Among the indicators suggesting problem hoarding behavior, Saxena cited urges to save things; difficulties with discarding things (which he characterized as "disposaphobia"); extensive clutter in the home that poses a public health or safety hazard; and associated features, such as severe indecisiveness, procrastination, and disorganization.
Wheaton indicated that the gold standard for diagnosing hoarding currently is the Y-BOCS, but that in the future, it may be the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS).7
"Not only does [DY-BOCS] ask more specific questions about hoarding but it breaks down obsessive-compulsive severity by categories . . . you can have someone with very severe hoarding who might also have less severe checking symptoms," he said.
Another useful tool, particularly for treatment studies, he added, is the Saving Inventory-Revised, a 23-item self-report questionnaire designed to measure hoarding-related behaviors, including difficulty in discarding, acquisition, and clutter.8
Saxena and colleagues also have developed a clinician-administered rating scale, the UCLA Hoarding Severity Scale,9 that measures the severity of compulsive hoarding and its associated features.
In recent months, the results of 2 treatment studies have been published, one involving pharmacotherapy and the other on cognitive-behavioral therapy (CBT).
Saxena and colleagues9 compared the response of 32 OCD patients with compulsive hoarding and 47 non-hoarding OCD patients to paroxetine(Drug information on paroxetine) (Paxil). To date, this is the only prospective trial of standardized pharmacotherapy in compulsive hoarders. Participants had to be free from psychotropic medication for 4 weeks before study entry and could not take other psychotropic medications during the study.
"The biggest finding and the one that was most surprising to some people is that paroxetine worked just as well for the compulsive hoarder as it did for the non-hoarding OCD patient," Saxena told Psychiatric Times. "The two groups had virtually identical improvements in OCD symptoms, anxiety symptoms, depression symptoms, and overall functioning. Furthermore, if you took the entire group, the severity of hoarding symptoms did not predict better or worse response to paroxetine. Both of these findings went against the conventional wisdom."
That conventional wisdom, formed on the basis of a few unreplicated studies, says that serotonin reuptake inhibitors do not work for compulsive hoarders and that hoarders do not respond well to treatment, he explained.
Currently, Saxena is lead investigator on another study looking at the neurobiology and treatment of compulsive hoarding. In that study, scheduled to continue for another 2 or 3 years, participants are undergoing positron emission tomography and MRI scans as well as neurocognitive testing both before and after treatment with venlafaxine (Effexor). This study, he predicted, will help investigators identify baseline abnormalities in brain structure and function, track how those abnormalities change with treatment, and possibly identify pretreatment predictors of response to treatment. For clinical treatment of patients with compulsive hoarding, Saxena advocates using both medications and CBT tailored to compulsive hoarding.10,11
Tolin and coauthors12 just published preliminary data on the efficacy of a new cognitive-behavioral treatment for compulsive hoarding. Patients received 26 sessions of CBT including frequent home visits over a 7-month period. At post-treatment evaluation, 5 of 10 treatment completers were rated as much or very much improved.
Optimistic about treatment, Saxena declared, "I have seen compulsivehoarders have major improvements with treatment. That is something even the clinical community doesn't quite understand. . . . These folks can get better, but you have to do treatment that is really focused on the core features."