Decision Making and Association in Hoarding

Hoarding is a serious and debilitating disorder that has a chronic course, is difficult to treat, and has a high treatment dropout rate. The most notable feature of hoarding is excessive clutter, which is driven by excessive acquiring of objects and difficulty discarding them. Two little researched factors that appear to be particularly central in contributing to acquiring and difficulty discarding are decision-making deficits and association. This study examined decision making and association, using self-report measures, a computerized decision-making task, and an association task, in a sample of 62 participants, consisting of 39 hoarders and 23 non-hoarding controls. These individuals were recruited from online sources and completed the study online. As predicted, hoarders scored significantly higher than controls on aspects of decision making: indecision, concern over mistakes and perfectionism. As predicted, group differences were not found for actual number of mistakes on a decision-making task. Contrary to predictions, hoarders and controls did not differ on the decision-making aspects of slowness; considering many pieces of information; or the information processing aspect of association. Results revealed no significant correlations between measures of hoarding symptoms and any aspects of decision making or association. Furthermore, concern over mistakes did not predict hoarding symptoms over and beyond actual mistakes. Indecision did not mediate concern over mistakes and hoarding symptoms, nor did indecision mediate perfectionism and hoarding symptoms on either hoarding measure in the hoarding group. These findings provide further support for the role of certain decision-making deficits in hoarding and highlight the need to conceptualize and examine potential ways these deficits impact acquisition and difficulty discarding. Definition, Prevalence, and Distinct Diagnostic Category of Hoarding Hoarding disorder is a serious and debilitating disorder that is estimated to impact 4% of the population (Samuels, Bienvenu, Grados, et al., 2008). Although hoarding was described in written literature as early as the 1300’s (Alighieri & Ciardi, 1954), hoarding received very little clinical attention until the 1990’s because it was thought to be a rare phenomenon (International OCD Foundation, n.d.). Frost and Gross were the first to study and describe the disorder (Frost & Gross, 1993). Frost and Hartl later expanded upon Frost and Gross’ initial description by establishing criteria that are still used as the basis for diagnosis today. Specifically, hoarding is “1) the acquisition of, and failure to discard a large number of possessions that appear be useless or of limited value; 2) living spaces sufficiently cluttered so as to preclude activities for which those rooms were designed; and 3) significant distress or impairment in functioning caused by the hoarding” (Frost & Hartl, 1996, p. 341). Since the publication of these seminal articles, hoarding has received increased attention in the research literature, and more recently, in the popular press. Despite some advances in the conceptualization and study of this disorder, little is known about its phenomenology, course, and contributing factors. Although researchers have begun to study hoarding, its minimal research base may be due in part to the fact that, until recently, it was classified as a symptom of obsessive-compulsive disorder by the DSM.