Executive Functioning Deficits in Hoarding Disorder

The cognitive­ behavioral model of Hoarding Disorder (HD) posits that hoarding results, at least in part, from executive functioning deficits. Patients with HD often self­report cognitive processing impairments; however, these same patients often do reasonably well on neuropsychological assessments. Even when significant differences with clinical and nonclinical control groups are noted, these differences tend not to be at the level of objective impairment as traditionally defined in clinical neuropsychology. The aim of the current study was to clarify the role of executive functioning in HD by determining the rate of objective cognitive impairment and the degree to which objective cognitive impairment is associated with self­reported impairment. Three adult outpatient groups were included in the study: 1) patients with HD (n = 15), 2) patients with obsessive­compulsive disorder (OCD) with significant hoarding symptoms (OCD+H, n = 13), and 3) patients with OCD without significant hoarding symptoms (OCD­H, n =12). Self­reported executive functioning was assessed via the ADHD Severity Scale (ADHDSS) and Cognitive Failures Questionnaire (CFQ). Objective: neuropsychological assessments were completed using the MindStreams computerized battery, and results from the Go/NoGo and Stroop tasks were included in current analyses. Results indicated significant group differences on self­report measures. Analysis of covariance (controlling for group differences in age) indicated that patients in the HD group and/or OCD+H group reported more severe cognitive impairments than the OCD­H group on the ADHDSS total and inattention subscale, and the CFQ total, memory, blunders, and memory for names subscales. However, rates of true neuropsychological impairment (defined as 1.5 standard deviations below normative mean on objective neuropsychological assessments) were low (≤ 20%) across all groups, and did not differ among the groups. Additionally, the groups did not differ on any objective neuropsychological assessment standardized score (age­adjusted). To assess the concordance between self­report and standardized neuropsychological measures the ADHDSS attention subscale was correlated with the errors of omission on the Go/NoGo task and the ADHDSS hyperactivity/impulsivity subscale was correlated with errors of commission on the Go/NoGo task. There were no significant correlations when the samples were combined or when looking at each group individually. Taken together, these study results indicated that while patients with HD or comorbid HD symptoms self­report significant problems with executive functioning, these impairments were not associated with impaired performance on objective measures. The reason for this mismatch is unclear. It could be that either: 1) there is no actual cognitive impairment, and clients are reporting a disordered behavior that is resulting from something other than cognitive impairment or 2) there is an actual cognitive impairment, which is not adequately assessed by standardized neuropsychological measures. Given the hypothesized role of executive functioning in the etiology and maintenance of HD, it will be important for future research to continue to reconcile these conflicting findings.