AT THE ANXIETY AND DEPRESSION CONFERENCE 2017
SAN FRANCISCO (FRONTLINE MEDICAL NEWS) – Procrastination, disorganization, indecisiveness, and perfectionism each are significant independent predictors of hoarding severity, even though none of these associated factors is included in the DSM-5 diagnostic criteria for hoarding disorder, according to Sanjaya Saxena, MD.
Of these four associated factors, disorganization and procrastination had the strongest correlation with hoarding severity in his study. Patients meeting the DSM-5 criteria for hoarding disorder scored significantly higher on measures of disorganization and procrastination than did patients with nonhoarding obsessive-compulsive disorder or anxiety disorders, said Dr. Saxena , professor of psychiatry and director of the obsessive-compulsive disorders program at the University of California, San Diego.
“These results suggest that these associated features, particularly disorganization and procrastination, should be assessed and addressed in the treatment of patients with hoarding disorder. Future studies should investigate the validity and clinical utility of adding these associated features to the diagnostic criteria for hoarding disorder,” he said at the annual conference of the Anxiety and Depression Association of America.
The DSM-5 lists as the core symptoms of hoarding disorder difficulty in discarding possessions; perceived need to save items; excessive acquisition, clutter, and resultant distress; and impaired functioning. But while procrastination, disorganization, perfectionism, and indecisiveness aren’t included in the diagnostic criteria, Dr. Saxena said he and some other experts have considered those features to be characteristic of affected individuals. So he decided to formally test the strength of the associations.
He reported on 21 patients with hoarding disorder and 13 controls with nonhoarding OCD or an anxiety disorder. All subjects completed a battery of assessment tools, including the Beck Depression Inventory , the Beck Anxiety Inventory , the Frost Multidimensional Perfectionism Scale , the Frost Indecisiveness Scale , the Adult Inventory of Procrastination Scale , and three different measures of hoarding severity. Participants also completed a disorganization index based on their answers to three questions drawn from the Swanson, Nolan, and Pelham ( SNAP-IV ) Rating Scale: How often did you have difficulty organizing tasks and activities as a child? How disorganized are you in your thinking, planning, and time management? And how disorganized are your belongings at home?
Neither disorganization, procrastination, perfectionism, nor indecisiveness turned out to be associated with severity of nonhoarding OCD or anxiety disorder symptoms. Surprisingly, no significant differences were found between hoarding disorder patients and controls on the measures of indecisiveness or perfectionism, Dr. Saxena said. And the two groups did not differ in their levels of anxiety and depression.
However, levels of procrastination and disorganization were strongly correlated with hoarding severity as assessed via the Saving Inventory – Revised , the UCLA Hoarding Severity Scale , and the Hoarding Rating Scale . The hoarding disorder group’s average score on the disorganization index was 5.67, more than twice that of the 2.67 in the control group. And patients with hoarding disorder had an average Adult Inventory of Procrastination score of 50.9 out of a possible maximum of 75 points, compared with 41 in controls.
In a multivariate regression analysis, age and level of depression collectively explained 23.5% of the variance in hoarding severity scores in the study population. Disorganization independently explained an additional 29.9% of the variance, and procrastination accounted for another 19.1%, Dr. Saxena reported.
He reported having no financial conflicts regarding his study, which was funded by the university’s department of psychiatry.
