Autistic Traits in Hoarding Disorder: a Comparative Study between Patients with Hoarding Disorder and Obsessive-Compulsive Disorder

Abstract

Abstract Introduction Hoarding symptoms have been described in patients with obsessive-compulsive disorders (OCD). There are indications that hoarding is related to autism problems rather than to OCD. Therefore, we aimed to investigate the presence of autistic traits, theory of mind and rigidity in patients with hoarding disorder (HD) and compare them to OCD patients without hoarding behavior. Method 34 participants in three groups (HD; mostly without OCD, OCD without hoarding and healthy controls) were tested on autistic traits (AQ; Autism Spectrum Quotient), theory of mind (Faux-pas Test), cognitive flexibility/ rigidity (Intra-/ Extra-dimensional Set Shifting; ID/EDS, Stroop Color-Word Test), planning (Tower of London; ToL), and obsessive-compulsive personality disorder (OCPD SCID II). Results HD and OCD patients displayed similarly elevated scores on the Obsessive-compulsive Inventory-Revised, on behavioral inhibition scale (BIS) and on AQ total score as well as on 4 of five of the AQ subscales compared to controls. Further, HD patients showed higher percentages of OCPD than both OCD patients and controls, and showed a tendency to perform lower on the neuropsychological task that reflects planning (ToL) compared to OCD and controls. On the Faux-pas test, no between-group differences were shown. Discussion HD patients show no dysfunction with respect to communication problems. However, they reveal similarly elevated scores as OCD patients on OCD symptoms, on behavioral inhibition, on rigidity (reflected in OCPD scores) and on autism symptoms that reflect a lack of cognitive flexibility. This striking overlap between HD and OCD with respect to behavioral inhibition/ lack of flexibility is in contrast with the notion to place hoarding as a distinct disorder in DSM-V, although sample size is too small to draw definite conclusions. More research is needed on the relationship between hoarding, OCPD and OCD.