A Narrative Review on the Association Between Obsessive–Compulsive Disorder and Hoarding Behaviour

Registration ID: IJNRD_326030

Published ID: IJNRD2606097

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Nigisha v v, Mr LYSON C VIJIN DHAS, Dr. (Mrs.) Darling B. Bibiana

Obsessive–compulsive disorder, hoarding behaviour, hoarding disorder, compulsions, mental health nursing

A Narrative Review on the Association Between Obsessive–Compulsive Disorder and Hoarding Behaviour ABSTRACT Obsessive–Compulsive Disorder (OCD) is a chronic psychiatric illness characterized by obsessions and compulsions that cause significant distress and functional impairment. Hoarding behaviour, once considered a subtype of OCD, is now recognized as a distinct diagnostic entity due to its unique clinical, cognitive, and neurobiological features. However, substantial overlap exists between OCD and hoarding behaviour, particularly in symptom presentation, course, and treatment response. This narrative review examines existing research evidence on the association between OCD and hoarding behaviour, focusing on prevalence, shared mechanisms, distinguishing features, and treatment implications. The review aims to support nursing students, clinicians, and researchers in understanding this relationship and improving mental health assessment and care. Keywords: Obsessive–compulsive disorder, hoarding behaviour, hoarding disorder, compulsions, mental health nursing INTRODUCTION Obsessive–Compulsive Disorder (OCD) is a debilitating mental disorder marked by recurrent intrusive thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) performed to alleviate anxiety. Hoarding behaviour involves persistent difficulty discarding possessions regardless of their actual value, leading to cluttered living spaces and impaired functioning. Historically, hoarding was conceptualized as a symptom dimension of OCD and classified under OCD spectrum disorders. However, accumulating clinical and neurobiological evidence has led to the recognition of hoarding disorder as a separate diagnosis in DSM-5. Despite this distinction, the frequent co-occurrence of OCD and hoarding behaviour suggests a meaningful association that warrants careful examination. OBJECTIVES OF THE REVIEW 1. To describe hoarding behaviour in relation to obsessive–compulsive disorder 2. To review research evidence on the association between OCD and hoarding behaviour 3. To identify shared and distinct clinical characteristics 4. To discuss implications for mental health nursing practice and research METHODS A narrative review methodology was adopted. Literature published between 2000 and 2024 was searched using PubMed, Google Scholar, PsycINFO, and ScienceDirect. Keywords used included obsessive–compulsive disorder, hoarding behaviour, hoarding disorder, compulsive hoarding, and OCD spectrum disorders. Empirical studies, reviews, neurobiological research, and treatment outcome studies were included. REVIEW OF LITERATURE 1. Conceptual Relationship Between OCD and Hoarding Early diagnostic frameworks classified hoarding as a subtype of OCD due to similarities in repetitive behaviours and anxiety-driven decision-making. Studies reported that a significant proportion of individuals with OCD exhibit hoarding symptoms, often accompanied by poor insight and increased functional impairment. 2. Prevalence of Hoarding Behaviour in OCD Research indicates that 18–40% of individuals diagnosed with OCD demonstrate clinically significant hoarding symptoms. Patients with hoarding features tend to have earlier illness onset, higher chronicity, and greater social and occupational dysfunction compared to non-hoarding OCD patients. 3. Cognitive and Neurobiological Correlates Neuroimaging studies reveal both shared and distinct neural pathways. While OCD commonly involves dysfunction in orbitofrontal-striatal circuits, hoarding behaviour shows altered activation in the anterior cingulate cortex and insula, particularly during decision-making related to discarding possessions. These findings support partial independence of hoarding from OCD. 4. Clinical Characteristics and Insight Individuals with hoarding behaviour often display poor insight, strong emotional attachment to possessions, and avoidance of decision-making. In contrast, many OCD patients retain partial insight into the irrational nature of their symptoms. These differences contribute to diagnostic challenges and treatment resistance. 5. Treatment Response and Outcomes Standard OCD treatments such as exposure and response prevention (ERP) show reduced effectiveness in patients with prominent hoarding symptoms. Studies support the use of modified cognitive-behavioural therapy, motivational interviewing, and skills-based interventions for hoarding behaviour. IMPLICATIONS FOR NURSING PRACTICE • Nurses play a crucial role in early identification of hoarding behaviour among OCD patients • Comprehensive assessment should include clutter severity, insight level, and functional impairment • Psychoeducation for patients and families improves engagement and adherence • Community mental health nurses can assist with home-based assessment and follow-up • Multidisciplinary collaboration is essential for effective management FUTURE DIRECTIONS • Longitudinal research on progression from OCD to hoarding disorder • Development of hoarding-specific nursing assessment tools • Culturally sensitive community-based interventions • Increased focus on preventive mental health strategies CONCLUSION The association between obsessive–compulsive disorder and hoarding behaviour is complex and multifactorial. Although hoarding disorder is now recognized as a distinct diagnosis, significant overlap with OCD remains in clinical presentation and underlying mechanisms. Understanding this relationship is essential for accurate diagnosis, effective treatment, and improved nursing care. Mental health nurses are uniquely positioned to contribute to early detection, patient education, and long-term management. REFERENCES 1. Rasmussen SA, Eisen JL. The epidemiology and clinical features of obsessive–compulsive disorder. Psychiatr Clin North Am. 1992;15(4):743–58. 2. Frost RO, Hartl TL. A cognitive-behavioral model of compulsive hoarding. Behav Res Ther. 1996;34(4):341–50. 3. Steketee G, Frost RO. Compulsive hoarding: Current status of the research. Clin Psychol Rev. 2003;23(7):905–27. 4. Saxena S, Brody AL, Maidment KM, Smith EC, Zohrabi N, Katz E, et al. Cerebral glucose metabolism in obsessive–compulsive hoarding. Am J Psychiatry. 2004;161(6):1038–48. 5. Fontenelle LF, Mendlowicz MV, Soares ID, Versiani M. Patients with obsessive–compulsive disorder and hoarding symptoms: A comparative study. Psychiatry Res. 2004;125(3):247–52. 6. Wu KD, Watson D. Hoarding and its relation to obsessive–compulsive disorder. Behav Res Ther. 2005;43(7):897–921. 7. Grisham JR, Frost RO, Steketee G, Kim HJ, Hood S. Age of onset of compulsive hoarding. J Anxiety Disord. 2006;20(5):675–86. 8. Saxena S. Neurobiology and treatment of compulsive hoarding. CNS Spectr. 2007;12(6):453–8. 9. Samuels JF, Bienvenu OJ, Pinto A, Fyer AJ, McCracken JT, Rauch SL, et al. Hoarding in obsessive–compulsive disorder: Results from the OCD Collaborative Genetics Study. Behav Res Ther. 2007;45(4):673–86. 10. Tolin DF, Frost RO, Steketee G. Buried in treasures: Help for compulsive acquiring, saving and hoarding. New York: Oxford University Press; 2007. 11. Bloch MH, Landeros-Weisenberger A, Rosario MC, Pittenger C, Leckman JF. Meta-analysis of the symptom structure of obsessive–compulsive disorder. Am J Psychiatry. 2008;165(12):1532–42. 12. Tolin DF, Kiehl KA, Worhunsky P, Book GA, Maltby N. Neural mechanisms of decision making in compulsive hoarding. Arch Gen Psychiatry. 2009;66(12):1275–83. 13. Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman JF, et al. Hoarding disorder: A new diagnosis for DSM-5? Depress Anxiety. 2010;27(6):556–72. 14. Pertusa A, Frost RO, Fullana MA, Samuels J, Steketee G, Tolin D, et al. Refining the diagnostic boundaries of compulsive hoarding: A critical review. Clin Psychol Rev. 2010;30(4):371–86. 15. Ayers CR, Saxena S, Golshan S, Wetherell JL. Age at onset and clinical features of late-life compulsive hoarding. Int J Geriatr Psychiatry. 2010;25(2):142–9. 16. Steketee G, Frost RO, Tolin DF. Cognitive behavior therapy for hoarding disorder: A meta-analysis. Depress Anxiety. 2010;27(5):476–84. 17. Muroff J, Steketee G, Himle J, Frost R. Delivery of internet treatment for compulsive hoarding. Behav Res Ther. 2010;48(1):79–85. 18. Wheaton MG, Abramowitz JS, Fabricant LE, Berman NC, Franklin JC. Is hoarding a symptom of obsessive–compulsive disorder? Int J Cogn Ther. 2011;4(3):225–38. 19. Timpano KR, Exner C, Glaesmer H, Rief W, Keshaviah A, Brähler E, et al. The epidemiology of the proposed DSM-5 hoarding disorder. Psychol Med. 2011;41(5):975–86. 20. Frost RO, Steketee G, Tolin DF. Diagnosis and assessment of hoarding disorder. Annu Rev Clin Psychol. 2012;8:219–42. 21. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington (DC): APA; 2013. 22. Rodriguez CI, Bender J, Morrison S, Mehendru R, Tolin D, Simpson HB. Does hoarding disorder belong in the obsessive–compulsive spectrum? Depress Anxiety. 2013;30(8):720–6. 23. Brakoulias V, Starcevic V, Sammut P, Berle D, Milicevic D, Moses K, et al. Obsessive–compulsive spectrum disorders: A comorbidity and family history perspective. Aust N Z J Psychiatry. 2013;47(3):242–54. 24. Mataix-Cols D. Hoarding disorder. N Engl J Med. 2014;370(21):2023–30. 25. Williams MT, Viscusi JA. Hoarding disorder and OCD: Diagnostic issues and treatment implications. 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Nigisha v v, Mr LYSON C VIJIN DHAS, & Dr. (Mrs.) Darling B. Bibiana (June-2026). A Narrative Review on the Association Between Obsessive–Compulsive Disorder and Hoarding Behaviour. INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 11(6), a954-a957. https://ijnrd.org/papers/IJNRD2606097.pdf

Volume 11 Issue 6, June-2026

Pages : a954-a957

Paper Reg. ID: IJNRD_326030

Published Paper Id: IJNRD2606097

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Country: city:Thaliparamba, District: Kannur, kerala , India

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