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Hoarding Research
People who hoard apparently useless items may be able to blame an area of their brain, say US researchers.
The University of Iowa team pinpointed a region in the frontal lobe that appeared to control this behaviour.
Researchers have linked hoarding to obsessive compulsive disorder (OCD), but it is not known what causes it and whether it is a unique condition.
The study in the journal Brain adds to growing evidence that hoarding has its own specific underlying mechanism.
Useless Junk
OCD is an anxiety disorder in which the person is compelled by irrational fears and thoughts to repeat seemingly needless actions over and over again.
It can manifest itself in repetitive behaviours, such as excessive hand washing, cleaning or repeated checking.
But some people with OCD have a compulsion to hoard things, which is well above and beyond the avid interest of an average stamp collector.
Researchers from the University of California Los Angeles have already shown that people with OCD who also hoard show different brain activity patterns to other OCD patients.
To gain a better understanding of the cause of obsessive collecting behaviour, Dr Steven Anderson and his team studied 13 people who had developed a hoarding compulsion after sustaining a brain injury.
Hoarding was defined as abnormal if it was extensive, the squirreled items were not useful or aesthetic and the individual was unwilling to discard any of their collection. Some of the patients had filled their homes with vast quantities of junk mail or broken appliances, for example.
They scanned the patients and compared their brain scans with those taken from other 73 brain injured patients who displayed no abnormal collecting behaviour. The scans showed up an obvious difference.
Dr Anderson said: "A pretty clear finding jumped out at us. "Damage to a part of the frontal lobes of the cortex, particularly on the right side, was shared by the individuals with abnormal behaviour. "Patients with OCD and some other disorders, such as schizophrenia, Tourette's syndrome and certain dementias, can have similar pathological collecting behaviour but we don't have a pointer to located where in the brain the problem is occurring. "Our hope is that our findings with these brain lesion studies will lead to insights in these conditions as well."
Dr Naomi Fineberg, an expert in OCD at Queen Elizabeth Hospital, Welwyn Garden City, said: "These studies, which are really in their infancy, are starting to confirm that hoarding may be different from the rest of OCD.
"The hoarding type is unresponsive to normal OCD treatments, so if we can identify areas of the brain specific for hoarding this will have quite profound implications. "The more we can start to understand about the neurobiology of hoarding the more we can start to think about targeting treatments accordingly."
But Professor Paul Salkovskis from the Institute of Psychiatry at King's College, London, said: "Knowing which area of the brain is affected does not help you in treatment one little bit. "Potentially, it's misleading because people feel if you can image a problem it means it is a biologically-based problem. "At this point there is no evidence that there is any biological difference between these patients. "The answer is cognitive behavioural therapy."
Research into treating children with OCD
What's it like for a child or teen to have obsessive-compulsive disorder?
Dr. John March of Duke University Medical Center said, "For example, a child gets a funny feeling or fear that they're going to be contaminated if they touch a doorknob, get a bad illness, they'll give that illness to their mother and both of them will die. And so they avoid touching the doorknob and if they can't avoid it, they go into the bathroom and wash their hands for 20 minutes to an hour."
The kids know that the thoughts and the compulsion to wash hands make no sense, but they are powerless to stop, so many seek help.
"If you are a child or a parent and you go to the doctor, the thing you want to know is, at the end of treatment is my child going to be well," March said.
To help answer that question, Dr. March, with researchers at two other universities, set out to compare treatments in about 100 kids, ages seven to 17, who had OCD. The treatments were cognitive behavioral therapy, or CBT; sertraline, and antidepressant; a combination of CBT and sertraline, and finally, placebo or sugar pill. The study appears in JAMA, the Journal of the American Medical Association.
"The combination treatment was superior to cognitive behavioral psychotherapy alone, also superior to sertraline alone," March said
In fact, after 12 weeks of treatment, more than half of the kids who received the combination treatment no longer suffered from OCD. That figure went down to about 40 percent for CBT alone, 21 percent for sertraline alone, and less than four percent for placebo.
"If you've got mild OCD and no other problems then you might want to start with CBT alone, but if you've got very severe OCD and it's been around for a long time and it's complicated for example by anxiety and depression, then you might want to opt for the combination treatment," March said.
Dr. March said patients, parents and physicians need to know that cognitive behavioral therapy is the critical first step in treating OCD in children and teens.
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