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. 2025 Jun;5(2):100215.
doi: 10.1016/j.psycom.2025.100215. Epub 2025 May 21.

Classification of hoarding and comorbid neuropsychiatric symptoms

Sara K Nutley  1 , Catherine W Striley  2 , Linda B Cottler  2 , Joseph Eichenbaum  3   4 , Rachel L Nosheny  3   4   5 , R Scott Mackin  3   5 , Carol A Mathews  1
Affiliations

Classification of hoarding and comorbid neuropsychiatric symptoms

Sara K Nutley et al. Psychiatry Res Commun. 2025 Jun.

Abstract

Background: Psychiatric comorbidity and self-reported cognitive dysfunction are common among individuals with hoarding disorder (HD). However, common patterns of co-occurring neuropsychiatric symptoms, and their potential impact on the clinical manifestation of hoarding, including functional impairment, are not well-established.

Methods: Latent class analysis (LCA) was used to identify and characterize distinct neuropsychiatric symptom subgroups among 7606 adult internet-based research participants who reported experiencing social impairment due to household clutter. An additional 1129 participants who screened negative but had evidence of hoarding on additional assessment ("false negative") were identified and compared to the LCA-identified classes. Demographic and clinical characteristics associated with class membership were assessed.

Results: The best fitting model yielded five subgroups, including three subgroups characterizing individuals with hoarding symptoms: "hoarding only" (12.1 %), hoarding with depressive symptoms ("depressed + hoarding"; 11.8 %), and hoarding with depressive symptoms, inattention, and subjective memory decline ("multisymptomatic"; 14.6 %). These subgroups fell along a continuum of increasing neuropsychiatric burden, with individuals in the "multisymptomatic" class experiencing the greatest deficits to general functional ability and cognitive functioning, as well as elevated rates of comorbid neuropsychiatric diagnoses. The "false negative" group was similar to the "hoarding only" class, although comprised of a significantly higher proportion of male participants and married individuals.

Conclusions: Neuropsychiatric symptom patterns among individuals with hoarding are heterogenous in nature and uniquely associated with clinical features and functional outcomes. These findings may inform the development of targeted interventions for HD that include assessment and management of depressive symptoms, inattention, and memory.

Keywords: Attention deficit hyperactivity disorder; Comorbidity; Depression; Hoarding disorder; Latent class analysis; Memory.

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Conflict of interest statement

Declaration of competing interest Dr. Mathews has received royalties from W.W. Norton and Company, and travel funding from the Tourette Association of America. She has received research funding from the National Institutes of Health, the International Obsessive Compulsive Foundation, the Tourette Association of America, and the Patient Centered Research Outcomes Institute. She is an unpaid member of the International OCD Foundation, and the Family Foundation for OCD Research. Dr. Mackin has received research funding from the National Institutes of Health and Janssen Research and Development LLC. Dr. Nosheny has received research funding from the National Institutes of Health, Genentech, Inc., and California Department of Public Health.

Figures

Fig. 1.
Fig. 1.
Proportion of participants endorsing hoarding and co-occurring neuropsychiatric symptoms, by hoarding symptom subgroup.
Fig. 2.
Fig. 2.
Prevalence of neuropsychiatric disorders (self-reported lifetime history), stratified by hoarding symptom subgroup.
See this image and copyright information in PMC

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