Term Paper: Compulsive Hoarding Due to Childhood Sexual Abuse

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Compulsive Hoarding Due to Childhood Sexual Abuse

The objective of this work is to research and examine childhood sexual abuse and compulsive hoarding. This work will identify the social impediments to the treatment interventions of this population with traumagenic compulsions and will further analyze how cognitive behavioral therapy would overcome these impediments and provide treatment for this disorder.

OCD Obsessive Compulsive Disorder

SLE Stressful Life Events

CSA Childhood Sexual Abuse

PTSD Post Traumatic Stress Disorder

CRF Corticotropin Releasing Factor

HPA Hypothalamic Pituitary Adrenal

ACTH Adrenocorticotropic Hormone

NIMH National Institute of Mental Health

LITERATURE REVIEW

The work of Saxena, et al. (2004) entitled: "Cerebral Glucose Metabolism in Obsessive-Compulsive Hoarding" states the fact that "Compulsive hoarding and saving symptoms, found in many patients with obsessive-compulsive disorder (OCD) are part of a discrete clinical syndrome that includes indecisiveness, disorganization, perfectionism, procrastination, and avoidance and has been associated with poor response to medications and cognitive behavior therapy." (p.1) it is related that the standards in diagnostic classifications view obsessive-compulsive disorder (OCD) "...to be a single entity" however research has related findings that show clearly that there are several different "symptoms dimensions" of OCD that exist. According to Saxena et al. (2004): "Large-scale factor and cluster analysis studies of OCD have identified four principal symptoms factors" including: (1') aggressive, sexual and religious obsessions with checking compulsions; (2) symmetry obsessions with ordering, arranging and repeating compulsions; (3) contamination obsessions with washing and cleaning compulsions; and (4) hoarding, saving, and collecting symptoms." (Saxena, 2004; p.1) Saxena (2004) defines 'hoarding' as: "...the acquisition of, and inability to discard, worthless items even though they appears to others to have no value." (p.1) This behavior of hoarding has been observed in "several neuropsychiatric disorders including schizophrenia, dementia, eating disorders, autism, and mental retardation, as well as nonclincial populations, but it is mostly found in patients with OCD." (Saxena, 2004; p.1) of those with OCD approximately 18 to 42% are characterized as having hoarding compulsions with 10 to 20% of all OCD patients believed to have compulsive hoarding are the "most prominent and distressing type of OCD." (Saxena, et al. 2004); p.1) the compulsive and hoarding symptoms are believed by Frost et al. (Saxena, et al., 2004) to be "part of a discrete clinical syndrome that also includes indecisiveness, perfectionism, procrastination, difficulty organizing tasks, and avoidance." (Saxena, et al., 2004) This disorder is "most commonly driven by obsessional fears of losing important items that the patient believes will be needed later, distorted beliefs about the importance of possessions, and excessive emotional attachments to possessions." (Saxena, et al.; p.1) the individual with this disorder has great fear concerning 'wrong decisions' about what to throw away and what to keep "so they acquire and save items to prepare for every imaginable contingency." (Saxena, 2004; p.1) the most commonly items which are saved or hoarded include "newspapers, magazines, old clothing, bags, books, mail, notes, and lists." (Saxena, 2004) the place where the individual functions, or their 'living spaces' become so cluttered that the individual is not able to correctly function resulting in "significant impairment in social and/or occupational functioning." (Saxena, et al., 2004) of those with OCD the individuals with the specific hoarding OCD have more "severe family and social disability, anxiety, depression, and personality disorder symptoms; lower global functioning and higher rates of hoarding tics in their first-degree relatives." (Saxena, et al. 2004) the patterns of genetic inheritance for compulsive hoarding is different that those of other OCD symptom factors and where the hoarding factors has a recessive inheritance patterns, the aggressive checking and symmetry factors reveal a dominant pattern. In a study conducted through a "genome-wide scan...in sibling pairs with Gilles de la Tourette's syndrome" states findings that "the hoarding phenotype was significantly associated with genetic markers on chromosomes 4q34-35, 5q35.2-35.3 and 17q25." (Saxena, et al. 2004) Related is that when these studies are "taken together..." It is indicated that compulsive hoarding syndrome is a genetically distinct subgroup or variant of OCD with a characteristic patterns associated symptoms and functional disability." (Saxena, et al. 2004) it has been shown that treatment of OCD hoarding compulsions are poorly responsive to selective reuptake inhibitors and cognitive behavior therapy. Therefore, the hoarding phenotype is held to be a "reliable predictor of poor treatment response in OCD...in order to develop more effective treatments for this syndrome, it is crucial to elucidate its pathophysiology." (Saxena, et al. 2004)

The work of Turner (2002) relates that child sexual abuse has been found to be linked to obsessive compulsive disorders later in the individuals life and specifically that compulsive shopping and spending as well as hoarding disorders are related to child sexual abuse because these types of disorders "provides something else to focus on, instead of facing what is going on" emotionally in the life of the individual. Turner additional states that Young (1999) in the work entitled: "The Role of Incest Issues in Relapse" relates that relapse of addictions and cross-addictions are often related to "uncovering painful early childhood incest experiences that have been defended through self-destructive behaviors. Comprehensive studies have established that relapse has been the most common outcome of recovery programs that treat addictive behaviors. However, the possible existence of childhood sexual abuse issues as predisposing factor of relapse, and the connection between cross-addiction and relapse, needs to be more fully explored." (Turner, 2002)

The work of Cromer (2005) entitled: "A Pathoplastic Vulnerability Model: An Association Between Traumatic Stressful life Events & OCD" relates that obsessive compulsive disorder (OCD) is an anxiety disorder that manifests by causing distress and "recurrent obsessions and compulsions" and is one of the ten leading causes of disability throughout the world according to Lopez & Murray. Cromer states that "While research in the last few decades has expanded our understanding of the classification and treatment of OCD, many of the mechanisms and vulnerability factors involved in the etiology and maintenance of this disorder remain unknown. One putative vulnerability factor for psychiatric disorders is stressful life events (SLEs)." (p. 8) Cromer reports a study conducted for the purpose of reviewing the literature regarding the role of 'stressful life events' (SLE) in the etiology and maintenance of obsessive-compulsive disorders (OCDs). Cromer relates that "Aversive life experiences have been associated with specific anxiety disorders..." And that stressful life events "often precede the onset" of the obsessive-compulsive disorders. The work of Zvolensky et al. (2001) is reported by Cromer (2005) to have found that: "...an individual's perception of stress predicted fear responses to a biological challenges. Similar results were found in an investigation with panic disordered patients." Studies have demonstrated that the individual's "perception of control ultimately influenced panic reaction to the biological challenges. Those individuals who did not have perceived control were therefore in the more stressful conditions, reported a greater number of anxiety symptoms and increased subjective anxiety." (Cromer, 2005; p. 9) Therefore, the individual's perception of stress is a primary factor in the anxiety related response processes. The affect of the stressful life event on the "development and maintenance of psychiatric disorders have been extensively examined..." however the "direct association between SLEs and OCD has received relatively less empirical attention." (Cromer, 2005; p. 10) the work of Pierre Janet in 1903 in the area of anxiety disorder held that obsessive-compulsive disorder was caused "by extreme emotional shock." (Cromer, 2005; p. 10) Janet related the case of a woman who after seeing her daughter's dead body who had died in a house fire, developed OCD and as well "numerous modern case studies highlight the potential role that extreme stress and trauma play" (Cromer, 2005; p. 10) in inducing obsessive-compulsive symptoms. Experimental studies have supported findings that a general association exists between life-stress and obsessive compulsive disorders and as well that a "unique relationship between traumatic negative life events and OCD may also exist." (Cromer, 2005) Cromer relates that the link between "trauma and OCD is also evidence in samples of individuals with co-morbid post-traumatic stress disorder (PTSD)" (p. 11) Further, the work of Pitman (1993) and de Silva & Marks (1999) as cited in Cromer (2005) relate that case studies have shown that the onset of OCD is clearly tied to "an extremely upsetting event such as high-combat exposure, industrial accidents or sexual assault." (Cromer, 2005; p.11) in fact, these case studies "appear to provide support for a traumatic origin model of OCD." (p.11) Cromer states that: "Gothelf and colleagues (2004) found that pediatric OCD patients reported significantly more total life events and increased negative life events in the year preceding OCD onset when compared to healthy controls. Finally, Hartl et al. (2005) found that compulsive hoarders (N=26; 32% with a reported diagnosis of OCD) related a significantly greater number of different types of trauma and more frequent traumatic experiences when compared to controls. Measurements were obtained via the Traumatic Events Scale-lifetime, which assesses 16 different traumatic events according to frequency and severity (Gershuny, Baer, Jenike, Minichiello, & Wilhelm, 2002). Interestingly, hoarding and non-hoarding groups did not differ in reported severity of disturbing… [END OF PREVIEW]

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