Oxford University Press supplied copies of a book to be used in a raffle for participants. Results of this study were presented at the Annual Meeting of the Association of Behavioral and Cognitive Therapies, November 2007, Philadelphia. The authors thank Dr. Nicholas Maltby for his technical assistance.

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Authors and Affiliations

  1. Anxiety Disorders Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA

    David F. Tolin & Kristin E. Fitch

  2. Yale University School of Medicine, New Haven, CT, USA

    David F. Tolin

  3. Smith College, Northampton, MA, USA

    Randy O. Frost

  4. Boston University School of Social Work, Boston, MA, USA

    Gail Steketee

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  1. David F. Tolin
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Correspondence to David F. Tolin.

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Tolin, D.F., Fitch, K.E., Frost, R.O. et al. Family Informants’ Perceptions of Insight in Compulsive Hoarding. Cogn Ther Res 34, 69–81 (2010). https://doi.org/10.1007/s10608-008-9217-7

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