Skip to main content
SpringerLink
Log in

Hoarding in children and adolescents with obsessive–compulsive disorder: prevalence, clinical correlates, and cognitive behavioral therapy outcome

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Hoarding, common in pediatric obsessive–compulsive disorder (OCD), has specific clinical correlates and is associated with poor prognosis. However, there are few studies of hoarding in pediatric OCD. This study estimates the occurrence of hoarding symptoms in a sample of children and adolescents with OCD, investigating possible differences in demographic and clinical variables between pediatric OCD with and without hoarding symptoms. Furthermore, the study investigates whether hoarding symptoms predict poorer treatment outcomes after cognitive behavioral therapy (CBT). The study sample comprised 269 children and adolescents with OCD, aged 7–17 years, from Denmark, Sweden, and Norway, who were all included in the Nordic long-term obsessive–compulsive disorder Treatment Study. All had an OCD diagnosis according to the DSM-IV and were treated with 14 weekly sessions of manualized, exposure-based CBT. Hoarding symptoms and OCD severity were assessed with the Children’s Yale–Brown Obsessive–Compulsive Scale and group differences in treatment outcome were analyzed using linear mixed-effect modelling. Seventy-two patients (26.8%) had one or more symptoms of hoarding. Comorbid tic disorders (p = 0.005) and indecision (p = 0.024) were more prevalent among those with hoarding symptoms than those without hoarding symptoms. In addition, youth with hoarding symptoms had a different OCD symptom profile. Having symptoms of hoarding did not affect CBT outcome (p = 0.933). Results from the study suggest that CBT is equally effective for those with and without hoarding-related OCD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Heyman I, Fombonne E, Simmons H et al (2001) Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. Br J Psychiatry 179:324–329. https://doi.org/10.1097/00004583-200107000-00017

    Article  CAS  PubMed  Google Scholar 

  2. Thomsen PH (1993) Obsessive-compulsive disorder in children and adolescents. Self-reported obsessive-compulsive behaviour in pupils in Denmark. Acta Psychiatry Scand 88:212–217. https://doi.org/10.1111/j.1600-0447.1993.tb03441.x

    Article  CAS  Google Scholar 

  3. Flament MF, Whitaker A, Rapoport JL et al (1988) Obsessive compulsive disorder in adolescence: an epidemiological study. J Am Acad Child Adolesc Psychiatry 27:764–771. https://doi.org/10.1097/00004583-198811000-00018

    Article  CAS  PubMed  Google Scholar 

  4. Canals J, Hernández-Martínez C, Cosi S, Voltas N (2012) The epidemiology of obsessive–compulsive disorder in Spanish school children. J Anxiety Disord 26:746–752. https://doi.org/10.1016/j.janxdis.2012.06.003

    Article  PubMed  Google Scholar 

  5. Huppert JD, Simpson HB, Nissenson KJ et al (2009) Quality of life and functional impairment in obsessive–compulsive disorder: a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety 26:39–45. https://doi.org/10.1002/da.20506

    Article  PubMed  PubMed Central  Google Scholar 

  6. Weidle B, Ivarsson T, Thomsen PH et al (2015) Quality of life in children with OCD before and after treatment. Eur Child Adolesc Psychiatry 24:1061–1074. https://doi.org/10.1007/s00787-014-0659-z

    Article  PubMed  Google Scholar 

  7. Geller DA, March J (2012) Practice parameter for the assessment and treatment of children and adolescents with obsessive–compulsive disorder. J Am Acad Child Adolesc Psychiatry 51:98–113. https://doi.org/10.1016/j.jaac.2011.09.019

    Article  Google Scholar 

  8. National Institute for Health and Clinical Excellence (2005) Obsessive–compulsive disorder: core interventions in the treatment of obsessive–compulsive disorder and body dysmorphic disorder. NICE, London

    Google Scholar 

  9. Skapinakis P, Caldwell D, Hollingworth W et al (2016) A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults. Health Technol Assess 20:1–392. https://doi.org/10.3310/hta20430

    Article  PubMed  PubMed Central  Google Scholar 

  10. Storch EA, Bussing R, Small BJ et al (2013) Randomized, placebo-controlled trial of cognitive-behavioral therapy alone or combined with sertraline in the treatment of pediatric obsessive–compulsive disorder. Behav Res Ther 51:823–829. https://doi.org/10.1016/j.brat.2013.09.007

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ivarsson T, Skarphedinsson G, Kornør H et al (2015) The place of and evidence for serotonin reuptake inhibitors (SRIs) for obsessive compulsive disorder (OCD) in children and adolescents: views based on a systematic review and meta-analysis. Psychiatry Res 227:93–103. https://doi.org/10.1016/j.psychres.2015.01.015

    Article  CAS  PubMed  Google Scholar 

  12. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Book  Google Scholar 

  13. Ivanov VZ, Mataix-Cols D, Serlachius E et al (2013) Prevalence, comorbidity and heritability of hoarding symptoms in adolescence: a population based twin study in 15-year olds. PLoS one 8:e69140. https://doi.org/10.1371/journal.pone.0069140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Iervolino AC, Perroud N, Fullana MA et al (2009) Prevalence and heritability of compulsive hoarding: a twin study. Am J Psychiatry 166:1156–1161. https://doi.org/10.1176/appi.ajp.2009.08121789

    Article  PubMed  Google Scholar 

  15. Samuels JF, Bienvenu OJ, Grados MA et al (2008) Prevalence and correlates of hoarding behavior in a community-based sample. Behav Res Ther 46:836–844. https://doi.org/10.1016/j.brat.2008.04.004

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tolin DF, Meunier SA, Frost RO, Steketee G (2010) Course of compulsive hoarding and its relationship to life events. Depress Anxiety 27:829–838. https://doi.org/10.1002/da.20684

    Article  PubMed  Google Scholar 

  17. Cath DC, Nizar K, Boomsma D, Mathews CA (2017) Age-specific prevalence of hoarding and obsessive compulsive disorder: a population-based study. Am J Geriatr Psychiatry 25:245–255. https://doi.org/10.1016/j.jagp.2016.11.006

    Article  PubMed  Google Scholar 

  18. Kichuk SA, Torres AR, Fontenelle LF et al (2013) Symptom dimensions are associated with age of onset and clinical course of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 44:233–239. https://doi.org/10.1016/j.pnpbp.2013.02.003

    Article  PubMed  PubMed Central  Google Scholar 

  19. Storch EA, Lack CW, Merlo LJ et al (2007) Clinical features of children and adolescents with obsessive–compulsive disorder and hoarding symptoms. Compr Psychiatry 48:313–318. https://doi.org/10.1016/j.comppsych.2007.03.001

    Article  PubMed  Google Scholar 

  20. Samuels JF, Grados MA, Riddle MA et al (2014) Hoarding in children and adolescents with obsessive–compulsive disorder. J Obsessive Compuls Relat Disord 3:325–331. https://doi.org/10.1016/j.jocrd.2014.08.001

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sheppard B, Chavira D, Azzam A et al (2010) ADHD prevalence and association with hoarding behaviors in childhood-onset OCD. Depress Anxiety 27:667–674. https://doi.org/10.1002/da.20691

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bloch MH, Bartley CA, Zipperer L et al (2014) Meta-analysis: hoarding symptoms associated with poor treatment outcome in obsessive–compulsive disorder. Mol Psychiatry 19:1025–1030. https://doi.org/10.1038/mp.2014.50

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Burton CL, Arnold PD, Soreni N (2015) Three reasons why studying hoarding in children and adolescents is important. J Can Acad Child Adolesc Psychiatry 24:128–130

    PubMed  PubMed Central  Google Scholar 

  24. Samuels JF, Bienvenu OJ, Pinto A et al (2007) Hoarding in obsessive–compulsive disorder: results from the OCD collaborative genetics study. Behav Res Ther 45:673–686. https://doi.org/10.1016/j.brat.2006.05.008

    Article  PubMed  Google Scholar 

  25. Selles RR, Højgaard DRMA, Ivarsson T et al (2018) Symptom insight in pediatric obsessive–compulsive disorder: outcomes of an international aggregated cross-sectional sample. J Am Acad Child Adolesc Psychiatry 57:615–619.e5. https://doi.org/10.1016/j.jaac.2018.04.012

    Article  PubMed  PubMed Central  Google Scholar 

  26. Frank H, Stewart E, Walther M et al (2014) Hoarding behavior among young children with obsessive–compulsive disorder. J Obsessive Compuls Relat Disord 3:6–11. https://doi.org/10.1016/j.jocrd.2013.11.001

    Article  PubMed  Google Scholar 

  27. Storch EA, Nadeau JM, Johnco C et al (2016) Hoarding in youth with autism spectrum disorders and anxiety: incidence, clinical correlates, and behavioral treatment response. J Autism Dev Disord 46:1602–1612. https://doi.org/10.1007/s10803-015-2687-z

    Article  PubMed  Google Scholar 

  28. Park JM, Samuels JF, Grados MA et al (2016) ADHD and executive functioning deficits in OCD youths who hoard. J Psychiatr Res 82:141–148. https://doi.org/10.1016/j.jpsychires.2016.07.024

    Article  PubMed  Google Scholar 

  29. Ruta L, Mugno D, D’Arrigo VG et al (2010) Obsessive–compulsive traits in children and adolescents with Asperger syndrome. Eur Child Adolesc Psychiatry 19:17–24. https://doi.org/10.1007/s00787-009-0035-6

    Article  PubMed  Google Scholar 

  30. Lewin AB, Wood JJ, Gunderson S et al (2011) Phenomenology of comorbid autism spectrum and obsessive–compulsive disorders among children. J Dev Phys Disabil 23:543–553. https://doi.org/10.1007/s10882-011-9247-z

    Article  Google Scholar 

  31. Højgaard DRMA, Mortensen EL, Ivarsson T et al (2017) Structure and clinical correlates of obsessive–compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations. Eur Child Adolesc Psychiatry. https://doi.org/10.1007/s00787-016-0887-5

    Article  PubMed  Google Scholar 

  32. Mataix-Cols D, Rauch SL, Manzo PA et al (1999) Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive–compulsive disorder. Am J Psychiatry 156:1409–1416

    CAS  PubMed  Google Scholar 

  33. Tolin DF, Frost RO, Steketee G, Muroff J (2015) Cognitive behavioral therapy for hoarding disorder: a meta-analysis. Depress Anxiety 32:158–166. https://doi.org/10.1002/da.22327

    Article  PubMed  Google Scholar 

  34. Storch EA, Rahman O, Park JM et al (2011) Compulsive hoarding in children. J Clin Psychol 67:507–516. https://doi.org/10.1002/jclp.20794

    Article  PubMed  Google Scholar 

  35. Storch EA, Merlo LJ, Larson MJ et al (2008) Symptom dimensions and cognitive-behavioural therapy outcome for pediatric obsessive–compulsive disorder. Acta Psychiatr Scand 117:67–75. https://doi.org/10.1111/j.1600-0447.2007.01113.x

    Article  CAS  PubMed  Google Scholar 

  36. Masi G, Millepiedi S, Perugi G et al (2009) Pharmacotherapy in paediatric obsessive-compulsive disorder: a naturalistic, retrospective study. CNS Drugs 23:241–252. https://doi.org/10.2165/00023210-200923030-00005

    Article  CAS  PubMed  Google Scholar 

  37. Bloch MH, Craiglow BG, Landeros-Weisenberger A et al (2009) Predictors of early adult outcomes in pediatric-onset obsessive–compulsive disorder. Pediatrics 124:1085–1093. https://doi.org/10.1542/peds.2009-0015

    Article  PubMed  Google Scholar 

  38. Torp NC, Dahl K, Skarphedinsson G et al (2015) Effectiveness of cognitive behavior treatment for pediatric obsessive–compulsive disorder: acute outcomes from the Nordic long-term ocd treatment study (NordLOTS). Behav Res Ther 64:15–23. https://doi.org/10.1016/j.brat.2014.11.005

    Article  PubMed  Google Scholar 

  39. Ivarsson T, Thomsen PH, Dahl K et al (2010) The rationale and some features of the Nordic long-term OCD treatment study (NordLOTS) in childhood and adolescence. Child Youth Care Forum 39:91–99. https://doi.org/10.1007/s10566-010-9097-3

    Article  Google Scholar 

  40. Scahill L, Riddle MA, McSwiggin-Hardin M et al (1997) Children’s Yale–Brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36:844–852. https://doi.org/10.1097/00004583-199706000-00023

    Article  CAS  PubMed  Google Scholar 

  41. Thomsen PH, Torp NC, Dahl K et al (2013) The Nordic long-term OCD treatment study (NordLOTS): rationale, design, and methods. Child Adolesc Psychiatry Ment Health 7:41. https://doi.org/10.1186/1753-2000-7-41

    Article  PubMed  PubMed Central  Google Scholar 

  42. Storch EA, Murphy TK, Geffken GR et al (2004) Psychometric evaluation of the children’s Yale–Brown obsessive–compulsive scale. Psychiatry Res 129:91–98. https://doi.org/10.1016/j.psychres.2004.06.009

    Article  PubMed  Google Scholar 

  43. Scahill L, Dimitropoulos A, McDougle CJ et al (2014) Children’s Yale–Brown obsessive compulsive scale in autism spectrum disorder: component structure and correlates of symptom checklist. J Am Acad Child Adolesc Psychiatry 53:97–107.e1. https://doi.org/10.1016/j.jaac.2013.09.018

    Article  PubMed  Google Scholar 

  44. Kaufman J, Birmaher B, Brent D et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. https://doi.org/10.1097/00004583-199707000-00021

    Article  CAS  PubMed  Google Scholar 

  45. Lauth B, Arnkelsson GB, Magnússon P et al (2010) Validity of K-SADS-PL (schedule for affective disorders and schizophrenia for school-age children-present and lifetime version) depression diagnoses in an adolescent clinical population. Nord J Psychiatry 64:409–420. https://doi.org/10.3109/08039481003777484

    Article  PubMed  Google Scholar 

  46. Villabø MA, Oerbeck B, Skirbekk B et al (2016) Convergent and divergent validity of K-SADS-PL anxiety and attention deficit hyperactivity disorder diagnoses in a clinical sample of school-aged children. Nord J Psychiatry 70:358–364. https://doi.org/10.3109/08039488.2015.1125944

    Article  PubMed  Google Scholar 

  47. Piacentini J, Peris TS, Bergman RL et al (2007) BRIEF REPORT: functional impairment in childhood OCD: development and psychometrics properties of the child obsessive–compulsive impact scale-revised (COIS-R). J Clin Child Adolesc Psychol 36:645–653. https://doi.org/10.1080/15374410701662790

    Article  PubMed  Google Scholar 

  48. Skarphedinsson G, Melin KH, Valderhaug R et al (2015) Evaluation of the factor structure of the child obsessive–compulsive impact scale—revised (COIS-R) in Scandinavia with confirmatory factor analysis. J Obsessive Compuls Relat Disord 7:65–72. https://doi.org/10.1016/j.jocrd.2015.03.005

    Article  Google Scholar 

  49. Achenbach TM, Thomas M (1999) The Child Behavior Checklist and related instruments. In: Maruish Mark E (ed) The use of psychological testing for treatment planning and outcomes assessment, 2nd edn. Lawrence Erlbaum Associates Inc, Mahwah, pp 429–466

    Google Scholar 

  50. Torp NC, Dahl K, Skarphedinsson G et al (2015) Predictors associated with improved cognitive-behavioral therapy outcome in pediatric obsessive–compulsive disorder. J Am Acad Child Adolesc Psychiatry 54:200–207.e1. https://doi.org/10.1016/j.jaac.2014.12.007

    Article  PubMed  Google Scholar 

  51. Angold A, Costello EJ, Messer SC et al (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5:237–249

    Google Scholar 

  52. Angold A, Costello J, Van Kämmen W, Stouthamer-Loeber M (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: factor composition and structure across development. Int J Methods Psychiatr Res 5:251–262

    Google Scholar 

  53. Wood A, Kroll L, Moore A, Harrington R (1995) Properties of the mood and feelings questionnaire in adolescent psychiatric outpatients: a research note. J Child Psychol Psychiatry 36:327–334. https://doi.org/10.1111/j.1469-7610.1995.tb01828.x

    Article  CAS  PubMed  Google Scholar 

  54. Ehlers S, Gillberg C (1993) The epidemiology of asperger syndrome. J Child Psychol Psychiatry 34:1327–1350. https://doi.org/10.1111/j.1469-7610.1993.tb02094.x

    Article  CAS  PubMed  Google Scholar 

  55. Posserud MB, Lundervold AJ, Gillberg C (2006) Autistic features in a total population of 7–9-year-old children assessed by the ASSQ (autism spectrum screening questionnaire). J Child Psychol Psychiatry Allied Discip 47:167–175. https://doi.org/10.1111/j.1469-7610.2005.01462.x

    Article  Google Scholar 

  56. Ehlers S, Gillberg C, Wing L (1999) A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. J Autism Dev Disord 29:129–141

    Article  CAS  PubMed  Google Scholar 

  57. Arildskov TW, Højgaard DRMA, Skarphedinsson G et al (2016) Subclinical autism spectrum symptoms in pediatric obsessive–compulsive disorder. Eur Child Adolesc Psychiatry 25:711–723. https://doi.org/10.1007/s00787-015-0782-5

    Article  PubMed  Google Scholar 

  58. Gueorguieva R, Krystal JH (2004) Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the archives of general psychiatry. Arch Gen Psychiatry 61:310–317. https://doi.org/10.1001/archpsyc.61.3.310

    Article  PubMed  Google Scholar 

  59. IBM Corp (2013) IBM SPSS statistics for windows, version 22.0. IBM Corp, Armonk, NY

  60. StataCorp (2015) Stata statistical software: release 14. StataCorp LP, College Station, TX:

  61. Bloch MH, Landeros-Weisenberger A, Rosario MC et al (2008) Meta-analysis of the symptom structure of obsessive–compulsive disorder. Am J Psychiatry 165:1532–1542. https://doi.org/10.1176/appi.ajp.2008.08020320

    Article  PubMed  PubMed Central  Google Scholar 

  62. Mataix-Cols D, Marks IM, Greist JH et al (2002) Obsessive–compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: results from a controlled trial. Psychother Psychosom 71:255–262

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank TrygFonden, Lundbeck Foundation and Central Region Denmark’s Research Fund for supporting the research presented in this article through project Grants.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Århus, Denmark

    Davíð R. M. A. Højgaard, Judith Becker Nissen, Katja A. Hybel & Per Hove Thomsen

  2. Faculty of Psychology, University of Iceland, Reykjavík, Iceland

    Gudmundur Skarphedinsson

  3. The Center for Child and Adolescent Mental Health. Eastern and Southern Norway (RBUP), Oslo, Norway

    Tord Ivarsson

  4. Regional Center for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway

    Bernhard Weidle & Per Hove Thomsen

  5. Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway

    Nor Christian Torp

  6. Department of Child and Adolescent Psychiatry, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden

    Karin Melin

Authors
  1. Davíð R. M. A. Højgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gudmundur Skarphedinsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tord Ivarsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernhard Weidle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Judith Becker Nissen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katja A. Hybel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nor Christian Torp
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Karin Melin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Per Hove Thomsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Davíð R. M. A. Højgaard.

Ethics declarations

Conflict of interest

Dr. Ivarsson has served on the speaker’s bureau of Shire Sweden. All remaining authors report no biomedical financial interests or potential conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Højgaard, D.R.M.A., Skarphedinsson, G., Ivarsson, T. et al. Hoarding in children and adolescents with obsessive–compulsive disorder: prevalence, clinical correlates, and cognitive behavioral therapy outcome. Eur Child Adolesc Psychiatry 28, 1097–1106 (2019). https://doi.org/10.1007/s00787-019-01276-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-019-01276-x

Keywords

Search

Navigation