June 04, 2004
Compulsive Hoarders Have Unique Brain Scan Patterns

PET scans show that compulsive hoarding is caused by a different neurological phenomenon than other types of obsessive compulsive behavior.

A PET imaging study conducted at the UCLA Neuropsychiatric Institute indicates the neurobiology of America's estimated 1 million compulsive hoarders differs significantly from people with other obsessive-compulsive disorder (OCD) symptoms. The findings indicate that different medications could improve treatment success.

Detailed in the June 4 edition of the peer-reviewed American Journal of Psychiatry, the study is the first to examine the neurobiology of people with compulsive hoarding and saving, one of several symptom clusters associated with OCD.

The study identified lower brain activity in the anterior cingulate gyrus of compulsive hoarders, compared with other OCD patients. This brain structure helps govern decision-making, focused attention, motivation and problem-solving, cognitive functions that are frequently impaired in compulsive hoarders. The study also found a correlation between severity of hoarding symptoms and lower brain activity in the anterior cingulate gyrus across all of the study subjects with OCD.

In addition, the hoarding group showed decreased brain activity in the posterior cingulate gyrus compared to healthy control subjects who had no OCD symptoms. The posterior cingulate gyrus is involved in spatial orientation and memory. The decreased activity in hoarders may explain why they have difficulty with excessive clutter and fear of losing belongings.

The findings also demonstrate how neurobiological testing could improve diagnosis and treatment of psychiatric disorders. Lower activity in the anterior and posterior cingulate areas may not only underlie compulsive hoarding symptoms, but also their poor response to standard treatments for OCD. The results suggest cognitive-enhancing medications commonly used in patients with age-related dementia may be more effective at treating compulsive hoarding behaviors than standard OCD medications such as serotonin reuptake inhibitors.

"Our work shows that hoarding and saving compulsions long associated with OCD may spring from unique, previously unrecognized neurobiological malfunctions that standard treatments do not necessarily address," said Dr. Sanjaya Saxena, lead author and director of the UCLA Neuropsychiatric Institute's OCD Research Program.

"In addition, the results emphasize the need to rethink how we categorize psychiatric disorders. Diagnosis and treatment should be driven by biology rather than symptoms. Our findings suggest that the compulsive hoarding syndrome may be a neurobiologically distinct variant of OCD," said Saxena, an associate professor-in-residence of psychiatry and biobehavioral sciences at UCLA's David Geffen School of Medicine.

Hoarding and saving behaviors are associated with a number of psychiatric disorders, including age-related dementia and cognitive impairment, but they are most commonly associated with OCD. An estimated 7 million to 8 million people in the United States suffer from OCD, with compulsive hoarding present in up to one-third. Compulsive hoarding is the primary source of impairment in 10 percent to 20 percent of OCD patients.

Compulsive hoarding is one of several symptom clusters associated with OCD. Others include contamination fears that lead to cleaning compulsions, aggressive and harm-related obsessions that lead to doubt and checking, and symmetry and order concerns. Each of these symptom clusters may be associated with a distinct pattern of brain activity. Standard OCD treatments, including serotonin reuptake inhibitor medications, typically are less effective in OCD patients with prominent compulsive hoarding behaviors.

The UCLA Neuropsychiatric Institute study involved 62 adults: 12 with OCD who had prominent compulsive hoarding behaviors, 33 with OCD who had mild or no symptoms of hoarding, and 17 control subjects who had no OCD symptoms. The researchers used positron emission tomography (PET) to measure brain glucose metabolism, a marker of regional brain activity, in each subject and compared the results.

Upcoming studies at the UCLA Neuropsychiatric Institute will use both PET and magnetic resonance imaging scanning to look for structural and functional abnormalities in the brains of subjects with compulsive hoarding and other types of OCD as the team seeks to further refine and understand these differences. The research team also will examine the effectiveness of newer medications that better address the unique brain activity found in subjects with compulsive hoarding behaviors.

Note that results from brain scans are obviously causing neuroscientists to reorganize the way they categorize and sort various mental disorders. This is analogous to the way that DNA sequencing results have been causing a recategorization of the relationships between species with species being shifted between genuses and other higher level categories of taxonomy. Systems of classification based on intuitive judgements of outwardly visible qualities are being replaced by qualities come from the measurement of phenomena at the cellular and molecular level. Reductionism marches onward.

Note also that the ability of brain scanner instruments to measure what is going on is providing both a more accurate method of diagnosis and yielding useful hints about what drugs may be most effective to treat each person. The reliance on the psychiatrist's intuitive judgement based on interviews and observation of visible behavior to form a diagnosis is being at least partially supplanted by direct internal observation of what is happening in the brain. Also, the ability to observe what is happening in the brain is pointing toward the potential of courses of treatment that otherwise may never have been considered.

Advances in medical instrumentation are making medical diagnosis more accurate and in the process it is removing subjective judgements from medicine. The removal of the subjective judgement creates the potential for far greater amounts of automation of diagnosis and treatment delivery.

Share |      Randall Parker, 2004 June 04 01:26 PM  Biological Mind


Comments
Zack Lynch said at June 6, 2004 5:49 PM:

RP,

You are right on with your analysis that brain imaging + biochips will lead to a fundamental redefinition of mental illnesses. Dump the DSM-IV, and wait for DSM-V...2010 is the expected date, but I bet it might take longer as brain imaging begins to call into question psychological descriptions of neurological disorders. Also, watch for serious growth to occur in breakthrough imaging technologies.

Z

Caroline said at September 2, 2004 5:36 PM:

How can my husband participate in future studies as mentioned in the article above? He is a compulsive hoarder as well as obessive cleaner....CLASSIC. No job, poor marriage, no friends or social life, his son is embarassed and hurt,etc.

m tyler said at September 20, 2004 9:35 AM:

Can you help me with 2 questions?

1.- How do I find out if I fall into this category?

2.- How do I seek diagnosis and the treatment you describe?

I struggle daily with the mental function symptoms you describe. It is a source of great frustration and disappointment and has been for as long as I can remember. I used to be resigned to it. But now I have a daughter who is counting on me. She is profoundly mentally retarded and lives in a medical facility. She needs me. I have to function at my best. I need to ascertain whether medical issues exist which can be corrected or improved. In this effort I recently began Ritalin treatment for a.d.d. w/o hyperactivity because since early childhood I have had these symptoms to a degree that drastically impairs function in daily life. The Ritalin has resulted in moderate improvement. However, I am not satisfied that the a.d.d. description fully describes what I experience. It doesnt encompass all of my key executive functioning, spatial skills and memory deficits in the same way that I experience them.

Executive functions are the same functions which I have never used successfully. THis has a profound impact both on my daily life and course of life.

Since childhood many of the "easy" things (according to everybody else) were intimidating and hard for me or even impossible. I was described as "gifted" and told I had a high I.Q. but was unable to accomplish the most basic fundamental tasks. This was troubling. My parents and I knew that if intelligence wasnt the issue, character must be. I wasn't living up to my potential. I knew as an underachiever I WAS lazy and careless and immature and unmotivated. But I also feared some deeper mental illness. Because Even when I really wanted to get it right and the consequences were severe for failing to get it right, I continually failed to get it right. In awe I always watched others doing the simple and the important things and me failing to do them. These were all things that someone "smart" can do without even trying. But I tried and failed. this has been fearful for me. I could see from very early on that I was different and was falling behind and it alarmed me and disgusted me. I tried to mask my defects. When I couldn't overcompensate or lie I hid. When I was 20 my mother told me I was schizophrenic. She told me this over time, alluding to it with hints initially, such as "I can't tell you what it is, because I don't want to scare you - but if you start feeling very strange you need to tell us. Just think of yourself as a ticking time bomb." When she specified the diagnosis she told me my biological mother was a schizophrenic who had to be institutionalized and its genetic, I was entering the danger years and beginning to behave like one. She told me, sadly, "You will eventually have to live at home and we will have to take care of you for the rest of your life, administering your meds because you cant be trusted to take them yourself." She told me that I was likely to kill the family in their sleep. I have not been diagnosed with schizophrenia. But I do have doubts about my abilities and perceptions. I have been told (in the few conversations I was unable to avoid on the topic of my lack of success) that lack of confidence is the only thing holding me back. But I don't think it is that simple, either. For example, my mother drummed it into me from childhood on that when I learned to drive the first thing I would do is drive the car right through a garage door because I think I'm so smart I'd be too arrogant to concentrate on something as mundane as driving like the rest of us - when I got my learners permit and had to go out driving with her she would grap me by my hair at my neck and slam my head into the wheel, screaming in fury when we approached stopsigns or redlights, there were alot of angry sudden, piercing, rising screams. But she did that alot since they adopted me at 2. Followed by violence. - I still am fearful of driving - but I also DO have perception difficulties that do make it challenging to determine visually what lane a car is in and how fast it is going and how long it will take to reach a given point.
My mother told me daily and for hours on end that I would be just like my Aunty Mickey - her obese sister who she hated who lived in squalor with an alcoholic pilot transvestite uncle who beat her and molested and beat their five kids. She was very obsessed with the link between me (the elder sister) and Her older sister. She would call me Mickey instead of my name alot and rant about how alike we are, and how I would end up just like her. My aunt Mickey is a hoarder. Now I am. I didn't even know what a hoarder was until I looked it up and saw how chilling I really am. My mess is more than just a mess. It is a sign of mental illness. I am adopted so the link between me and my doomed Aunt isnt genetic. It is chilling because so many of my mothers predictions and prophecies have been bizarre and dreadful. Many have been obviously delusional (such as her obsession that I was pregnant when I was a virgin in 7th grade, she let me know continually and in very charged and scary encounters that she was the only one I wasnt fooling) but many have had some basis in real observations.

Anyway, every year I have fallen farther behind. Now I have just fallen by the wayside. I lack many basic adult skills for independent living. I am not a competent adult. I don't admit it, but I actually am incompetent and have been for many years. I don't advertise this. I try to hide it. I am reclusive. I am generally happy and optimistic and friendly, I am fit and healthy (appearing), I get along with people, and though my social skills are not great they're not terrible. I think I seem pretty average. I try to fit in. I think most people think I am o.k., but I'm not.

I am very reclusive. No one enters my home. I don't invite intimacy because I know you can't live like I do and not be mentally ill.

If there is a medical reason for my difficulties and I can address it I want to do so. My daughter is my life. She is my life. Everyday I fail to be the mother she deserves. Every day I drop the ball. She is the only thing I care about and I can't get it right. The thing I care about most in the world. It matters. She is all that matters to me and I don't walk the walk. I am not responsible. Everyday I visit at My convenience to play with her and love her but I let the staff do the lionshare of my work. My attempts to advocate for her are spotty and inconsistent. I have no follow through. I inevitably start things without finishing. My documentation and records are a mess. There is no routine. My hopes and dreams for her are strangling in the shambles and so her hopes and dreams as a person are also going down the drain. Despite this she has achieved things beyond any of the medical community's wildest dreams for her but I can see where unmet needs are holding her back and keeping her life from being and rich and full as it should be. I want her to have every opportunity. And most of all I want her to have me. I don't want to keep denying mmy full attention and even my very presence!! I want to be there!
I am an absentee mother. Every time a need IS met my daughter takes the ball and runs with it. But I can't keep up with her. Since a recent reconstruction of her skull she has gone from silence and immobility to increasing successes at initiating verbal interaction, laughing babbling, smiling, playing, - and she tries to master gross motor and locomotion skills but with inadequate help from me - from any of us. She is deprived. There are things I want to but fail to provide. I am not doing my utmost for her by a long shot and she isnt getting what she deserves from me. I wont be able to live with my self until I set it right - until I am giving it my all, everyday.

I want to be the mother she deserves. It is my responsibility to do this right. I am needed. Her life, her destiny hangs in the balance. I want to do the best I can.

If I have neurological medical needs that can be met I want to address them. If treatment can improve my neurological function - I want to investigate this. I need to function at my best. CAN YOU HELP ME? Thank you. God Bless You.

If you can help,
Please email me at
losgatos76@yahoo.com

rich bergan said at December 7, 2004 8:57 AM:

I am the director of animal Services in Sandy Utah, I have been given the task of researching a viable criminal ordanance to deal with "animal hoarders" Your study sheds logical light on a problem we in Animal Control see all to often. Our frustration is that this is not a problem that can be solved by a monitary fine or a jail sentence. I would like to see some proceedures that can be used to help these collectors. These collectors are not stupid and if they grant us permission to enter their home on the first occasion and the result is that we come back with court orders to seize and destroy all sick or injured animals and the court orders them not to keep pets in the future. They simply stop cooperating and deny anyone access to their private property and then contuinue with their untreated compulsive behavior.
There must be some protocol that professionals in psycological fields can use in opening communication with obsessive compulsive people. And just as important, words, phrases, demeanor and actions that should be avoided.
My goal would be to have a plan that Animal Service and Code Enforcement officers or other public employees might be able to use to help the horder and the community that they impact. I will be waiting for some pearls of wisdom from you or anyone who can help us

Randall Parker said at December 7, 2004 11:20 AM:

Rick,

I agree with you that a mental disorder can't be solved with either a fine or a jail sentence.

When you ask for a court order against keeping pets can you also try to get a court order to see a psychiatrist some number of times?

Cathy taylor said at December 17, 2004 1:48 AM:

Hello,

I just visited my father in France and found out that my step-mother has compulsive hoarding. Several rooms in their house are full of clothes, empty bottles, bags filled with unopened items etc. They live in a large house and the only rooms available are the living-room and the kitchen. Even though, there are bags filled all over these rooms, but it is not in the condition of the rest of the house. She is always reluctant for me to visit and I now understand why. Even though she recognizes to a certain degree her problem, she says it doesn't bother her. In fact, it is my father who showed me the rest of the house. I was shocked to say the least. Can you help me to understand:

What is the psychological reasons people do hoard? Is it the result of a childhood trauma? How can she be confronted with her compulsive behavior? How can I help?

Thank you very much!

Cathy Taylor

Randall Parker said at December 17, 2004 2:20 AM:

Cathy,

Hoarding is one of many obsessive compulsive disorders (OCDs). There are SSRI anti-depressant drugs that are used as OCD treatments that work for some patients. See my posts Stanford Researchers Discover Treatment For Obsessive Shopping Disorder and Anti-Depressant Drug Treats Kleptomania.

As for the causes: There are genetic variations that cause some forms of OCD. Still other cases are caused by physical injuries to brains. Still other cases probably have other causes.

As for how you can help: try to get her to a doctor in France who knows how to treat OCD cases.

My name is Ann said at December 18, 2004 3:25 AM:

I have been diagnosed with ocd for about l5 years, treated with most or all of the ssri's.... PLEASE RESPOND ASAP.....could someone send me an email to tell me how to get back to this site/ i've been up all night finding it.....my daughter has breast cancer ...i need to be functional for her now, if ever.....Thank you so much for any information on anyone who has used or knows someone who has used namenda, or something similar.....(if something similar , please post dosage, and if namenda has been used , how has it worked out??? I'm know this is scrambled, but i am exhausted and trying to get it posted before i give out! thank you!(hoar

Reed said at May 29, 2005 8:52 PM:

Of course, with an end to subjective judgements of what constitutes mental disorder, every human will have to fit into a cookie-cutter mold in order to pass psychiatric screenings and what not. It'll be the end to crazy people screaming in the streets, but it'll also be the end to the Teslas and Einsteins of the world.

Of course, that'll eventually be irrelevant, as people will start designing their kids to be Einsteins or Teslas...

Leslie said at July 16, 2005 9:57 PM:

I can identfy with Caroline... my husband is also a hoarder- CLASSIC... No job, marriage disintegrating,etc. Add to that Kleptomania (recent onset... 4 arrests in two years) and "skin-picker". His family feels he must hit rock-bottom before he will seek or be successful in treatment. The damage that is occurring on the way to "rock bottom", however, might make recovery so much more difficult... plus, I don't even have the disorder !
Looking forward to all new information and looking for clinical trials for my husband to participate in... fortunately, he IS willing to do so. Please feel free to contact me.
Thanks,
Leslie

Leslie said at July 16, 2005 9:57 PM:

I can identfy with Caroline... my husband is also a hoarder- CLASSIC... No job, marriage disintegrating,etc. Add to that Kleptomania (recent onset... 4 arrests in two years) and "skin-picker". His family feels he must hit rock-bottom before he will seek or be successful in treatment. The damage that is occurring on the way to "rock bottom", however, might make recovery so much more difficult... plus, I don't even have the disorder !
Looking forward to all new information and looking for clinical trials for my husband to participate in... fortunately, he IS willing to do so. Please feel free to contact me.
Thanks,
Leslie

Jenny said at October 17, 2005 1:42 AM:

I have a sister in law who is very smart, adept on the computer, reads books all the time, is a coach for her daughter's team and to all appearances seems normal enough. But to see her car or house is shocking. They are both piled high with what appears to be clothing, empty food wrappers, paper, boxes, you name it is there. I can tell she gets a little nervous about the mess in both locations, but tries to act like it is perfectly normal. My question to you is this-- When can you tell if a person is just a lazy slob, or if they are in need of psychiatric help? We have tried to address the problem to her, but she turns a deaf ear and calls anyone who keeps a decent house a compulsive clean freak.
Any help would be appreciated.
Jenny

Jenny said at October 17, 2005 2:05 AM:

I have a sister in law who is very smart, adept on the computer, reads books all the time, is a coach for her daughter's team and to all appearances seems normal enough. But to see her car or house is shocking. They are both piled high with what appears to be clothing, empty food wrappers, paper, boxes, you name it is there. I can tell she gets a little nervous about the mess in both locations, but tries to act like it is perfectly normal. My question to you is this-- When can you tell if a person is just a lazy slob, or if they are in need of psychiatric help? We have tried to address the problem to her, but she turns a deaf ear and calls anyone who keeps a decent house a compulsive clean freak.
Any help would be appreciated.
Jenny

Coy0tea said at May 27, 2006 9:32 AM:

At age 65 cant get into my own home...looking for help, willing to participate in research study.
Colorado
Thanks

Emily Rivers said at July 23, 2010 7:27 AM:

I've noticed that most (almost all) of the people who have been shown on the TV program, Hoarders, are highly intelligent. Their vocabulary is usually much better than the average "reality program" individual. Even the few children are exceptional. I have a feeling that this disorder is associated with disorganized schizophrenia. It may be caused by whatever causes that more serious disorder. I knew a woman once who was a hoarder. When you listen to them talk, it's amazing how similar are their thought processes. Maybe some of the medications used to treat schizophrenia would help. Are researchers looking into this?
Thanks,
Emily

albie said at December 20, 2010 10:49 AM:

In my experience regarding EEG, I want to say that there aro no normal two people whith the same brain patterns. the only strange situation I encountered was in the VistaBay diagnosis center, where two drug addicts, almost in a coma, had almost identicaly brain waves. I still don't understand why, but there has to be a explination.

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