Hoarding and depression: The mediating role of perceived burdensomeness
Introduction
Hoarding disorder, characterized by a persistent difficulty discarding or parting with possessions to the point of incapacitating clutter, has emerged as a considerable public health burden (American Psychiatric Association, 2013). With a prevalence rate that almost quadruples the rates of bipolar disorder and schizophrenia (Timpano et al., 2011), hoarding has been found to be associated with substantial impairment in social, occupational, and economical domains (Tolin et al., 2008a, Tolin et al., 2008b). In addition, hoarding puts individuals at risk for the development of serious and sometimes life threatening medical and mental health conditions (Tolin et al., 2008b), highlighting the need for research in this area.
Recent advances in our understanding of the classification and measurement of hoarding have led to more reliable diagnoses and improved understanding of associated comorbidity. Indeed, hoarding was originally regarded as a symptom or subtype of obsessive-compulsive disorder (OCD). Whereas hoarding can occur in the context of OCD (Pertusa et al., 2008), OCD appears to affect only a minority of individuals with hoarding disorder (Frost et al., 2011, Pertusa et al., 2010). In fact, recent research has found depressive disorders to be the most prevalent comorbid condition occurring in over half of individuals diagnosed with hoarding disorder (Frost et al., 2000b, Frost et al., 2011). Despite this considerable comorbidity, little to no research has examined factors that may be contributing this association.
Thwarted belongingness and perceived burdensomeness are two interpersonal constructs that may help to explain the robust associations between hoarding and depression. Thwarted belongingness, characterized by loneliness, detachment from others, and the perceived or definite absence of social connections, as well as perceived burdensomeness, the perception that one is a burden on others, have been proposed to arise as a result of interpersonal disturbances (Van Orden et al., 2012). These two interpersonal constructs have been extensively examined in the context of suicidal risk (Cukrowicz et al., 2011, Van Orden et al., 2008, Van Orden et al., 2012) and as such have been found to be highly correlated with depressive symptoms (Davidson et al., 2011, Hames et al., 2013, Hames et al., 2015).
Elevated burdensomeness and impaired belongingness are likely to impact many with hoarding disorder. In regard to burdensomeness, research has found that hoarding constitutes a serious threat not just for the individual who hoards but also for those living with or close to the sufferer creating significant interpersonal strain (Tolin et al., 2008a). For instance, Frost and Gross (1993) found that two-thirds of their hoarding sample reported that their saving behaviors posed a burden for family members and friends, particularly those living in the home. Tolin et al. (2008a), extended this research by conducting the first systematic study examining the burden of hoarding on family members. Individuals who resided with a hoarding family member rated their childhood as less happy, had friends over less often, argued with their parents more, and reported more humiliation about the state of their home than those who did not. In addition, they reported a high degree of hostility and rejection toward the individual who hoards.
Research has also demonstrated increased social isolation and limited social networks among those who hoard (Kim et al., 2001). It has been suggested that beliefs associated with hoarding, specifically an excessive emotional attachment to possessions, may be one factor contributing to this interpersonal strain (Grisham and Barlow, 2005). Indeed, research has found that individuals who hoard tend to anthropomorphize their belongings, connecting more to material objects than to other human beings (Timpano and Shaw, 2013). In addition, excessive clutter may also contribute to limited social behaviors due to embarrassment and an inability to invite others over to the home (Frost and Hartl, 1996).
Taken together, individuals with hoarding disorder are likely to experience substantial interpersonal problems including increased social isolation and perceptions of burdensomeness on others. However, research has not yet examined whether these interpersonal problems may help to explain the link between hoarding and depression, which is quite plausible considering the well-established role of interpersonal problems in the development of depression (Hames et al., 2013). Thus, the current study sought to examine the associations between hoarding and depression and the potential mediating role of perceived burdensomeness and thwarted belongingness. In an effort to replicate prior research, we first examined the relationship between hoarding and depression. Consistent with extant research, it was hypothesized that increased hoarding severity would be associated with increased depression symptoms. Second, we examined the relationship between hoarding severity and perceived burdensomeness and thwarted belongingness. Once again, it was hypothesized that increased hoarding severity would be associated with perceived burdensomeness and thwarted belongingness. Finally, mediation procedures were used to test the hypothesis that increased levels of perceived burdensomeness and thwarted belongingness would mediate the relationship between hoarding severity and increased depression symptoms.
Section snippets
Participants and procedure
Participants were recruited from February 2015 to March 2015 through an online crowdsourcing marketplace, Amazon's Mechanical Turk (MTurk). Participants were recruited to participate in a study designed to examine the relations between mood and anxiety risk factors. In general, data collected through MTurk appears to be of good quality, capturing a wide range of variability (Buhrmester et al., 2011, Paolacci and Chandler, 2014). There are some differences, however. Individuals completing MTurk
Preliminary analyses
First, we examined means, standard deviations, and zero-order correlations for all variables of interest (see Table 1). The SIR mean was similar to that found in prior research in a hoarding sample, and was above the recommended clinical cut-off of 41 (Frost et al., 2004). Additionally, the mean DASS depression score was consistent with that found in previous hoarding samples (Grisham et al., 2005). Means for burdensomeness and belongingness were elevated compared to previous research in a
Discussion
Consistent with other reports (Frost et al., 2000b, Frost et al., 2011, Samuels et al., 2002, Tolin et al., 2010), we found a significant positive association between symptoms of depression and increased hoarding severity. The magnitude of this effect was in the medium range, highlighting the robust associations between these variables. Further, the strength of this relationship was similar to that found between hoarding and obsessive-compulsive symptoms (Frost et al., 2004), supporting a
Role of funding
There are no sources of funding to disclose.
Contributors
Author one wrote the discussion and majority of the introduction section. Author two wrote the results section. Authors three and five assisted with the introduction section. Author four wrote the methods section and author six provided critical feedback on all drafts of the manuscript. All authors contributed substantially to the manuscript.
Conflict of interest
There are no conflicts of interest to disclose.
Acknowledgments
We have no acknowledgements to disclose.
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2020, Journal of Obsessive-Compulsive and Related DisordersCitation Excerpt :Also limiting the conclusions of this study is the failure to account for depression as a possible confounding factor. Loneliness and HD are both associated with higher levels of depressive symptoms (Raines et al., 2016; Wang, Mann, Lloyd-Evans, Ma, & Johnson, 2018) and it is possible that the observed associations and mediational pathways might no longer be significant after accounting for depression. The aim of Study 2 is to replicate Study 1's findings in a sample of participants who were pre-selected for higher hoarding difficulties and to statistically control for the effects of depression, in addition to age.
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