The Role of Intrusive Imagery in Hoarding Disorder

Frost & Hartl (1996) proposed a model of Hoarding Disorder (HD) in which hoarding behaviours (i.e., acquiring, clutter and difficulty discarding) are maintained by a mixture of positive and negative emotions. These emotions are in turn driven by the activation of specific beliefs about objects (i.e., utility, beauty and sentimental value) and the self (e.g., as vulnerable or responsible). While several studies have attempted to document verbal cognitions relating to these beliefs (see Frost & Hartl, 1996), no study has yet examined the potential role of mental imagery in the development and maintenance of HD. Recurrent or intrusive mental imagery is a feature of a broad range of mental health disorders (Brewin, et al., 2010). Vivid and distressing recurrent images have been found to be common in people with OCD, and these images frequently corresponded to memories of earlier adverse events (Speckens et al., 2007). Given that traumatic histories are common in people with both HD and OCD (e.g., Landau et al., 2011; Cromer, Schmidt, & Murphy, 2007), people who hoard might reasonably be expected to experience negative intrusive images and memories. This present study aimed to investigate the prevalence and characteristics of mental images experienced by individuals who meet the DSM-5 criteria for HD (n=25) in comparison with a community control (CC) group (n=25), using a mixed cross-sectional and experimental design. Participants were asked about the everyday imagery they experience using a questionnaire adapted from those used in similar previous studies (e.g., Gregory, Brewin, Mansell & Donaldson, 2010) before then being asked about the images they experience in response to two recent real-life examples of discarding: (1) an object of low subjective value, and (2) an object of high subjective value. These findings will be the first to address whether intrusive mental imagery is implicated in HD, and more specifically in the maintenance of a key hoarding behaviour (i.e., failure to discard).