Prevalence, comorbidity and heritability of hoarding symptoms in adolescence: a population based twin study in 15-year olds

PLoS One. 2013 Jul 10;8(7):e69140. doi: 10.1371/journal.pone.0069140. Print 2013.

Abstract

Background: Hoarding Disorder (HD) is often assumed to be an 'old age' problem, but many individuals diagnosed with HD retrospectively report first experiencing symptoms in childhood or adolescence. We examined the prevalence, comorbidity and etiology of hoarding symptoms in adolescence.

Methods: To determine the presence of clinically significant hoarding symptoms, a population-based sample of 15-year old twins (N = 3,974) completed the Hoarding Rating Scale-Self Report. Co-occurring Obsessive Compulsive Disorder (OCD), Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) were estimated from parental report. Model-fitting analyses divided hoarding symptom scores into additive genetic, shared, and non-shared environmental effects.

Results: The prevalence of clinically significant hoarding symptoms was 2% (95% CI 1.6-2.5%), with a significantly higher prevalence in girls than boys. Exclusion of the clutter criterion (as adolescents do not have control over their environment) increased the prevalence rate to 3.7% (95% CI 3.1-4.3%). Excessive acquisition was reported by 30-40% among those with clinically significant hoarding symptoms. The prevalence of co-occurring OCD (2.9%), ASD (2.9%) and ADHD (10.0%) was comparable in hoarding and non-hoarding teenagers. Model-fitting analyses suggested that, in boys, additive genetic (32%; 95% CI 13-44%) and non-shared environmental effects accounted for most of the variance. In contrast, among girls, shared and non-shared environmental effects explained most of the variance, while additive genetic factors played a negligible role.

Conclusions: Hoarding symptoms are relatively prevalent in adolescents, particularly in girls, and cause distress and/or impairment. Hoarding was rarely associated with other common neurodevelopmental disorders, supporting its DSM-5 status as an independent diagnosis. The relative importance of genetic and shared environmental factors for hoarding differed across sexes. The findings are suggestive of dynamic developmental genetic and environmental effects operating from adolescence onto adulthood.

Publication types

  • Research Support, Non-U.S. Gov't
  • Twin Study

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology
  • Attention Deficit Disorder with Hyperactivity / complications
  • Child Development Disorders, Pervasive / complications
  • Child Development Disorders, Pervasive / epidemiology
  • Comorbidity
  • Diseases in Twins / epidemiology*
  • Female
  • Hoarding Disorder / epidemiology*
  • Hoarding Disorder / genetics*
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / complications
  • Obsessive-Compulsive Disorder / epidemiology
  • Population
  • Prevalence
  • Self Report

Grants and funding

This study was supported by the Swedish Council for Working Life (http://www.fas.se/en/), the Research Council of the Swedish National Alcohol Monopoly, funds under the Agreement on Medical Training and Research Agreement, the Swedish Research Council (http://www.vr.se/inenglish.4.12fff4451215cbd83e4800015152.html) and the Swedish Society of Medicine (Stiftelsen Söderström-Königska Sjukhemmet)(http://www.sls.se/Om-SLS/In-English/) and Riksbankens Jubileumsfond (http://www.rj.se/english/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.