Understanding Hoarding Behavior and its Correlates Among Clinical and Non-clinical Groups

Abstract

Hoarding is a mental health condition that has been added in DSM-V under the category of Obsessive Compulsive and Related Disorders and is characterized by difficulty discarding a number of objects irrespective of their actual value resulting in clutter causing significant distress and impairment in daily living (APA, 2013). Though it is considered to be a universal phenomenon, most of research has been done in Western societies and has rarely been examined in Asian cultures including Pakistan. The present study, therefore, aimed to examine the manifestation and correlates of hoarding behavior in cultural context of Pakistan which has been achieved across a sequence of three interrelated studies. Objective of study I was to explore the phenomenon of hoarding behavior in Pakistan qualitatively. Grounded theory method was utilized as it infers that reality of any event or action is socially constructed (Charmaz, 2005) and takes context as an important factor. Six focus groups were conducted to collect data from adult sample from general public. Initially focus group guide was designed based on existing literature comprising of open ended questions which was revised after each FGD, following the grounded theory method. Analysis revealed four main aspects of hoarding behavior that were: cognitive component, affective component, personality dynamics and the socio-cultural aspect, each comprising of further categories and sub categories. In addition, five semi structured interviews were done with clinical experts (3 psychiatrists, 2 psychologists) to assess their understanding regarding nature and perceived prevalence of the hoarding behavior in reference to clinical settings of Pakistan. Five main themes emerged through interviews were: nature of phenomenon, perceived prevalence, under-reported, experiential factors, and biological factors. Findings of qualitative study support the existing literature in many respects. However, it also revealed certain unique aspects like status transformation with ix resulting sense of competition, gender role, impact of material deprivation, and religious construction for explanation of hoarding behavior as more of culture specific influences. Results also support the prevalence of hoarding behavior as an associated symptom in number of psychopathologies, however, as a separate disorder it is not well recognized in clinical settings of Pakistan. Study II comprised of two phases. Phase-I aimed to develop an indigenous instrument to measure factors associated with hoarding based on the narrative from qualitative exploration. Both inductive and deductive approaches were used and a systematic procedure for scale development was followed. Data was collected from a sample of 400 individuals on which factor structure of scale was determined. A three factor solution with 22 items was found to be most coherent empirically and theoretically. Scale was named as “Determinants of Hoarding Scale” with three subscales labeled as Materialism (N = 8), Perceived Utility Value (N = 7), and Emotional Associations (N = 7). Psychometric properties of scale were found to be satisfactory with alpha value of .82 for Materialism, .81 for Perceived Utility Value, .83 for Emotional Associations, and .90 for complete scale. Confirmatory factor analysis was done on an independent data set of 250 individuals to establish construct validity. Phase-II intended to adapt the study measures into Urdu language that were not already available in target language. Therefore, Saving Inventory-Revised (SI-R; Frost, Steketee, & Grisham, 2004), Hoarding Rating Scale (HRS-I; Tolin, Frost, & Steketee, 2010), and Family Adaptability and Cohesion Evaluation Sclaes (FACES IV; Olson, 2011) were translated into Urdu using translation/back translation approach (Brislin, 1973). Data was collected from 221 individuals on translated Urdu versions of scales along with already translated measures that included Adult Attachment Scale (AAS; Collins & Read, 1990), Young Schema Questionnaire-S3 (YSQ-S3; Young, 2005), Depression Anxiety Stress Scale (DASS; Lovibond & x Lovibond, 1995), and Obsessive Compulsive Inventory-Revised (OCI-R; Foa et al., 2002). Confirmatory factor analysis was conducted for each adapted scale. Results revealed the replication of factor structure for HRS-I without any modification while few modifications have been done for FACES-IV. However in case of SI-R, a uni dimentional model was found to be most appropriate instead of original three factor solution for present data. Correlation among study variables was also computed and the results revealed that the trend of relationship between different variables was in postulated direction. Findings of the study provided ground for use of study measures for hypothesis testing in main study. Study III intended to assess the impact of family functioning and attachment styles on development and maintenance of hoarding behavior along with examining the mediating role of psychological distress (depression, anxiety, and OCD) and maladaptive schemas among clinical and non-clinical groups. It also identified the moderating role of demographic variables in association with hoarding behavior. Data was collected on all study measures from both clinical (N = 100) and non-clinical (N = 100) participants. Results revealed significant impact of family functioning and attachment styles on hoarding behavior both directly and through psychological distress and maladaptive cognitive schemas. Moreover, along with emotional associations and perceived utility value, materialism proved to be a strong correlate of hoarding behavior. Also, non-significant results with respect to relationship between attachment styles and hoarding behavior through anxiety and OCI-NH are notable. Whereas depression proved to be the strongest mediator. The present study therefore is suggestive of certain cultural influences on expression and understanding of hoarding behavior. However, results need to be interpreted in certain limitations while further research is needed to confirm the unique cultural influences.