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To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder

Molecular Psychiatry volume 14, pages 318–331 (2009)Cite this article

Abstract

Preliminary neuroimaging studies suggest that patients with the ‘compulsive hoarding syndrome’ may be a neurobiologically distinct variant of obsessive-compulsive disorder (OCD) but further research is needed. A total of 29 OCD patients (13 with and 16 without prominent hoarding symptoms) and 21 healthy controls of both sexes participated in two functional magnetic resonance imaging experiments consisting of the provocation of hoarding-related and symptom-unrelated (aversive control) anxiety. In response to the hoarding-related (but not symptom-unrelated) anxiety provocation, OCD patients with prominent hoarding symptoms showed greater activation in bilateral anterior ventromedial prefrontal cortex (VMPFC) than patients without hoarding symptoms and healthy controls. In the entire patient group (n=29), provoked anxiety was positively correlated with activation in a frontolimbic network that included the anterior VMPFC, medial temporal structures, thalamus and sensorimotor cortex. Negative correlations were observed in the left dorsal anterior cingulate gyrus, bilateral temporal cortex, bilateral dorsolateral/medial prefrontal regions, basal ganglia and parieto-occipital regions. These results were independent from the effects of age, sex, level of education, state anxiety, depression, comorbidity and use of medication. The findings are consistent with the animal and lesion literature and several landmark clinical features of compulsive hoarding, particularly decision-making difficulties. Whether the results are generalizable to hoarders who do not meet criteria for OCD remains to be investigated.

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Acknowledgements

We thank the MRI team of the Institute of Psychiatry for their help with the design and MRI physics of this project and Dr Odile van den Heuvel for her helpful comments on an earlier draft. This study was funded by project grant no. 064846 from the Wellcome Trust, UK and a pilot grant from the South London and Maudsley NHS Trust.

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Authors and Affiliations

  1. Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK

    S K An, D Mataix-Cols, N S Lawrence, S Wooderson & M L Phillips

  2. Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea

    S K An

  3. Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea

    S K An

  4. Department of Psychology, Institute of Psychiatry, King's College London, London, UK

    D Mataix-Cols & A Speckens

  5. Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK

    V Giampietro & M J Brammer

  6. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

    M L Phillips

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Correspondence to D Mataix-Cols.

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An, S., Mataix-Cols, D., Lawrence, N. et al. To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder. Mol Psychiatry 14, 318–331 (2009). https://doi.org/10.1038/sj.mp.4002129

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