Skip to main content
    • Aa
    • Aa

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

  • D. F. Tolin (a1) (a2), K. A. Kiehl (a3), P. Worhunsky (a1), G. A. Book (a1) and N. Maltby (a1)...

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.

Corresponding author
*Address for correspondence: D. F. Tolin, Ph.D., Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

JS Abramowitz , ME Franklin , SA Schwartz , JM Furr (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology 71, 10491057.

JM Allman , A Hakeem , JM Erwin , E Nimchinsky , P Hof (2001). The anterior cingulate cortex. The evolution of an interface between emotion and cognition. Annals of the New York Academy of Sciences 935, 107117.

SW Anderson , H Damasio , AR Damasio (2005). A neural basis for collecting behaviour in humans. Brain 128, 201212.

A Bechara , AR Damasio , H Damasio , SW Anderson (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50, 715.

A Bechara , H Damasio , D Tranel , AR Damasio (1997). Deciding advantageously before knowing the advantageous strategy. Science 275, 12931295.

JE Calamari , PS Wiegartz , BC Riemann , RJ Cohen , A Greer , DM Jacobi , SC Jahn , C Carmin (2004). Obsessive-compulsive disorder subtypes: an attempted replication and extension of a symptom-based taxonomy. Behaviour Research and Therapy 42, 647670.

CS Carter , TS Braver , DM Barch , M Botvinick , D Noll , J Cohen (1998). Anterior cingulate cortex, error detection, and the online monitoring of performance. Science 280, 747749.

O Devinsky , MJ Morrell , BA Vogt (1995). Contributions of anterior cingulate cortex to behaviour. Brain 118, 279306.

F du Boisgueheneuc , R Levy , E Volle , M Seassau , H Duffau , S Kinkingnehun , Y Samson , S Zhang , B Dubois (2006). Functions of the left superior frontal gyrus in humans: a lesion study. Brain 129, 33153328.

L Freire , A Roche , JF Mangin (2002). What is the best similarity measure for motion correction in fMRI time series? IEEE Transactions on Medical Imaging 21, 470484.

RO Frost , TL Hartl (1996). A cognitive-behavioral model of compulsive hoarding. Behaviour Research and Therapy 34, 341350.

RO Frost , HJ Kim , C Morris , C Bloss , M Murray-Close , G Steketee (1998). Hoarding, compulsive buying and reasons for saving. Behaviour Research and Therapy 36, 657664.

RO Frost , G Steketee , J Grisham (2004). Measurement of compulsive hoarding: Saving Inventory – Revised. Behaviour Research and Therapy 42, 11631182.

II Goldberg , M Harel , R Malach (2006). When the brain loses its self: prefrontal inactivation during sensorimotor processing. Neuron 50, 329339.

JE Grant , BL Odlaug , JR Wozniak (2007). Neuropsychological functioning in kleptomania. Behaviour Research and Therapy 45, 16631670.

RC Gur , JD Ragland , LH Mozley , PD Mozley , R Smith , A Alavi , W Bilker , RE Gur (1997). Lateralized changes in regional cerebral blood flow during performance of verbal and facial recognition tasks: correlations with performance and ‘effort’. Brain and Cognition 33, 388414.

KA Kiehl , PF Liddle , JB Hopfinger (2000). Error processing and the rostral anterior cingulate: an event-related fMRI study. Psychophysiology 37, 216223.

B Kolb (1977). Studies on the caudate-putamen and the dorsomedial thalamic nucleus of the rat: implications for mammalian frontal-lobe functions. Physiology and Behavior 18, 237244.

ML Kringelbach (2005). The human orbitofrontal cortex: linking reward to hedonic experience. Nature Reviews Neuroscience 6, 691702.

ML Kringelbach , ET Rolls (2004). The functional neuroanatomy of the human orbitofrontal cortex: evidence from neuroimaging and neuropsychology. Progress in Neurobiology 72, 341372.

NS Lawrence , S Wooderson , D Mataix-Cols , R David , A Speckens , ML Phillips (2006). Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder. Neuropsychology 20, 409419.

SA Luchian , RJ McNally , JM Hooley (2007). Cognitive aspects of nonclinical obsessive-compulsive hoarding. Behaviour Research and Therapy 45, 16571662.

N Maltby , DF Tolin , P Worhunsky , TM O'Keefe , KA Kiehl (2005). Dysfunctional action monitoring hyperactivates frontal-striatal circuits in obsessive-compulsive disorder: an event-related fMRI study. NeuroImage 24, 495503.

D Mataix-Cols , IM Marks , JH Greist , KA Kobak , L Baer (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: results from a controlled trial. Psychotherapy and Psychosomatics 71, 255262.

D Mataix-Cols , S Wooderson , N Lawrence , MJ Brammer , A Speckens , ML Phillips (2004). Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Archives of General Psychiatry 61, 564576.

G Northoff , S Grimm , H Boeker , C Schmidt , F Bermpohl , A Heinzel , D Hell , P Boesiger (2006). Affective judgment and beneficial decision making: ventromedial prefrontal activity correlates with performance in the Iowa Gambling Task. Human Brain Mapping 27, 572587.

FE Polli , JJ Barton , MS Cain , KN Thakkar , SL Rauch , DS Manoach (2005). Rostral and dorsal anterior cingulate cortex make dissociable contributions during antisaccade error commission. Proceedings of the National Academy of Sciences of the United States of America 102, 1570015705.

ET Rolls (2004). The functions of the orbitofrontal cortex. Brain and Cognition 55, 1129.

S Saxena , AL Brody , KM Maidment , EC Smith , N Zohrabi , E Katz , SK Baker , LR Baxter Jr (2004). Cerebral glucose metabolism in obsessive-compulsive hoarding. American Journal of Psychiatry 161, 10381048.

G Steketee , RO Frost , M Kyrios (2003). Beliefs about possessions among compulsive hoarders. Cognitive Therapy and Research 27, 467479.

DF Tolin , RE Brady , SE Hannan (2008). Obsessional beliefs and symptoms of obsessive-compulsive disorder in a clinical sample. Journal of Psychopathology and Behavioral Assessment 30, 3142.

JP Wincze , G Steketee , RO Frost (2007). Categorization in compulsive hoarding. Behaviour Research and Therapy 45, 6372.

KD Wu , D Watson (2005). Hoarding and its relation to obsessive-compulsive disorder. Behaviour Research and Therapy 43, 897921.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 2
Total number of PDF views: 77 *
Loading metrics...

Abstract views

Total abstract views: 236 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 26th May 2017. This data will be updated every 24 hours.