2008-05-03 notes on hoarding
From Biohack
The Role of the Orbitofrontal Cortex in Anxiety Disorders Neurocognitive endophenotypes of obsessive-compulsive disorder Functional and Biochemical Alterations of the Medial Frontal Cortex in Obsessive-Compulsive Disorder Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification An autistic dimension: A proposed subtype of obsessive-compulsive disorder Representation of future and previous spatial goals by separate neural populations in prefrontal cortex. Frontal-Striatal Dysfunction During Planning in Obsessive-Compulsive Disorder
Categorization in compulsive hoarding (Wincze, Steketee, Frost)
Based on hypothesizing about the role of information processing, and in particular, underinclusive categorization in compulsive hoarding, this study examined categorization processes in people with clinically significant compulsive hoarding problems. Twenty-one participants with primary compulsive hoarding, 21 with OCD without hoarding, and 21 non-psychiatric controls completed three categorization tasks. Hoarding and OCD participants reported significantly more distress prior to each of the three tasks than did controls. On tasks sorting common household items, the groups did not differ on the number of piles created nor on the amount of time taken to sort. However, on a task sorting personally relevant items, hoarding participants took more time, created more piles, and reported more anxiety than non-psychiatric controls. Hoarders also took more time than the OCD group, and tended to create more piles. Hoarding severity was correlated with the number of piles created, but only when the objects were personally relevant. Results support under-inclusive categorizing for people with compulsive hoarding, but the effect was largely confined to objects of personal relevance.
Cerebral activations during number multiplication and comparison: a PET study ==> Both multiplication and comparison activated the left and right lateral occipital cortices, the left precentral gyrus, and the supplementary motor area.
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The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. J V Pardo, P J Pardo, K W Janer, and M E Raichle
Regional cerebral blood flow, an index of local neuronal activity, was measured using positron emission tomography (PET) during the performance of the classic Stroop color/word task in eight healthy right-handed subjects. In the first condition of this paradigm, subjects name the color of the words presented on a video monitor. All the words are the color names congruent to the color presented (e.g., the noun "red" displayed in red color). In the second condition, subjects also name the color of the words presented on the monitor. However, during these trials all words are color names incongruent to the color presented (e.g., the noun "red" displayed in green color). The difference in brain activity between these two conditions (i.e., incongruent minus congruent) could reveal brain systems involved in the attentionally mediated resolution of the conflict between the habitual response of reading words vs. the task demands of naming the color of the words--i.e., the Stroop interference effect. The most robust responses occurred in the anterior cingulate cortex. Other responses noted were in the left premotor cortex, left postcentral cortex, left putamen, supplementary motor area, right superior temporal gyrus, and bilateral peristriate cortices. These data provide support for the role of the anterior cingulate cortex in attentional processing through the selection and recruitment of processing centers appropriate for task execution. Furthermore, the extensive distributed network of activated regions suggests that the Stroop interference effect cannot be explained simply in terms of stimulus encoding or response interference.
"These data provide support for the role of the anterior cingulate cortex in attentional processing through the selection and recruitment of processing centers appropriate for task execution."
anterior cingulate, selective attention
TMS in anxiety
To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study. Actual and perceived memory deficits in individuals with compulsive hoarding.
Do traumatic events influence the clinical expression of compulsive hoarding? Traumatic experiences have been posited as one potential catalyst for the abrupt onset of obsessive–compulsive symptoms including compulsive hoarding. To determine whether traumatic life events (TLEs) might influence the expression of compulsive hoarding in obsessive–compulsive disorder (OCD), interview responses to the Posttraumatic Stress Disorder module of the Structured Clinical Interview for DSM-IV (SCID) were examined in 180 individuals with OCD. Compared to individuals with OCD who did not meet criteria for hoarding, participants classified as hoarders (24% of the sample) were significantly more likely to have reported at least one TLE in their lifetime. Patients who met criteria for hoarding and who had also experienced TLEs had significantly greater hoarding symptom severity than those hoarders not exposed to trauma. This association was found to be robust. That is, the relationship between TLEs and hoarding symptom severity was not better accounted for by age, age of OCD onset, depressive symptoms, general OCD symptomatology, or mood and anxiety comorbidity. Closer examination revealed that the clutter factor of compulsive hoarding (and not difficulty discarding or acquisitioning) was most strongly associated with having experienced a traumatic event.
Forced collectionism after orbitofrontal damage E. Volle, MD, R. Beato, MD, R. Levy, MD PhD and B. Dubois, MD A collector is a person who collects things on purpose, either as a hobby or business, or for personal satisfaction, e.g., stamp, coin, or art collector. In such instances, the act of collecting things represents voluntary, controlled, goal-directed, selective searching. Pathologic patterns of collecting have been observed following brain damage, particularly frontal lobe damage, ranging from a tendency to grasp (prehension behavior) to an irrepressible need to seize surrounding objects and store them (hoarding behavior). These adnormal behaviors express an excessive adherence to environmental stimuli but in no way express a planned process directed toward specific items. In this article, we describe an unusual pattern of pathologic collecting behavior due to frontal lobe damage: involuntary irrepressible collecting that is goal-directed and selective. The authors report a patient who collected specifically household electrical appliances following a bilateral damage of orbito- and polar-prefrontal cortex. The patient had involuntary irrepressible collecting that was goal-directed and selective. This "forced collectionism" is different from that of the usual collectionism encountered in patients with frontal lobe lesions, as the latter is in no way a planned process directed toward specific items.
Second, a number of items on the hoarding scale measure beliefs about possessions (their nature and function) rather than symptoms of the disorder (e.g., “I see my belongings as extensions of myself, they are a part of who I am.”). While we have identified a number of relevant beliefs, no single set of beliefs characterizes all people with this problem. Rather than including all relevant beliefs in this measure and having a number of them not apply, it seems prudent to separate symptoms of hoarding from beliefs thought to be associated with it. Separate assessment of hoarding beliefs may help to explain hoarding symptoms ( Steketee, Frost, & Kyrios, 2003).
Frost & Steketee - Categorization problems. A related information-processing deficit we have hypothesized is underinclusive categorization, similar to that suggested by Reed (1985) for OCD generally. To someone with this problem, each possession is so unique and so important that it belongs in a category by itself, and therefore cannot be put away with similar things. This is, in part, why the homes of compulsive hoarders are so chaotic and cluttered. This phenomenon was clearly evident when one client tried to sort a pile of possessions. She frequently picked up an object, but could not decide where it belonged, and therefore put it back on the pile to be dealt with later. We call this process "churning" since, despite the client's best intentions, the only result is that the location of possessions in the pile changed. Almost nothing is discarded and few items are put away in planned locations because "unique" possessions cannot be placed with other unique items. This phenomenon reveals the heart of the organization problems experienced by people with compulsive hoarding.
- Bryan's thoughts on this -- it's not so much that dissimilar items can't be placed together (an OCD/AS issue where it's just "Not Right") but rather more about the 'information' processing aspect of it -- you say you'll get back to it later, but you don't necessarily schedule a specific time, and you don't necessarily have a ritual to process through the stack of items. So in this compulsive-acquisition process (are there any hoarders that repetitively/recursively hoard?), it's about interrupts. The objects that are in front of them represent the interrupts, and then they decide what to do with the object (the focus of attention), and since they don't have everything cached at the moment, and there's something else to be done, they don't focus with the 'emotional'/amgydalan issues re: discarding/ignoring.
Focus of attention. A third type of information-processing problem has to do with maintaining focus and perspective. It has been our observation that hoarders appear to spend most of their time thinking about the potential usefulness or necessity of a possession--that is, the benefits of saving--and very little time thinking about the cost of saving when they are trying to decide about discarding a possession. The sight of a possession seems to enhance its importance, and the reasons to save it dominate their consideration. In this context, decision making is heavily influenced by the sight of a possession, making it difficult to evaluate the practical importance of an object. Once in sight, the normal continuum from useless to very useful is narrowed severely. Under these circumstances, an object must not only be kept, but it must be kept in sight and nearby. A by-product of this process is that truly important items are piled together with unimportant ones, and the result is chaos.
Lost opportunity. One of the strongest beliefs among compulsive hoarders is that getting rid of a possession represents a loss of opportunity or important information. For people who save newspapers, magazines, and other documents/papers, this appears exceptionally powerful. Sometimes there is specific information at issue, but the saving behavior is out of proportion to its importance. This fear not only applies to things in the hoarder's possession, but to things it is possible for the hoarder to acquire. Not buying or picking up something that is a potential opportunity can cause intense distress and rumination for long periods of time. This belief remains unshaken by the fact that few, if any, opportunities or useful information have ever been generated by saved items. It is as though they imagine a potential opportunity that might be contained in these possessions, and this is enough to convince them to save the items. They express an intention to examine each possession to find the opportunity, but with so many saved possessions, there simply are not enough hours in the day to do so. Some hoarders spend hours trying to sort through these possessions, whereas others postpone the attempt, planning to "do it later." Later seldom comes.
Beliefs about safety. Other types of beliefs associated with hoarding pertain to the role possessions play in making the person feel comfortable and/or safe. People who hoard, like those with OCD, appear to overestimate dangerousness. Possessions come to represent signals of safety. Not surprisingly, if possessions become associated with feelings of safety and comfort, getting rid of them may violate this feeling of safety. Many hoarders describe their possessions in terms of their safety or comfort value. For example, one of our clients described her home and possessions as her "cocoon." Another labeled piles of disorganized papers and other items amidst which she liked to sit as her "bunker." Still another realized that she used her piles of papers spread on the floor as an ineffectual form of protection against feared intruders; she believed she slept better in a cluttered bed. Several of our patients describe their homes as the only place they feel comfortable or safe. Reported beliefs about the emotional comfort value of possessions include the following: "Without my possessions, I will be vulnerable." "I could not tolerate it if I were to get rid of the things piled up in my house." For those who have come to rely on their possessions as sources of comfort and security, removing them means challenging these beliefs. Perhaps because of concerns about safety, many people who hoard are uncomfortable about sharing their possessions with others or having others touch or use their possessions. Contact with others may change the safety signal value of the item and feel like a violation. Because of this sensitivity, as well as for other reasons, we establish a rule in treatment that the therapist will never touch or move a possession without explicit permission.
that they must compensate. Consequently, they keep things to remind themselves and come to rely heavily on visual cues for memory. That is, they tend to keep things in sight so they won't forget them. We have seen clients whose closets and dressers are empty and their would-be contents piled high on furniture and floors. When asked about it, they say they have to keep them in sight so as not to forget, making it difficult to organize objects and put them away. Some hoarders develop and rely on a visualspatial organization scheme. They remember where to find things by their approximate location in the pile. One hoarder sought to recall where she had placed items by inserting color-coded paper as markers in the pile. Attempts to change from this system to a filing system where things are put away leave many hoarders feeling as though they have lost something, even though their things are more easily accessible.
- Hey, that's me. I use lots of visuospatial clues, like when referring to the page in a book that I found a quote I usually "hand-wave" it away and mention some general area of the page that I found the quote on, or the general chunk of the book ("about the middle"); I also do this in piles of paper, such as in the stack-system for my backpack. Carrying around an entire laptop and all paperwork from the entire schoolyear in the backpack is an excellent example of hoarding.
A similar phenomena seems to occur with information. One of our participants kept old newspapers because she was convinced she would not be able to remember the information they contained. Further, she considered it essential that she remember the information even though she had never even read the newspapers. Their presence gave her the sense that she had access to the information. The following types of beliefs are ones we have observed among hoarders: "If I save things, I don't have to rely on my memory," "My memory is so bad I must leave things in sight or I'll forget about them," "If I put things into a filing system, I'll forget about them." The behaviors associated with these beliefs include the saving of things as well as keeping things in sight.
- 74663 +(556)- [X]
<kyhm> Let's just say "arting" doesn't make a good verb... ^_^
- Superkuh is still laughing.
<Ezelek> How about stabbing? <kyhm> stabbing makes a great verb... <Kestenvarn> How about stabbed as an adjective? <kyhm> As in, "I'm feeling stabbed today?" Doesn't do it for me... <Kestenvarn> I'm rather stabbed you would say such a shocking thing. <kyhm> Stab it all, why doesn't this stabbed thing work? <Kestenvarn> I'm stabbed. Why? <kyhm> Stab me... ^_^ <Kestenvarn> Well, go stab yourself! <Ezelek> Note to self: Don't let any of them near words. Of any kind.
http://www.koert.com/work/cursorpredictor CURSOR TRAJECTORY PREDICTION (betatest for compulsive clickers)
http://drunkmenworkhere.org/ - Fresh Zero Content for Compulsive Clickers
T E C H N I C A L L Y S P E A K I N GI should also mention that infohoarding often goes hand-in-hand. with completism, the obsessive gathering of the complete collec- ... ieeexplore.ieee.org/iel5/6/4283494/04283540.pdf?tp=&isnumber=&arnumber=4283540 -
Title Defensive miserliness: Hoarding attention in the service of emotional regulation Author Boden, Joseph Matthew Degree Doctor of Philosophy, Case Western Reserve University, Psychology, 1995. Advisor Roy F. Baumeister Pages 90p. Abstract The purpose of the present investigation was to determine whether repressors will allocate attentional resources in a way that is especially conducive to using attention to regulate their emotional experience. This bias in allocation was referred to as defensive miserliness. A pair of experiments examined whether repressors were better able than nonrepressors to shift their attention from one stimulus to another in two divided attention tasks. The experiments also examined whether repressors became unwilling to shift their attention across tasks when the threat of experiencing negative emotions was made salient. The results of the first experiment suggested that repressors did indeed show a bias in the manner in which their attentional resources were allocated. A more rigorous and complex test of the hypothesis conducted in the second experiment, however, failed to support the defensive miserliness hypothesis. The bias demonstrated by repressors in the first experiment is believed to explain in part why repressors are successful at regulating emotional states, and why shifting attention is one effective way to control emotions.
'The bowerbird symptom' : a case of severe hoarding of possessions Fitzgerald Objective: To describe a severe case of hoarding of possessions in a patient with obsessive-compulsive disorder. Clinical picture: A 22-year-old male presented with a history from early childhood of persistent collecting of valueless objects and the inability to give up possessions. He had significant insight but ambivalent feelings about changing his behaviour, despite the degree of disruption it produced in his environment. Treatment and Outcome: Attempts to engage the patient in treatment were unsuccessful because of the patient's ambivalence towards change. Conclusions: The symptom of hoarding behaviour may be a severe and disruptive expression of psychiatric distress, and in obsessive-compulsive disorder it is likely to indicate a poor prognosis due to the difficulties of engaging the patient in treatment.
hoarding + wisconsin
"the bowerbird symptom"
mrn.org Synesthesia research group in Waterloo, CA http://www.sciencedaily.com/videos/2007/0107-what_color_is_a.htm
