Doctorate in Clinical Psychology: Main Research Portfolio
: 1) Can Borderline Personality Disorder be treated effectively in forensic settings? A systematic Review; 2) Evaluation of a brief educational intervention for clinical staff aimed at promoting trauma-informed approaches to care; 3) The role of intrusive imagery in hoarding disorder.

  • Nick Stewart

Student thesis: Doctoral ThesisDoctor of Clinical Psychology (DClinPsy)


The cardinal feature of Hoarding Disorder (HD) is persistent difficulty discarding possessions, with the resulting clutter compromising the intended use of living areas. Within the dominant cognitive-behavioural model of hoarding (Frost & Hartl, 1996), hoarding behaviours are positively and negatively reinforced in the context of certain object-related beliefs. Available treatments for HD have so far yielded modest outcomes, indicating a need for new approaches. Intrusive imagery has so far been neglected in HD research, despite the frequency of trauma in the histories of people with the condition. To address this, 27 individuals who met the DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about their everyday experiences of mental imagery. Participants were also asked about the images they experienced during two recent real-life examples of actual or attempted discard of (1) an object of low subjective value; and (2) an object of high subjective value. Everyday imagery in the HD group commonly reflected themes of illness, death and reminiscence. Imagery in HD participants tended to carry negative emotional valence in comparison with CCs, and was associated with greater interference in everyday life and attempts to avoid the imagery. HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD participants experienced positive imagery when discarding, or trying to discard, high value objects. These findings indicate that although people with HD frequently report traumatic histories, this is not reflected in the everyday imagery that they experience.  There is some evidence to suggest that the negative and positive memories experienced in relation to low and high value objects may aid our understanding of discarding and saving behaviour in HD. The theoretical and clinical implications of these findings are further discussed. 
Date of Award17 Sept 2018
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorJames Gregory (Supervisor), Megan Wilkinson-Tough (Supervisor), Anna Strudwick (Supervisor), Maria Loades (Supervisor) & Chris Gillmore (Supervisor)


  • borderline personality disorder
  • forensic
  • offending
  • dialectical behaviour therapy
  • schema therapy
  • art therapy
  • trauma-informed approaches
  • trauma
  • PTSD
  • Complex PTSD
  • hoarding disorder
  • intrusive imagery
  • intrusive memories
  • cognitive-behavioural therapy

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