OCD: Hoarding and Rumination

1. OCD: Hoarding and Rumination Emily Galvez Veronica Franco Alexandra Urdaneta

2. overview • Rumination • Concerning with OCD, it’s a train of prolonged thinking about a question or theme that is undirected and unproductive. • These thoughts are unobjectionable • Indulged thoughts rather than resisted • Overthinking a negative emotion Hoarding OCD hoarding is a compulsion that results from excessive concerns that certain objects cannot be discarded because they might be needed later “Pathological collecting”

3. Biological factors • There have been a number of family studies of OCD looking at evidence for genetic patterns. A recent meta-analytic review by Hettema and colleagues (2001) reported that a person with OCD is 4 times more likely to have another family member with OCD than a person who does not have the disorder • Compulsive hoarding may be hereditary. Up to 85% of people with compulsive hoarding can identify another family member who has this problem.

4. Cognitive factors • Abnormal brain development and brain lesions may also play a role. Compulsive hoarding can begin after brain damage, such as strokes, surgery, injuries, or infections • Traumatic experiences have been theorized as one potential catalyst for the rapid onset of obsessive–compulsive symptoms including compulsive hoarding. (Behavior Research and Therapy, Volume 45, Issue 11, Nov. 2001. Pgs. 2581-2592)

5. Sociocultural factors • Hoarding causes major interference with work and social life. • The home of a hoarder can be so severely cluttered that normal everyday activities become impossible. Hoarding prevents living spaces to be used in the way they were supposed to be used. • Hoarding can cause fatal falls, especially in older adults, poor sanitation, and in ability to eat in the home, and serious health risks from infestation. • Hoarders suffer from strained relationships with family and friends because of the hoarding. Romantic relationships and daily life activities are significantly impaired because of the hoarding. • Hoarders also may experience threats from authorities (police, health department officials) who will demand the hoarding behaviors stop because of health risks

6. Symptoms Hoarding Rumination The individual may believe that if they don’t engage in certain rituals, then bad things will happen. Symptom of distress The individual over thinks every situation, resulting in no satisfactory conclusion This ongoing cycle leads to depression • Hoarders have more abnormal grooming behaviors, such as skin picking, nail biting, and trichotillomania (compulsive hair-pulling). • Collecting items and anxiety of letting items go.

7. Prevalence Hoarding Rumination Numbers aren’t specifically given for rumination occurring in OCD. But there is a few case studies done specifically on Rumination but they’re not exclusive or very detailed. • 1.4 to 2 million people in the United States have compulsive hoarding syndrome (Maidment, 2005; Collingwood, 2006). • Hoarding accompanies OCD in 25% to 40% of individuals diagnosed (Understanding Hoarding, 2005; Seedat and Stein, 2002). • 2-3% of the general population has OCD and up to one-third of those diagnosed with OCD exhibit hoarding behavior (Cohen, 2004; Haggerty, 2006).

8. Diagnosis Hoarding Rumination Thoughts being excessively repeated in their head Denial to answer the thought provoking question The individual is becoming obsessive with the questions and scenarios in their mind. The patients are ego-dystonic compulsions experienced or expressed are not consistent with the individual's self-perception, meaning the patient realizes the obsessions are not reasonable. • A person must experience significant distress and/or impairment in functioning as a result of their hoarding behavior. • Common types of functional impairment include: fire or health hazards caused by excessive clutter, infestations, inability to have guests over to the home, inability to prepare or eat food in the home, inability to find important possessions because of clutter, inability to finish tasks on time, and interpersonal conflicts caused by the clutter.

9. Cultural Factors Hoarding General OCD There was a study on OCD and it’s impact on a patient’s life. Even though the Arabian socioculture is similar, they stated that there was a difference amongst the different countries and the patients impact of OCD. The study compared patients in Saudi Arabia and Egypt. The biggest similarity was that the patient’s OCD had a negative impact on their life. It was a negative aspect because the disorder wasn’t well treated there and the patient considered abnormal was not talked to so often. • Hoarding behaviors exist all over the world but few studies examine hoarding criteria across cultures. • A study was done on hoarding behaviors on the Japanese. The hoarding characteristics of the Japanese OCD hoarding patients were similar to patients from Western cultures as far as what types of items were kept and the extent of the clutter. • In a study of African Americans, it was found that African American hoarders were more likely to suffer from substance abuse. It is believed that the effects of alcohol contributed to the neglect disorganization and clutter of their living space. This study also found that African American hoarders had difficulty with indecisiveness.

10. Gender Variations Hoarding Rumination • Rumination is more seen and developed in women than men. • Women are seen to over-think more which if already diagnosed with OCD can lead them to repetitively think the questions and resulting into depression • Male OCD patients tend to withdraw so much thinking but they are seen to develop the checking type of OCD • Female hoarders were more likely to suffer from bipolar I, substance abuse, panic disorder, binge-eating disorder, and had greater OCD severity. Male hoarders had an increased prevalence of social phobia compared to non-hoarding males. (Michael Wheaton and colleagues, 2008)

11. Treatment Approaches Rumination • Cognitive behavior therapy (CBT) using the technique of exposure and response prevention appears to improve compulsive hoarding symptoms. This technique decreases excessive fears of making decisions, losing important possessions, throwing things away, and organizing saved items out of sight, by gradual exposure to tasks that provoke these fears. • Drugs with powerful effects on the brain chemical serotonin seem most effective. Serotonin reuptake inhibitors (SRI's) are highly effective for treatment of OCD, but it is not clear whether they are as effective for compulsive hoarding as for other OCD symptoms. Hoarding Drug Therapies Behavioral Therapy Rumination: to reduce one's general anxiety level and, or avoid situations which create anxiety Medication with Behavioral Therapy

12. Etiology and therapeutic approach Hoarding Rumination With Rumination and the general OCD treatments, there’s no one treatment that works for everyone. It’s a common difficulty and impossibility to find a specific “cause” for OCD (Hoarding and Rumination) In Walker-Tesser model includes a group of contributing factors to the disorder It’s still possible to treat the symptoms of Rumination even though there is no cause for it. By using Behavioral therapy Genetics is not the greatest risk factor when it comes to OCD or any abnormal disorder because you can’t just simply change your genes. Genetics are a predisposition that increase the risk of having OCD. Culture affects the beliefs about the causes and treatments on OCD. Being in a different culture results in different therapeautic approaches. • Medications: Studies have shown that hoarders who try selective serotonin reuptake inhibitor antidepressants (SSRI's) such as Paroxetine show improvement in hoarding symptoms (with or without psychotherapy). One study showed that 28% of study participants were classified as responders to treatment and another 22% were partial responders. Overall, 50% of compulsive hoarders had at least a partial response to medication treatment. However other studies have shown that selective serotonin reuptake inhibitor has not been proven effective in people with OCD hoarding • Cognitive behavioral therapies: Research has shown that hoarding does respond to cognitive behavioral therapy (CBT). Treatment for hoarding can be intense and very hands-on, but with patience and perseverance, it can be very effective.

13. Treatment: Medications known as Selective Serotonin Re-uptake Inhibitors (SSRIs) are often used to treat OCD, although it is not fully known why the SSRI medications seem to help some people with OCD. Cognitive behavior therapy (CBT) Applied WALKER-TESSNER MODEL FOR ocd Traumatic (Sociocultural Factors): Severe life events . Different cultures are subject to treating OCD in with a different method of cure. Factors (Biological) Neurotransmitters Imbalance of serotonin . Serotonin is the chemical in the brain that sends messages between brain cells and it is thought to be involved in regulating everything from anxiety, to memory, to sleep. 2. Inherited factors 3. Brain abnormalities OCD • Cognitive Factors: • 1. Irrational and Illogical thinking • 2. Cognitive distortions • 3. Negative thinking patterns