Hoarding disorder is characterized by difficulty discarding possessions, leading to severe clutter and impairment in daily functioning. It is now classified as a distinct psychiatric diagnosis, separate from OCD.
Cognitive-behavioral models suggest that abnormal object attachment in hoarding disorder may be an attempt to compensate for unmet interpersonal needs or attachment difficulties.
Hoarding disorder is associated with reduced social support, possibly due to stigma, family conflicts, and negative experiences in relationships. Perceived criticism, shame, and trauma are potential factors influencing social support in hoarding disorder.
Social support plays a crucial role in maintaining mental well-being and recovering from hoarding disorder.
Edwards, V., Salkovskis, P. M., & Bream, V. (2023). Do they really care? Specificity of social support issues in hoarding disorder and obsessive–compulsive disorder. British Journal of Clinical Psychology, 62(3), 573-591. https://doi.org/10.1111/bjc.12426
Key Points
- The main findings of this study on social support in hoarding disorder (HD) and obsessive-compulsive disorder (OCD) include:
- Individuals with HD and OCD have smaller social networks compared to healthy controls (HC), but reduced social support is specific to HD.
- Loneliness and thwarted belongingness are significantly higher in HD compared to OCD and HC.
- The research has limitations, such as a predominantly Caucasian female sample and cross-sectional design.
- Social support plays a substantial role in mental well-being and recovery from mental health difficulties, making this topic universally relevant and important.
Rationale
Previous research has indicated that social support may be specifically reduced in individuals with hoarding disorder (HD) compared to those with obsessive-compulsive disorder (OCD) and healthy controls (HC).
Barton et al. (2021) found that despite having similarly sized social networks, individuals with HD reported feeling less supported than those with OCD. This suggests that the subjective experience of support may be impaired in HD, even when the objective size of the social network is comparable to other groups.
The current study aimed to extend these findings by providing a comprehensive evaluation of social networks, perceived support, loneliness, and thwarted belongingness in individuals with HD, OCD, and HC. By including a clinical comparison group (OCD) and healthy controls, the study sought to determine whether deficits in social support and elevated levels of loneliness and thwarted belongingness are specific to HD or are also present in other mental health conditions.
Additionally, the study explored potential mechanisms that may contribute to reduced social support in HD, such as perceived criticism and trauma.
Previous research has shown that individuals with HD often experience high levels of family conflict, stigma, and blame (Chasson et al., 2018; Park et al., 2014), as well as increased rates of physical assault and sexual trauma (Przeworski et al., 2014; Shaw et al., 2016). Investigating these factors may provide insights into the underlying reasons for reduced social support in HD.
Understanding the role of social support in HD is crucial for informing clinical interventions and promoting well-being.
If deficits in social support and elevated levels of loneliness and thwarted belongingness are found to be specific to HD, this would highlight the need for targeted interventions that focus on enhancing social connections and reducing feelings of isolation.
By identifying potential mechanisms that contribute to reduced social support, such as perceived criticism and trauma, clinicians can develop strategies to address these issues and improve treatment outcomes for individuals with HD.
Method
This cross-sectional study compared measures of social support, loneliness, and thwarted belongingness between three groups: hoarding disorder (HD), obsessive-compulsive disorder (OCD) and healthy controls (HC).
Participants completed a structured clinical interview by telephone to assign diagnostic categories, followed by online questionnaires.
Procedure
Participants were recruited from the general population in the United Kingdom through voluntary organizations, social media, and snowball sampling.
They completed a telephone screening interview using the Structured Clinical Interview for DSM-5 (SCID) to determine group membership, followed by self-report demographic and psychometric measures online or by paper copy.
Sample
Participants were predominantly female (79.6%), Caucasian (89.4%), and had secondary school education or higher (100%). The mean age was 50.38 years (SD=16.54). The OCD group was significantly younger than the HD and HC groups.
HD (n=37), OCD (n=31), and HC (n=45).
Measures
- Social support was measured using the Revised Norbeck Social Support Questionnaire (NSSQ-R) and the Medical Outcomes Study Social Support Survey (MOS-SSS).
- Loneliness was assessed using the UCLA Loneliness Scale Version 3 (UCLA-3).
- Thwarted belongingness and perceived burdensomeness were measured using the Interpersonal Needs Questionnaire-Revised (INQ-R).
- Exploratory variables included the Perceived Criticism Measure (PCM) and the Life Events Checklist for DSM-5 (LEC-5).
Statistical measures
Analysis of variance (ANOVA) was used to compare means across the three groups. Chi-square analysis was used to determine differences between groups on categorical demographic variables. Multiple comparisons used the LSD test or Dunnets T3, depending on homogeneity of variance.
Results
- Primary hypothesis: Those in HD and OCD groups will both have smaller social networks relative to HC, however, HD will report lower levels of perceived support compared to OCD and HC.
HD and OCD groups had significantly smaller social networks than HC, but HD reported lower levels of perceived support compared to OCD and HC, which did not differ significantly.
- Secondary hypothesis: Individuals with HD will report greater loneliness and thwarted belongingness than those with OCD and HC.
The HD group reported significantly greater loneliness and thwarted belongingness than OCD and HC groups.
- Exploratory variables: Exploratory variables (possible mechanisms) were perceived criticism and trauma.
No significant differences were found between groups for perceived criticism or trauma.
Insight
The results highlight that while individuals with HD and OCD have similarly reduced social networks, those with HD experience significantly less perceived support, greater loneliness, and higher thwarted belongingness.
These findings suggest that the subjective experience of support and connection may be particularly impaired in HD, potentially contributing to the maintenance of hoarding symptoms.
Future research should explore the directionality of these relationships and identify potential mechanisms underlying deficits in social support.
Strengths
- The study utilized structured clinical interviews (SCID) to assign individuals to diagnostic groups and included a comparably impaired clinical control group (OCD) along with healthy controls.
- Comprehensive measures of social support were employed, considering both the size of social networks and the perceived quality of support.
Limitations
- The sample was predominantly Caucasian, female, and highly educated, limiting generalizability.
- The cross-sectional design precludes causal inferences about the relationship between social support and HD symptoms.
- The OCD group was significantly younger than the HD and HC groups, which may have influenced the results.
Clinical Implications
Clinical interventions for HD should consider incorporating strategies to enhance social support and reduce loneliness and thwarted belongingness.
Whether feeling unsupported and lonely results from HD, professionals should help individuals access support and connection opportunities.
Improving support and belonging may reduce reliance on objects and change acquiring/discarding behaviors.
Helping supporters provide and maintain support through psychoeducation, facilitating discussions, strengthening connectedness, and promoting reconciliation is crucial, especially when individuals lack insight into their hoarding difficulties.
Promoting understanding and support for both individuals with HD and their social networks is essential for well-being and motivation to change.
References
Primary reference
Edwards, V., Salkovskis, P. M., & Bream, V. (2023). Do they really care? Specificity of social support issues in hoarding disorder and obsessive–compulsive disorder. British Journal of Clinical Psychology, 62(3), 573-591. https://doi.org/10.1111/bjc.12426
Other references
Barton, J. A., Salkovskis, P., & Walters, S. (2021). Investigating the diagnostic specificity of attachment and relational needs in hoarding disorder. Journal of Obsessive-Compulsive and Related Disorders, 30, 100659.
Chasson, G. S., Guy, A. A., Bates, S., & Corrigan, P. W. (2018). They aren’t like me, they are bad, and they are to blame: A theoretically-informed study of stigma of hoarding disorder and obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 16, 56-65.
Park, J. M., Lewin, A. B., & Storch, E. A. (2014). Adult offspring perspectives on parental hoarding behaviors. Psychiatry Research, 220(1-2), 328-334.
Przeworski, A., Cain, N., & Dunbeck, K. (2014). Traumatic life events in individuals with hoarding symptoms, obsessive-compulsive symptoms, and comorbid obsessive-compulsive and hoarding symptoms. Journal of Obsessive-Compulsive and Related Disorders, 3(1), 52-59.
Shaw, A. M., Witcraft, S. M., & Timpano, K. R. (2016). The relationship between traumatic life events and hoarding symptoms: A multi-method approach. Cognitive Behaviour Therapy, 45(1), 49-59.
Yap, K., & Grisham, J. R. (2019). Unpacking the construct of emotional attachment to objects and its association with hoarding symptoms. Journal of Behavioral Addictions, 8(2), 249-258.
Keep Learning
- How might the experience of social support differ between individuals with HD and those with OCD, given their similar social network sizes?
- What factors might contribute to the higher levels of loneliness and thwarted belongingness observed in individuals with HD compared to those with OCD and healthy controls?
- How can clinical interventions for HD be adapted to effectively address deficits in social support, loneliness, and thwarted belongingness?
- What potential mechanisms underlying the relationship between social support and HD symptoms warrant further investigation, and how might these be studied?
