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Behaviour Research and Therapy 44 (2006) 1503–1512


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Shorter communication

The hoarding dimension of OCD: Psychological comorbidity


and the five-factor personality model
V. Holland LaSalle-Riccia,b,, Diane B. Arnkoff a, Carol R. Glassa,
Sarah A. Crawleya,b, Jonne G. Ronquilloa,b, Dennis L. Murphyb
a
The Catholic University of America, Adult OCD Unit, NIMH, 10 Center Drive MSC 1264, 10/3D41, Bethesda, MD 20892, USA
b
National Institutes of Health, Adult OCD Unit, NIMH, 10 Center Drive MSC 1264, 10/3D41, Bethesda, MD 20892, USA

Received 19 April 2005; received in revised form 6 November 2005; accepted 8 November 2005

Abstract

Although hoarding has been associated with several psychological disorders, it is most frequently linked to
obsessive–compulsive disorder (OCD). The present study assessed hoarding obsessions and compulsions in 204 individuals
with OCD, and evaluated how hoarding was related to obsessive–compulsive symptom severity, psychological
comorbidity, and personality as measured by the five-factor model. Results indicated that hoarding in OCD is a
dimensional variable that is positively associated with dysphoria, total number of lifetime Axis I disorders, and lifetime
histories of bipolar I, PTSD, and body dysmorphic disorder. Hoarding was negatively correlated with the NEO-
Personality Inventory-Revised (NEO-PI-R) factor of Conscientiousness and positively associated with the NEO-PI-R
factor of Neuroticism. When all personality and psychopathology variables were entered into a regression equation,
dysphoria, bipolar II disorder, Conscientiousness, age, and Extraversion emerged as significant predictors of hoarding
severity. Recommendations are made for clinicians and for future research.
r 2005 Elsevier Ltd. All rights reserved.

Keywords: Hoarding; Obsessive–compulsive disorder; Personality; Five-factor model; Comorbidity

Introduction

Obsessive–compulsive disorder (OCD), once thought to be a rare anxiety disorder, is now believed to affect
between 1% and 3% of the general population (e.g., Weissmann et al., 1994). While certain clinical symptoms
are common to all persons with OCD, other features vary among individuals. Hoarding obsessions and
compulsions are examples of such variable OCD characteristics that have only recently been explored
empirically.
Hoarding may be defined as the acquisition of and failure to discard apparently useless possessions (Frost &
Gross, 1993). In some extreme cases, hoarding may pose dangerous emotional and physical risks to
individuals, as well as to entire communities. Extensive clutter increases fire hazards and the threat of personal

Corresponding author. Tel.: +1 202 607 4593; fax: +1 301 469 0188.
E-mail address: vholly@aol.com (V.H. LaSalle-Ricci).

0005-7967/$ - see front matter r 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.brat.2005.11.009
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injury or death, and hoarding of food and animals may elevate risk of illness or contamination. Although
some data suggest a familial pattern (Frost & Gross, 1993; Samuels et al., 2002) and chromosomal regions
linked to hoarding obsessions and compulsions have been found in a Tourette’s Disorder sibling sample
(Zhang et al., 2002), the causes of hoarding remain unknown and are likely multimodal.
Hoarding is a symptom of several psychological disorders, and hoarding behaviors exist in a wide range of
conditions including dementia (Hwang, Tsai, Yang, Liu, & Lirng, 1998), focal lesions of the mesial frontal
cortex identified by MRI (Anderson, Damasio, & Damasio, 2005), depression (Shafran & Tallis, 1996), and
anorexia nervosa (Frankenburg, 1984). However, hoarding is most commonly associated with OCD, where
symptoms affect between 18% and 42% of OCD clients (Hanna, 1995; Rasmussen & Eisen, 1992; Samuels et
al., 2002).
Relatively little is known about the relationships among hoarding, psychopathology, and personality in
OCD-affected individuals, although several studies have found that hoarding is related to treatment response,
outcome, and comorbidity patterns. Hoarding has been associated with less improvement following exposure
with response prevention (Mataix-Cols, Marks, Greist, Kobak, & Baer, 2002), cognitive-behavior therapy
(Abramowitz, Franklin, Schwartz, & Furr, 2003; Black et al., 1998; Saxena et al., 2002), psychosocial
rehabilitation (Saxena et al., 2002), and psychopharmacological treatment (Black et al., 1998; Mataix-Cols,
Rauch, Manzo, Jenike, & Baer, 1999; Saxena et al., 2002).
In studies of psychopathology, Frost, Steketee, Williams, and Warren (2000) reported that OCD hoarding
clients scored higher on scales of anxiety and depression and evidenced more dependent and schizotypal
personality disorder symptoms than OCD clients who did not hoard. Samuels et al. (2002) found that OCD
hoarders displayed a higher prevalence of Axis I disorders (including social phobia, brief depression, and
hypomania), Axis II disorders (including obsessive–compulsive, borderline, histrionic, and narcissistic
personality disorders), and pathological grooming behaviors (including trichotillomania, nail biting, and skin
picking). Steketee, Frost, and Kyrios (2003) found that compulsive hoarders (70% diagnosed with OCD)
scored significantly higher than individuals with OCD (without hoarding) and controls on measures of
depression and anxiety. Fontenelle, Mendlowicz, Soares, and Versiani (2004) reported higher rates of
comorbid bipolar II disorder and eating disorders among OCD hoarders. Hartl, Duffany, Allen, Steketee, and
Frost (2005) found that compulsive hoarders (32% with a prior diagnosis of OCD) reported a larger number
of types of trauma, greater frequency of traumas experienced, and higher scores on inattention and
hyperactivity scales. Frost, Krause, and Steketee (1996) found that compulsive hoarders scored higher on a
measure of general psychopathology, and Frost and Gross (1993) reported that hoarders seek psychotherapy
more often than nonhoarders. More research, with larger sample sizes, is needed to establish whether patterns
of comorbidity are related to the hoarding dimension.
No study to date has assessed the relationship between hoarding and normal personality as measured by the
Big Five (McCrae & Costa, 1999). The Five-Factor Model (FFM) proposes that personality is comprised of
Neuroticism, Extraversion, Openness to experience, Agreeableness, and Conscientiousness. Some investiga-
tions have assessed five-factor personality traits among individuals with OCD, although none have compared
differences based on the presence of hoarding. Samuels et al. (2000) found that individuals with OCD had
significantly higher levels of Neuroticism when compared to controls. OCD-affected individuals also scored
significantly lower than controls on Extraversion and higher on Agreeableness, but their scores were similar to
the population means for those factors. One study comparing depressed individuals to those with OCD found
that the latter scored higher on Extraversion and Agreeableness, and lower on Neuroticism, once depression
was controlled (Rector, Hood, Richter, & Bagby, 2002). Finally, Bienvenu et al. (2004) found that individuals
with OCD scored high on both Neuroticism and Openness compared to controls.
Of particular interest in OCD samples is Neuroticism, which refers to high degrees of emotional instability
(Costa & McCrae, 1992). Elevated levels of Neuroticism are linked with a predisposition to psychological
distress (Costa & Widiger, 1994) and increased psychopathology (Widiger & Trull, 1992). Low levels of
Extraversion, or preference for interpersonal interaction, activity, and ability to experience joy (Costa &
Widiger, 1994) have also been associated with the presence of psychological disorders (Widiger & Trull, 1992)
and may be related to hoarding in OCD. Finally, Conscientiousness may be negatively correlated with
hoarding, as Conscientiousness is related to being highly orderly (Costa & McCrae, 1992) and measures the
degree to which a person is organized, persistent, and goal-directed (Costa & Widiger, 1994).
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The purpose of the present study was to assess the extent of hoarding in a large sample of individuals with
OCD, and to determine whether the hoarding dimension was related to obsessive–compulsive symptom
severity, psychological comorbidity, and five-factor personality traits. Consistent with the available literature
on comorbidity, the first prediction was that hoarding would be associated with a higher prevalence of social
phobia, major depression, and bipolar disorders. The second prediction stated that hoarding would exhibit a
positive relationship with Neuroticism and negative relationships with Extraversion and Conscientiousness. In
line with previous research, the third prediction was that hoarding would be associated with dysphoria and
obsessive–compulsive symptom severity.

Method

Participants

Participants included 204 outpatients from the Adult OCD Clinic at the National Institute of Mental Health
(NIMH) who were participating in a genetic testing protocol and had given written informed consent. Ten
additional participants were excluded because they failed to return study materials. Inclusion criteria included
being at least 18 years of age and having an OCD diagnosis based on the Structured Clinical Interview for
DSM-IV (SCID-P; First, Spitzer, Gibbon, & Williams, 2001) criteria. Exclusion criteria included active
schizophrenia or psychosis (one individual excluded), severe mental retardation that did not permit an
evaluation to characterize OCD (one individual excluded), or OCD symptoms that occurred exclusively in the
context of depression (two individuals excluded).
The mean age of OCD onset was 14.18 years (SD ¼ 8:67) and ranged from 3 to 55 years. The average
Yale–Brown Obsessive Compulsive Scale (Y–BOCS; Goodman et al., 1989a) score was 21.63 (SD ¼ 9:34) and
ranged from 5 to 40. Approximately 62.9% were women. The sample was largely white (95%), but also
included small subgroups of Hispanic (1.6%), African American (1.1%), Asian (1.1%), and other (1.1%)
participants. Forty-four percent were married at the time of initial contact. In line with previous studies (e.g.,
LaSalle et al., 2004), nearly 90% of individuals in the sample had a history of at least one previous Axis I
psychological diagnosis other than OCD. The number of additional Axis I disorders ranged from 0 to 8
(M ¼ 2:46, SD ¼ 1:79).

Measures

Structured clinical interview for DSM-IV-TR Axis I Disorders, research version, patient edition (SCID-P)
Participants were interviewed using the SCID-P for DSM-IV-TR (First et al., 2001), which is a semi-
structured interview designed to determine lifetime and current diagnoses of OCD and other major DSM Axis
I disorders. SCID interviews were administered by trained and clinically experienced interviewers. In an effort
to reach further reliability and interviewer consensus, each participant’s SCID was re-assessed by two
independent clinicians for blind diagnoses. Segal, Hersen, and Van Hasselt (1994) found the SCID highly
reliable for most Axis I disorders. SCID diagnoses in the present study also demonstrated excellent reliability,
with kappas of .93 for major depression and .86 for anorexia nervosa; diagnostic concordance for OCD was
100%.

Yale– Brown Obsessive Compulsive Scale


The magnitude of obsessions and compulsions was measured with the self-report version of the Yale–Brown
Obsessive Compulsive Scale (Goodman et al., 1989b), a frequently used 10-item assessment tool for
the severity of obsessive–compulsive symptoms. Scores on the Y–BOCS are significantly correlated (.74) with
the modified version of the Clinical Global Impression Scale for Global Severity of OCD (Goodman et al.,
1989a).

Saving Inventory-Revised (SI-R)


The SI-R (Frost, Steketee, & Greene, 2003) is a 23-item questionnaire designed to measure hoarding
behaviors. This instrument includes three subscales for clutter, difficulty discarding, and acquisition. The SI-R
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has been found to have strong internal consistency, good test–retest reliability, and good convergent validity
(Coles, Frost, Heimberg, & Steketee, 2003; Frost, Steketee, & Grisham, 2004).

Hoarding subscales
Two hoarding-related questions from the Yale–Brown Obsessive Compulsive Symptom Checklist
(Y-BOCS-SC; Goodman et al., 1989b) and three hoarding-related questions from the Thoughts and
Behaviors Inventory (TBI; Slattery et al., 2004) were used to examine the validity of these items for the
assessment of hoarding. The Y–BOCS-SC is an obsessive–compulsive symptom inventory that has
demonstrated high reliability and validity (Goodman et al., 1989a), and the TBI is an updated and modified
version of the Y–BOCS-SC.

NEO-Personality Inventory-Revised (NEO-PI-R)


The NEO-PI-R (Costa & McCrae, 1992) is a 240-item personality questionnaire that is currently considered
the gold standard of personality assessment. The NEO measures five broad domains of personality, each of
which is divided into six facets, using the FFM. The NEO-PI-R is highly reliable, with alpha coefficients for
domain scores ranging from .89 to .95 (Costa & McCrae, 1992). Additionally, factor domains and facet scores
demonstrate excellent content, convergent, and discriminant validity (Costa & McCrae, 1992; McCrae &
Costa, 1988; Trapnell & Wiggins, 1990).

Beck Depression Inventory (BDI)


The BDI (Beck, Rush, Shaw, & Emery, 1979) is a 21-item measure of global dysphoria that assesses
current mood. Reliability and validity of the BDI are well established (e.g., Beck, Steer, & Garbin,
1988).

Procedure

All participants were mailed a questionnaire packet including two copies of an informed consent form, the
SI-R, Y–BOCS-SC, TBI, Y–BOCS, NEO-PI-R, and BDI. Participants returned one copy of the informed
consent form along with the questionnaire packet and then completed the SCID interview either in person or
over the telephone.

Results

Hoarding descriptive statistics and correlations

In order to control for multiple tests, a conservative significance level was set at po:01 for all correlation
analyses. The mean SI-R score was 27.56 (SD ¼ 1:79) and ranged from 0 to 82 (see Fig. 1). Because of the wide
range of hoarding severity in this sample, we elected to examine hoarding on a continuum, rather than as a
categorical variable. Total scores on the SI-R were significantly and positively correlated with total number of
additional lifetime psychological disorders (rð197Þ ¼ :20, p ¼ :01) and BDI scores, and there was a trend
toward a positive relationship with Y–BOCS (see Table 1). As expected, SI-R scores exhibited large
correlations with the TBI hoarding subscale and the Y–BOCS-SC hoarding subscale. All three SI-R subscales
were significantly and positively correlated with SI-R total score and were very highly correlated with each
other.

Hoarding, comorbidity, and personality

Point bi-serial correlations were used to assess the relationship between hoarding and Axis I disorders, as
assessed by the SCID-P (see Table 2). Diagnoses of bipolar I disorder, PTSD, and body dysmorphic disorder
were significantly and positively correlated with hoarding.
Pearson correlations were used to determine the relationships between hoarding and personality factors and
facets on the NEO-PI-R (see Table 3). Hoarding was significantly and positively related to the Neuroticism
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25

20

15
Frequency

10

0
0.00 20.00 40.00 60.00 80.00
Saving Inventory-Revised
(N=204)

Fig. 1. Distribution of saving inventory-revised total hoarding scores.

Table 1
Pearson correlations among SI-R subscales, hoarding subscales, and psychopathology scales

SI-R total Discarding Clutter Acquisition

SI-R total
Discarding factor items .91***
Clutter factor items .92*** .78***
Acquisition factor items .86*** .74*** .65***
a
Hoarding subscales
Y–BOCS-SC .68*** .67*** .60*** .58***
TBI .53*** .60*** .47*** .39***
Other scales
Y–BOCS .19* .19* .12 .24**
BDI .32*** .22** .33*** .33***

Note: SI-R ¼ Saving Inventory Revised; Y–BOCS-SC ¼ Yale–Brown Obsessive Compulsive Scale-Symptom Checklist; TBI ¼ Thoughts
and Behaviors Inventory; Y–BOCS ¼ Yale–Brown Obsessive Compulsive Inventory; BDI ¼ Beck Depression Inventory.*po:05 (trend);
**po:01; ***po:001.
a
Hoarding subscales include two items from the Y–BOCS-SC and three items from the TBI.

factor and four of the six Neuroticism facets: Anxiety (rð145Þ ¼ :24, po:01), Self-Consciousness (rð145Þ ¼ :32,
po:001), Impulsiveness (rð145Þ ¼ :28, po:01), and Vulnerability (rð145Þ ¼ :26, po:01). Hoarding thoughts
and behaviors were significantly and inversely related to the Conscientiousness factor and to one of the six
Conscientiousness facets: Order (rð144Þ ¼ :27, p ¼ :001).
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Table 2
Point bi-serial correlations between hoarding and Axis I disorders

SI-R total Discarding Clutter Acquisition

Major depression .08 .06 .08 .00


Dysthymia .06 .06 .07 .01
Bipolar I .18** .15* .10 .21*
Bipolar II .03 .04 .08 .03
Substance abuse or dependence .17* .17* .11 .22**
Alcohol abuse or dependence .06 .05 .07 .11
Panic disorder .09 .06 .06 .08
Social phobia .05 .09 .04 .15*
Specific phobia .06 .06 .02 .06
Generalized anxiety disorder .02 .06 .02 .03
Posttraumatic stress disorder .19** .15* .15* .23**
Agoraphobia .10 .00 .05 .14
Body dysmorphic disorder .21** .20** .19** .19*
Anorexia nervosa .03 .03 .04 .03
Bulimia nervosa .00 .02 .04 .05
Binge-eating disorder .14* .10 .15* .14

Note: SI-R ¼ Saving Inventory-Revised.


*po.05 (trend); **po.01.

Table 3
Pearson correlations between hoarding and personality variables

NEO-PI-Ra SI-R total

Neuroticism .30***
Extraversion .04
Openness .02
Agreeableness .05
Conscientiousness .28**

Note: NEO-PI-R ¼ NEO-Personality Inventory-Revised; SI-R total ¼ Saving Inventory-Revised.


**po:01; ***po:001.

Multivariate predictions

In an attempt to evaluate the entire clinical picture of hoarding, age, BDI, all SCID variables, and the NEO
factors were entered into a stepwise regression. BDI (F ð1; 95Þ ¼ 13:2, b ¼ :37, po:001, R2 change ¼ .11),
bipolar II (F ð1; 95Þ ¼ 10:42, b ¼ :25, p ¼ :01, R2 change ¼ .06), Conscientiousness (F ð1; 95Þ ¼ 8:79, b ¼ :22,
p ¼ :03, R2 change ¼ .06), age (F ð1; 95Þ ¼ 8:27, b ¼ :22 p ¼ :02, R2 change ¼ .05), and Extraversion
(F ð1; 95Þ ¼ 8:27, b ¼ :22, p ¼ :01, R2 change ¼ .04) were significant predictors of SI-R total scores. Higher
levels of dysphoria, the presence of bipolar II disorder, less Conscientiousness, higher age, and more
Extraversion were related to increased hoarding severity.

Discussion

The present investigation is the first to examine the relationships among psychopathology, NEO five-factor
personality, and hoarding in a large, SCID-evaluated, clinical OCD sample. Hoarding was assessed using a
reliable and valid measure of hoarding (SI-R) and two hoarding subsections of OCD symptom inventories
(Y–BOCS-SC and TBI). The SI-R was positively and significantly correlated with the other two subscales,
lending more validity to the SI-R as a means of assessing hoarding in OCD populations. Hoarding appeared
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to represent a continuous variable, and was thus analyzed dimensionally. Only a handful of individuals failed
to endorse any hoarding symptoms, which replicates previous research on individuals with OCD (Frost et al.,
2004).
When clinicians treat clients with OCD, obsessions and compulsions may seem so severe that they become
the sole focus of psychotherapeutic and psychopharmacologic treatment. Due to the severity of
obsessive–compulsive symptoms, potential comorbid psychiatric diagnoses may be overlooked in clinical
practice and may, therefore, go untreated entirely. It is thus critical that research address the issue of
psychological comorbidity and that this research, in turn, guide clinical practice. In our sample, SI-R was
positively and significantly correlated with BDI score, bipolar I, PTSD, body dysmorphic disorder, and total
number of psychological disorders assessed. Contrary to our hypotheses, hoarding was not associated with a
history of social phobia. Additionally, there was only a trend toward a significant positive relationship
between hoarding and obsessive–compulsive symptom severity. These findings suggest that hoarding is related
to a range of psychopathology that is not limited to anxiety or its disorders.
Previous studies have found greater incidences of depression (Samuels et al., 2002; Steketee et al., 2003) and
bipolar II disorder (Fontenelle et al., 2004) among OCD hoarders. No other study to date has reported on the
relationship between hoarding and PTSD, although Hartl et al. (2005) did find that compulsive hoarders (32%
with OCD) reported a greater lifetime history of trauma than did controls. Furthermore, Steketee et al. (2003)
found a correlation between hoarding and measures of anxiety.
Findings regarding the relationship between hoarding and comorbidity have important implications for
psychological and psychopharmacological treatment. First, clients presenting for treatment of obsessions and
compulsions should be assessed for the presence of hoarding thoughts and behaviors. Second, OCD clients
who hoard should be carefully evaluated for depression and suicide risk, as one preliminary study found that
approximately 26% of clients with OCD experience suicidality ranging from ideation to multiple attempts
(Nelson, LaSalle, Cromer, Stayer, & Murphy, 2003).
Third, psychological and psychopharmacological treatments of OCD may have differential impacts on
comorbid depression, as depression has been linked to poorer treatment outcome (e.g., Abramowitz, Franklin,
Street, Kozak, & Foa, 2000; Foa et al., 1983). Some research suggests that comorbid conditions such as
depression may need to be resolved before cognitive-behavior therapy for OCD can be effective (Perugi et al.,
1997, 1998). Other comorbid conditions have also been associated with poorer treatment outcome for OCD,
including bipolar disorders (Perugi et al., 2002) and PTSD (Gershuny, Baer, Jenike, Minichiello, & Wilhelm,
2002). Several studies have found that the presence of hoarding symptoms is related to poorer psychotherapy
treatment outcomes (e.g., Abramowitz et al., 2003; Mataix-Cols et al., 2002) and that clients who hoard are
less likely to respond to selective serotonin reuptake inhibitors (Mataix-Cols et al., 1999).
The relationship between psychopathology and normal personality is important, as it may aid in clarifying
the etiology of psychopathology (Bienvenu et al., 2004) and in informing treatment. As predicted, hoarding
was negatively correlated with the NEO-PI-R factor of Conscientiousness. This relationship remained
significant even when BDI, SCID, and NEO-PI-R data were entered into a regression equation. The
relationship between Conscientiousness and hoarding, especially the relationship between the Order facet and
hoarding, is predicted by the cognitive-behavioral model of compulsive hoarding (Frost & Hartl, 1996). This
model suggests that hoarding is a complex behavior stemming from four factors: (1) behavioral avoidance, (2)
false beliefs about possessions, (3) difficulties forming emotional attachments, and (4) problems processing
information. The current study suggests a relationship between hoarding and information processing deficits,
such as being orderly. These findings may have important treatment implications because hoarders could
benefit from specific behavioral interventions aimed at improving their organizational and processing skills.
The expected positive relationship between hoarding and Neuroticism did emerge in this sample, suggesting
that hoarding is related to anxiety, negative affectivity, and depression. Some previous research has
demonstrated increased levels of Neuroticism in individuals with OCD (Rector et al., 2002; Samuels et al.,
2000), but findings also suggest that those with OCD are less neurotic than depressed individuals. Although a
significant correlation was found between Neuroticism and hoarding in the current study, this association was
largely accounted for by BDI score, and the relationship was no longer significant when all variables were
entered into a regression. This result may suggest that the association between Neuroticism and hoarding is
accounted for by the relationship between Neuroticism and current depression.
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Extraversion measures the preference for interpersonal interaction, activity, need for stimulation, and
ability to experience joy (Costa & Widiger, 1994). Contrary to our prediction, Extraversion was virtually
uncorrelated with hoarding thoughts and behaviors. Extraversion was a significant predictor in the regression
equation, although not in the anticipated direction. In this sample, higher Extraversion was predictive of
higher hoarding scores. It is possible that individuals who hoard and score high on Extraversion may be more
willing to invite behavioral therapists into their home to work on decluttering and maintaining treatment
gains. Therefore, increased Extraversion may enhance treatment gains. Longitudinal research examining
personality and hoarding may help to clarify the etiology and maintenance of hoarding symptoms.
Regression analyses also revealed that higher BDI scores, the presence of bipolar II, lower Conscientious-
ness, higher age, and higher Extraversion were significant (po:05) predictors of hoarding, as measured by
SI-R total scores. Our findings are in line with previous research suggesting that hoarding is linked to
depression (Samuels et al., 2002; Steketee et al., 2003) and bipolar II disorder (Fontenelle et al., 2004).
Likewise, previous research on hoarding in OCD suggests a hoarding-age connection (Fontenelle et al., 2004;
Saxena et al., 2002). No study to date has examined hoarding and personality factors, so replication of the
personality findings is warranted. An inverse relationship between hoarding and Conscientiousness was
anticipated, but not the positive relationship between hoarding and Extraversion found in the regression
model. Despite significant correlations with hoarding behavior, bipolar I, PTSD, and body dysmorphic
disorder did not significantly contribute to hoarding when SCID-P, NEO-PI-R, age, and BDI score were
entered into the equation. Likewise, Neuroticism failed to predict hoarding once all variables were entered,
probably due to the high overlap between dysphoria and Neuroticism.
There are limitations to the current study. Most significantly, the SCID-P does not assess all possible
comorbid conditions; thus other clinically important symptoms (e.g., compulsive skin picking, trichotillo-
mania, ADHD, or personality disorders), may exhibit a significant relationship with the hoarding
dimension. Prior studies suggest that individuals with OCD who hoard are at increased risk for symptoms
of inattention and hyperactivity (Hartl et al., 2005), borderline, histrionic, narcissistic (Samuels et al.,
2002), obsessive–compulsive (Mataix-Cols, Baer, Rauch, Manzo, & Jenike, 2000; Samuels et al., 2002), and
avoidant personality disorders (Mataix-Cols et al., 2000), as well as more dependent and schizotypal
personality disorder symptoms (Frost et al., 2000). Future research should utilize measures that assess
for a broader range of Axis I and Axis II diagnoses in order to further understand the relationship
between hoarding and psychopathology in individuals with OCD. Secondly, the presence of hoarding
obsessions and compulsions was assessed using self-report measures. Home visits may be a useful addition to
the SI-R in the assessment of hoarding obsessions and compulsions. Third, this study did not include
individuals who hoard but have limited or absent OCD symptoms. Results may not generalize to such
individuals.
In conclusion, results from this study suggest that both comorbid conditions and five-factor personality
traits are helpful in defining the clinical characteristics associated with hoarding in OCD samples. Hoarding is
a complex symptom that may be an entity that is genetically and psychologically distinct from the anxiety
disorders. Given the multiple psychological variables that are related to hoarding thoughts and behaviors,
clinicians should aim to assess hoarding obsessions and compulsions at the outset of therapy.
Psychotherapeutic and psychopharmacologic treatment should be tailored to address the specific psychiatric
features a client may portray.

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