Compulsive hoarding affects 2-4% of the US population, and is defined as the excessive collection of and inability or unwillingness to throw away seemingly useless items, resulting in living and/or work spaces that are unusable for their intended purposes. Compulsive hoarding carries a substantial public health burden, causing significant impairment and distress for individuals and families. Hoarding and cluttering behaviors create a direct physical health risk of falls, fire hazards, and sanitation problems, and are a direct contributor to up to 6% of deaths by house fire. Although beginning early in adolescence, compulsive hoarding behaviors usually do not become problematic until the 50s or 60s. We and others have shown that people with compulsive hoarding have specific problems with information processing and other cognitive functions that leads to indecision, and ultimately, to fear of throwing things away. We are currently investigating whether these cognitive problems are also seen in first-degree relatives of people with hoarding behaviors. This project will use neuroimaging techniques, specifically, functional magnetic resonance imaging (fMRI), to examine brain activation patterns in people with and without compulsive hoarding while they are performing computerized tasks designed to tap into the specific problems in decision-making, attention, information processing, categorization, and error-monitoring that we have previously identified. We will examine brain activation patterns in 15 individuals with compulsive hoarding, 15 of their first-degree relatives, 15 people with a closely related disorder (obsessive compulsive disorder or OCD) and 15 of their first-degree relatives, and in 15 healthy controls.
This project will help to 1) identify specific brain regions associated with the cognitive problems underlying compulsive hoarding, 2) allow us to compare the brain activation patterns of compulsive hoarding and OCD, a closely-related disorder, and determine which patterns are shared between disorders and which are specific, and 3) determine whether first-degree relatives without hoarding behaviors show evidence of more subtle cognitive processing problems and associated brain function patterns. In combination with our studies examining neuropsychological function, brain wave patterns, and genetic inheritance patterns of compulsive hoarding, we hope to begin to better understand the causes of this impairing syndrome, eventually allowing us to identify individuals who are at risk for developing this disorder early on, when prevention and treatment can be most effective.