Hoarding has been a hidden disorder for many years, but with recent media coverage interest has increased dramatically among research scientists and clinicians. A recent study by the National Institute of Mental Health (NIMH) found that certain areas of the brain responsible for decision-making were under-activated when dealing with others’ possessions, but over-activated when deciding whether to keep or discard their own things.
Brain scans revealed the abnormal activation in areas of the anterior cingulate cortex and insula known to process error monitoring, weighing the value of things, assessing risks, unpleasant feelings, and emotional decisions.
Hoarding disorder, a proposed category in psychiatry’s new diagnostic manual, is basically made up of three connected problems: collecting too many items, difficulty getting rid of items, and problems with organization.
The new findings pinpoint brain circuit activity suspected of underlying the lack of self-insight, indecisiveness, sense that the wrong decision is being made, inflated estimates of the desirability of objects, and exaggerated perception of risk that are often experienced with the disorder.
In the study, brain activity of 43 hoarding disorder patients was compared to that of 31 obsessive compulsive disorder (OCD) patients and 33 healthy controls while they had to decide whether to keep or discard their own or others’ junk mail and newspapers. Notably, such ownership did not appear to differentially affect brain activity in the OCD patients. Hoarding disorder patients, as expected, decided to keep many more items than the other groups.
“The results of this study reflect an accelerating trend toward finding disturbed regulation of brain systems responsible for various dimensions of behavior that may cut across mental disorders as traditionally defined,” said Bruce Cuthbert, Ph.D., director of NIMH’s Division of Adult Translational Research.
In this case, the implicated brain areas are hubs that weigh the emotional significance of things and regulate emotional responses and states. Hoarding patients experience symptoms of indecisiveness, and feeling of things being “not just right. The more abnormal the activity in these control centers, the more severe the symptoms.
The results add to evidence of impaired decision-making in hoarding disorders and may help to separate its brain workings from those of OCD and depression.