An exploratory study of the neural mechanisms of decision making in compulsive hoarding

• Published in: Psychological medicine 2009-02, Vol.39 (2), p.325-336
• Main Authors: Tolin, D. F., Kiehl, K. A., Worhunsky, P., Book, G. A., Maltby, N.
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; Brain; Cerebellum - blood supply; Cerebellum - metabolism; Cerebrovascular Circulation; Cognition & reasoning; Compulsive behaviour; Decision Making; Environment; Female; fMRI; Frontal Lobe - blood supply; Frontal Lobe - metabolism; Functional magnetic resonance imaging; Gyrus Cinguli - blood supply; Gyrus Cinguli - metabolism; Hoarding; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neuroses; Obsessive-Compulsive Disorder - metabolism; Obsessive-Compulsive Disorder - psychology; Obsessive-compulsive disorders; Obsessive-Compulsive neuroses; obsessive–compulsive disorder; Prefrontal Cortex - blood supply; Prefrontal Cortex - metabolism; Psychology. Psychoanalysis. Psychiatry; Psychopathology; Psychopathology. Psychiatry; Research Design; Temporal Lobe - blood supply; Temporal Lobe - metabolism
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291708003371

Prior studies have suggested unique patterns of neural activity associated with compulsive hoarding. However, to date no studies have examined the process of making actual decisions about whether to keep or discard possessions in patients with hoarding symptoms. An increasing body of clinical data and experimental psychopathology research suggests that hoarding is associated with impaired decision making; therefore, it is important to understand the neural underpinnings of decision-making abnormalities in hoarding patients. Twelve adult patients diagnosed with compulsive hoarding, 17% of whom also met criteria for obsessive-compulsive disorder (OCD), and 12 matched healthy controls underwent functional magnetic resonance imaging (fMRI) while making decisions about whether or not to discard personal paper items (e.g. junk mail) brought to the laboratory as well as control items that did not belong to them. Items were either saved or destroyed following each decision. When deciding about whether to keep or discard personal possessions, compulsive hoarding participants displayed excessive hemodynamic activity in lateral orbitofrontal cortex and parahippocampal gyrus. Among hoarding participants, decisions to keep personal possessions were associated with greater activity in superior temporal gyrus, middle temporal gyrus, medial frontal gyrus, anterior cingulate cortex, precentral gyrus, and cerebellum than were decisions to discard personal possessions. These results provide partial support for an emerging model of compulsive hoarding based on complications of the decision-making process. They also suggest that compulsive hoarding may be characterized by focal deficits in the processing of reward and changes in reward contingencies, particularly when these are perceived to be punishing.