Abstract
Hoarding disorder (HD) is functionally and cognitively debilitating, as well as socially isolating, particularly in older adults. There is strong avoidance to the distress of parting with personal possessions in HD. The current study explored the feasibility of a behavioral avoidance task (BAT) for HD by utilizing subjective and behavioral assessments of fear response during a sorting task administered to older adults.
The current study utilized data from 16 older adults (mean age 68, range 60–82) meeting DSM-5 criteria for HD. During the BAT, participants’ subjective units of distress (SUDS) were recorded at regular intervals. The number of items sorted and the percent of items discarded were recorded as behavioral indicators of approach-orientation to the task.
Twelve of the 16 participants were able to engage in the task for a full five minutes. The average initial SUDS score was 21 out of 100 with 100 being the most amount of distress. The average peak SUDS score was 39. The average within-session habituation was 14 points. Participants were able to sort an average of 39 items and discard 49% of sorted items. The majority of participants (62%) reported that the task was at least “somewhat similar” to what they experience when sorting objects in their homes. Participants with higher initial SUDS scores were able to sort more items (r=.74, p=.001) but did not discard a significantly higher percentage of items (r=.39, p=.14).
Clinicians treating geriatric HD should consider utilizing a BAT to monitor change in distress and avoidance of sorting/discarding.