Empathy and symptoms dimensions of patients with obsessive-compulsive disorder

Patients with obsessive-compulsive disorder (OCD) often display cognitions and/or behaviors that may well reflect the existence of “hyper-attachment” to different environmental elements, including their offspring, family members, divine entities, or even inanimate objects. Based on the fact that both OCD symptoms and physiologic interpersonal attachment mechanisms involve overlapping ventral fronto-limbic circuits, we hypothesized that there is a relationship between empathy, evaluated with the Interpersonal Reactivity Index (IRI), and OCD symptom dimensions. We evaluated 53 patients with OCD and 53 age- and sex-matched individuals from the community with the Structured Clinical Interview for the Diagnosis of DSM-IV axis I disorders, the Saving Inventory-Revised, the IRI (composed of four sub-scales), the Obsessive-Compulsive Inventory - Revised, the Beck Depression Inventory, and the Beck Anxiety Inventory. Patients with OCD displayed greater levels of affective empathy (i.e., empathic concern (p = 0.006) and personal discomfort (p < 0.001)) than community controls. In bivariate analyses, the severity of hoarding symptoms of patients with OCD correlated with empathic concern (r = 0.39; p < 0.001), fantasy (r = 0.36; p < 0.01), and personal discomfort (r = 0.39; p < 0.001). In partial correlation analyses adjusting for comorbid depression and anxiety, only the association between hoarding and fantasy remained robust (r = 0.41; p < 0.001). A model that included severity of hoarding, depression, and anxiety symptoms predicted 33% of the variance on the fantasy scale. Our findings suggest that hoarding is linked to specific aspects of interpersonal reactivity. Comorbid depression and anxiety, however, explain a large proportion of the empathic profile exhibited by patients with OCD.     

Specific and general facets of hoarding: A bifactor model

Whereas it has been suggested that hoarding is a multidimensional construct comprising distinct but interrelated factors (i.e., difficulty discarding, excessive clutter, and excessive acquisition), a high degree of overlap as well as a lack of discriminant validity among these factors and exogenous constructs suggests that a correlated factors approach may not adequately capture this phenomenon. The factor structure of the Saving Inventory Revised (SIR) was examined in a large non-selected clinic sample (N = 490). A bifactor model of hoarding, comprising a general Hoarding factor and orthogonal Urge-Related Acquiring, Distress-Related Acquiring, Difficulty Discarding, and Clutter factors fit the data best. Further, whereas the general Hoarding factor was related to several depression facets, the specific hoarding factors demonstrated differential relations with depression. This study establishes that acquiring behaviors are motivated by both positive/urge-related and negative/distress-related emotions. Additionally, general and distinct factors should be considered to properly contextualize hoarding behavior.     

Atomoxetine for hoarding disorder: A pre-clinical and clinical investigation

Despite several studies suggested that inattention and impulsivity-compulsivity could represent two core dimensions of hoarding disorder (HD), only a small case series study investigated the effectiveness of attention-deficit-hyperactivity-disorder (ADHD) medications in HD. The aim of the present study was to target attentional and inhibitory control networks in HD patients through the ADHD medication atomoxetine, moving from a preclinical investigation on an animal model of compulsive-like behavior (marble burying test) to a clinical investigation on both medicated and unmedicated patients with a primary diagnosis of HD without ADHD. Our preclinical investigation showed that acute administration of atomoxetine significantly reduced the compulsive-like behaviours of mice in the marble burying test without affecting neither locomotor activity and coordination nor exploration behaviours. When compared, atomoxetine and fluoxetine showed similar effects on the marble burying test. However, fluoxetine impaired both locomotor and exploratory activity. In our clinical investigation 12 patients were enrolled and 11 patients completed an open trial with atomoxetine at flexible dose (40–80 mg) for 12 weeks. At the endpoint the mean UCLA Hoarding Severity Scale score decreased by 41.3% for the whole group (p = 0003). Six patients were classified as full responders (mean symptom reduction of 57.2%) and three patients as partial responders (mean symptom reduction of 27.3%). Inattentive and impulsivity symptoms showed a significant mean score reduction of 18.5% from baseline to the endpoint (F (1,9) = 20.9, p = 0.0013). Hoarding symptoms improvement was correlated to reduction of patients’ disability and increased in their global functioning. These preclinical and clinical data suggest that atomoxetine may be effective for HD and therefore should be considered for future controlled trials.     

ADHD and executive functioning deficits in OCD youths who hoard

Hoarding is common among youth with obsessive compulsive disorder (OCD), with up to 26% of OCD youth exhibiting hoarding symptoms. Recent evidence from adult hoarding and OCD cohorts suggests that hoarding symptoms are associated with executive functioning deficits similar to those observed in subjects with attention deficit hyperactivity disorder (ADHD). However, while hoarding behavior often onsets during childhood, there is little information about executive function deficits and ADHD in affected children and adolescents.The study sample included 431 youths (ages 6–17 years) diagnosed with OCD who participated in the OCD Collaborative Genetics Study and the OCD Collaborative Genetics Association Study and completed a series of clinician-administered and parent report assessments, including diagnostic interviews and measures of executive functioning (Behavior Rating Inventory of Executive Functioning; BRIEF) and hoarding severity (Hoarding Rating Scale-Interview; HRS-I).113 youths (26%) had clinically significant levels of hoarding compulsions. Youths with and without hoarding differed significantly on most executive functioning subdomains and composite indices as measured by the parent-rated BRIEF. Groups did not differ in the frequency of full DSM-IV ADHD diagnoses; however, the hoarding group had significantly greater number of inattention and hyperactivity symptoms compared to the non-hoarding group. In multivariate models, we found that overall BRIEF scores were related to hoarding severity, adjusting for age, gender and ADHD symptoms.These findings suggest an association between hoarding and executive functioning deficits in youths with OCD, and assessing executive functioning may be important for investigating the etiology and treatment of children and adolescents with hoarding and OCD.     

Changes in actual versus defended body weight elicited by a varied, palatable ("supermarket") diet in rats

Male rats fed on a varied, palatable supermarket diet for 11 weeks gained more weight than chow-fed controls. When palatable food was discontinued, their body weights became static, but remained significantly higher than control weights for a further 5 weeks. Hoarding of food was readily elicited by food deprivation in the dietarily obese as well as in the chow-fed rats. Previous studies have shown that the critical body weight at which hoarding appears does not covary with body weight, but appears to reflect a defended level of body weight. In the present study, critical weights were not significantly different between groups before supermarket diet, but were significantly higher in the supermarket rats after obesity had developed. Thus, the increase in body weight brought about by a supermarket diet (unlike that in ventromedial hypothalamic obesity) can be accompanied by an increase in the defended level of body weight as inferred from the critical weight for the onset of hoarding behaviour.     

Possible mechanism for the effect of anorexic agents on feeding and hoarding behaviour in rats

Amphetamine, fenfluramine, and chlorphentermine were tested for their effect on feeding and hoarding activity in rats, and the results interpreted according to a hypothalamic model for the regulation of motivated behaviour. All three compounds inhibited both feeding and hoarding, and the degree of inhibition was dose-dependent. Since feeding and hoarding are both influenced by activity in the lateral hypothalamus while feeding alone is modified by ventromedial hypothalamic activity, the result is consistent with a direct (inhibitory) action of the drugs on the lateral hypothalamus, rather than on the ventromedial region.     

Septal lesions and the recovery of function in the juvenile hamster

Recovery of function of social behavior, hoarding, nesting, and weight gain was investigated in the juvenile hamster following bilateral septal lesions. Hamsters receiving septal lesions during the juvenile period showed as much disruption in behavior as animals receiving septal lesions as adults. As compared to control animals, both septal lesioned groups were more aggressive, showed a reduction in hoarding behavior, lost the ability to build nests, and gained significantly more weight.     

Prefrontal lesions alter eating and hoarding behavior in rats

Aspiration lesions of orbital frontal cortex in the rat produced adipsia and aphagia persisting from 4–7 days. After recovery, food hoarding behavior was normal. Medial frontal cortical lesions did not affect food or water intake but produced a permanent deficit in food hoarding behavior. These results are taken as evidence that, like the rhesus monkey, the prefrontal cortex of the rat is dissociable into discrete subfields.     

Prevalence of Hoarding in an Adult Inpatient Population and Its Association With Axis I Diagnoses

Objective

Hoarding behavior is not limited to obsessive-compulsive disorder (OCD) alone. With the objective of highlighting the association between hoarding behavior and common psychiatric disorders, we explored its occurrence in psychiatric inpatients and co-occurrence with Axis I diagnoses.

Characteristics,circumstances and pathology of sudden or unnatural deaths of cases with evidence of pathological hoarding

The study aimed to determine the characteristics and circumstances of cases sudden or unnatural death (n = 61) with evidence of pathological hoarding, their major organ pathology and toxicology. The mean age was 65·8 yrs (a mean of 16.1 years of potential life lost), 62·3% were male, and 28·2% were obese. 95·1% lived alone, and 96·7% died in their residence, with no medical intervention. In all cases severe squalor and extensive hoarding were noted. The direct cause of death was attributed to disease in 75·4%, heart disease being a significant factor in 52·5%. Accidents causing death directly related to hoarding occurred in two cases. Autopsy revealed extensive pathology: severe coronary artery narrowing (42·4%), myocardial replacement fibrosis (44·1%), emphysema (39·0%), nephrosclerosis (46·6%). Signs of hypothermia were present in 14·8%, and diabetes was diagnosed in 21·3%. The most commonly detected substance was alcohol (32·1%). Medications for heart disease (5·4%) or diabetes (7·1%) were rare. The overall clinical picture was of an isolated group, with a heavy burden of physical disease and, in all probability, a high level of psychiatric disorders, who died alone in their homes.