Individuals with hoarding disorder (HD) report substantial social impairments such as problems engaging in social activities, interpersonal difficulties, lower social support and increased social isolation. A growing body of research suggests that attachment and social functioning impairments may serve an integral role in the development and/or maintenance of hoarding pathology and its consequences, however most of this work has been conducted in non-clinical groups. This dissertation will examine self-reported social functioning and attachment variables collected across two clinical samples of adults with HD and explore if HD treatment benefits social functioning with three aims.
Aim 1 characterized family and social impairments in HD and their relationship with symptom severity cross-sectionally (n = 60). The majority of participants reported they live alone, and that family and friends never visit them in their home. Over 1/3 of participants indicated they never have visitors to their home, even service workers. Increased clutter and hoarding severity were associated with a lower frequency of family and friends visiting in the home. Family competence and conflict were positively associated with hoarding severity.
Aim 2 sought to enhance our understanding of attachment anomalies in HD by exploring how interconnected individuals with HD feel with their items in comparison to their primary social supports before and after treatment in a sample of 36 Veterans. Results indicated individuals felt on average about as interconnected with their items as primary social supports and that changes were minimal following HD treatment. Overall perceived social connectedness increased significantly at post-treatment, however with a moderate effect.
Utilizing the same sample, Aim 3 characterized social functioning (PROMIS emotional support; satisfaction with social roles; friendship; loneliness) at three timepoints during a behavioral intervention for HD and evaluated the impact of hoarding treatment on social functioning using multilevel modeling. Results indicated there were large, significant effects of both time and the time-by-condition interaction for one aspect of social functioning- satisfaction with social roles, and that participants enrolled in the Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) treatment condition evidenced greater improvements than those randomized to exposure therapy (ET) only.
Results underscore the importance of targeting attachment and social functioning impairments in hoarding treatment. Further research is needed to understand the mechanisms driving social dysfunction in HD to inform interventions that support more comprehensive recovery.
