Decision-making in youth with hoarding symptoms

Abstract

Hoarding symptoms are characterized by (1) a persistent difficulty discarding personal items (2) clutter that interferes with living areas and (3) clinically significant distress or impairment in functioning. Hoarding symptoms are common, affecting 2-6% of the general population and 20% to 56.7% of individuals with obsessive-compulsive disorder (OCD). Research suggests that individuals who hoard have impaired decision-making, particularly when it involve making decisions about personal possessions. This is thought to be a key deficit in hoarding resulting in an inability to discard unneeded possessions. Although the onset of hoarding symptoms is usually during childhood or adolescence (youth), little research has investigated hoarding symptoms in youth. The present study compared different aspects of decision-making processes between youth with OCD and youth with OCD and hoarding symptoms. Specifically, we assessed decision-making and the influence of ownership using the Balloon Analogue Risk Task (BART) and an endowment trading task, respectively. Additionally, we assessed cognitive flexibility, inhibitory control and delay discounting using the Wisconsin Card Sorting Task (WCST), the Stop Signal Task (SST) and Monetary Choice Questionnaire (MCQ), respectively. Participants included 52 youth (8-18 years old), all with a primary DSM-5 diagnosis of OCD. Parents completed the Child Saving Inventory to measure the presence of hoarding symptoms and to create hoarding severity groups. Youth with hoarding symptoms exhibited differences in ownership-based decision making; specifically, we found a larger endowment effect compared to the non-hoarding group. Compared to participants with OCD only, participants with hoarding exhibited significantly increased cognitive flexibility and lowered perseveration on the WCST. Performance of the hoarding and non-hoarding groups did not differ on other aspects of decision-making, including non-ownership decision-making, inhibitory control and delay discounting. Further regression analysis suggested that increased hoarding severity was associated with higher inattentive symptoms and improved performance on the WCST. These findings support the notion that hoarding is associated with specific differences in making decisions about personal items.