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Hoarding in Obsessive-Compulsive Disorder: Clinical and Genetic Correlates

Christine Lochner, M.A.; Craig J. Kinnear, M.Sc.; Sian M. J. Hemmings, M.Sc.; Cathlene Seller, F.C.Psych., M.Med.Psych.; Dana J. H. Niehaus, M.Med.Psych.; James A. Knowles, Ph.D.; Willie Daniels, Ph.D.; Johanna C. Moolman-Smook, Ph.D.; Soraya Seedat, F.C.Psych., M.Med.Psych.; and Dan J. Stein, M.D., Ph.D.

Objective: Hoarding may be an important symptom dimension in obsessive-compulsive disorder (OCD). Hoarding in OCD has been associated with poor insight, poorer response to selective serotonin reuptake inhibitors than other OCD symptom dimensions, and a distinctive psychobiological profile. The clinical and genetic correlates of hoarding in OCD therefore deserve additional investigation.

Method: Adult OCD patients (N = 315) underwent a comprehensive clinical assessment that included the Structured Clinical Interview for DSM-IV Axis I Disorders (Patient Edition) and for Diagnosis of Obsessive-Compulsive Spectrum Disorders. DNA extracted from venous blood (10-30 mL) in a Caucasian subset of the interviewed OCD patients (N = 204) and Caucasian controls (N = 169), including patients (N = 94) and controls (N = 138) of Afrikaner descent, was genotyped to investigate polymorphisms in genes involved in monoamine function and previously hypothesized to be relevant to OCD. Data were collected from 1998 through 2004.

Results: OCD patients with hoarding made up 18.1% of the total sample. Compared with nonhoarding OCD, OCD with hoarding was associated with a number of comorbid Axis I disorders, obsessive-compulsive personality disorder, significantly higher OCD severity scores, and more functional impairment. In subjects of Afrikaner descent, the L/L genotype of the COMT Val158Met polymorphism was significantly more common in the OCD hoarding group, with a preponderance of low activity alleles, compared with nonhoarding patients and controls.

Conclusions: These data are consistent with the hypothesis that hoarding represents a unique symptom subtype in OCD with a distinctive clinical and psychobiological profile. Further work is needed to determine the psychobiological mechanisms responsible for hoarding and to replicate the genetic findings noted here.

(J Clin Psychiatry 2005;66:1155-1160)

Received Nov. 24, 2004; accepted March 10, 2005. From the MRC Unit on Anxiety Disorders, Department of Psychiatry (Ms. Lochner and Drs. Niehaus, Seedat, and Stein), MRC/US Centre on Molecular and Cellular Biology (Mr. Kinnear, Ms. Hemmings, and Dr. Moolman-Smook), the Department of Psychiatry (Dr. Seller), and the Department of Medical Physiology (Dr. Daniels), University of Stellenbosch, Cape Town, South Africa; Columbia University/New York State Psychiatric Institute, Department of Psychiatry, New York (Dr. Knowles); and the Department of Psychiatry, University of Florida, Gainesville (Dr. Stein).

This work is supported by the Medical Research Council of South Africa and by grants from the Obsessive-Compulsive Foundation, New Haven, Conn., and the National Alliance for Research on Schizophrenia and Depression, Great Neck, N.Y.

Mss. Lochner and Hemmings, Mr. Kinnear, and Drs. Seller, Niehaus, Knowles, Daniels, Moolman-Smook, Seedat, and Stein report no other pertinent commercial relationships.

The authors gratefully acknowledge the assistance of the Obsessive-Compulsive Association of South Africa, Johannesburg.

Corresponding author and reprints: Christine Lochner, M.A., P.O. Box 19063, Tygerberg, 7505, South Africa (e-mail: