Conference Coverage

Hoarding disorder looks different in adolescents



NEW YORK – Hoarding in adolescence is not characterized by accumulation of clutter, as it is in adults, but is no less burdensome a disorder both to patients and families, Volen Z. Ivanov reported at the annual meeting of the American Psychiatric Association.

Indeed, one of the most prominent features of the condition in adults, at least to observers – the presence of clutter – was not endorsed by any of 21 adolescents who met other hoarding criteria, he said.

However, "even if the clutter takes a while to build up, we know that other parts of the disorder are prominent early in life."

Mr. Ivanov, a PhD candidate at Karolinska Instituet, Solna, Sweden, looked at 8,455 adolescents born between 1994 and 1996 who were in the Swedish Twin Registry. The teens had been enrolled in a 2013 study, also by Mr. Ivanov, that assessed the prevalence of hoarding among adolescents.

In that study, Mr. Ivanov found that "clinically significant" hoarding symptoms were present in 2% of the adolescent Swedish population (95% confidence interval, 1.6%-2.5%), and exclusion of the diagnostic criterion stipulating the presence of clutter further increased the prevalence to 3.7% (95% CI 3.1%-4.3%) (PLoS ONE 2013;8:e69140 [doi:10.1371/journal.pone 0069140]).

The present study sought to validate that finding: namely, that clutter need not be present among adolescents to diagnose clinically significant hoarding.

To that end, the researchers targeted 21 of these previously identified hoarding adolescents who met at least criteria A and B according to the new DSM-5 diagnostic definition of hoarding: "persistent difficulty discarding or parting with possessions, regardless of their actual value" and "this difficulty is due to a perceived need to save items and to distress associated with discarding them."

None of the adolescents endorsed the third criteria, "the difficulty in discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use."

The hoarding adolescents were compared with 43 healthy controls, also from the registry.

The researchers found that hoarding adolescents scored a mean of 11.8 on the Hoarding Rating Scale–Self-Report, a 5-item scale with each item measured on a Likert scale from 0 to 8. Healthy controls, on the other hand, scored a mean of 4.1 (P less than .001). Similarly, hoarders tallied a mean 31.8 points on the Saving Inventory-Revised, compared with controls’ mean score of 12.8 (P less than .001).

The hoarders were more likely to have a higher psychiatric burden overall, in the form of comorbid diagnoses over their lifetime, compared with controls (mean 1.5 diagnoses among hoarders, versus 0.1 among controls, P less than .001).

On the other hand, looking at the Family Impact Scale for Hoarding (FISH), the researchers found no significant difference between family burden among hoarders (0.06) and nonhoarding teens (0.18) (P = .33).

According to Mr. Ivanov, while the present study is still ongoing with the goal of collecting data from at least 20 more hoarding adolescents in Sweden, the findings demonstrate that hoarding in young people need not manifest itself in the overwhelming clutter seen with adults and need not burden the child’s family.

Future studies should focus on how hoarding evolves from adolescence through adulthood, and how environment during adolescence might contribute to the development of the disorder, he added.

Mr. Ivanov disclosed no conflicts of interest.

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