Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 54
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Tolin, David F. 2011. Understanding and treating hoarding: A biopsychosocial perspective. Journal of Clinical Psychology, Vol. 67, Issue. 5, p. 517.

    Nestadt, Gerald Grados, Marco and Samuels, Jack F. 2010. Genetics of Obsessive-Compulsive Disorder. Psychiatric Clinics of North America, Vol. 33, Issue. 1, p. 141.

    Fitch, Kristin E. and Cougle, Jesse R. 2013. Perceived and actual information processing deficits in nonclinical hoarding. Journal of Obsessive-Compulsive and Related Disorders, Vol. 2, Issue. 2, p. 192.

    Frost, Randy O 2010. Treatment of hoarding. Expert Review of Neurotherapeutics, Vol. 10, Issue. 2, p. 251.

    Steketee, Gail Frost, Randy O. Tolin, David F. Rasmussen, Jessica and Brown, Timothy A. 2010. Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder. Depression and Anxiety, Vol. 27, Issue. 5, p. 476.

    Mataix-Cols, David Pertusa, Alberto and Snowdon, John 2011. Neuropsychological and neural correlates of hoarding: a practice-friendly review. Journal of Clinical Psychology, Vol. 67, Issue. 5, p. 467.

    Muroff, Jordana 2011. Thinking Outside the Box: Novel Delivery Methods for Treating Hoarding. International Journal of Cognitive Therapy, Vol. 4, Issue. 3, p. 280.

    Michaelides, Michael Thanos, Panayotis K. Volkow, Nora D. and Wang, Gene-Jack 2011. Functional Neuroimaging in Obesity. Psychiatric Annals, Vol. 41, Issue. 10, p. 496.

    Hoche, Franziska Guell, Xavier Sherman, Janet C. Vangel, Mark G. and Schmahmann, Jeremy D. 2015. Cerebellar Contribution to Social Cognition. The Cerebellum,

    Nordsletten, Ashley E. and Mataix-Cols, David 2012. Hoarding versus collecting: Where does pathology diverge from play?. Clinical Psychology Review, Vol. 32, Issue. 3, p. 165.

    Pato, Michele T. Steketee, Gail Eisen, Jane L. Yip, Agustin G. and Phillips, Katharine A. 2015. Psychiatry.

    Woody, Sheila R. Kellman-McFarlane, Kirstie and Welsted, Alison 2014. Review of cognitive performance in hoarding disorder. Clinical Psychology Review, Vol. 34, Issue. 4, p. 324.

    Carbonella, Julia Y. and Timpano, Kiara R. 2016. Examining the Link Between Hoarding Symptoms and Cognitive Flexibility Deficits. Behavior Therapy, Vol. 47, Issue. 2, p. 262.

    Sorrell, Jeanne M. 2012. Understanding Hoarding in Older Adults. Journal of Psychosocial Nursing and Mental Health Services, Vol. 50, Issue. 3, p. 17.

    Tolin, David F. and Villavicencio, Anna 2011. An exploration of economic reasoning in hoarding disorder patients. Behaviour Research and Therapy, Vol. 49, Issue. 12, p. 914.

    Frost, Randy O. Patronek, Gary and Rosenfield, Elizabeth 2011. Comparison of object and animal hoarding. Depression and Anxiety, Vol. 28, Issue. 10, p. 885.

    Brennan, Elle and Flessner, Christopher 2015. An interrogation of cognitive findings in pediatric obsessive–compulsive and related disorders. Psychiatry Research, Vol. 227, Issue. 2-3, p. 135.

    Raines, Amanda M. Unruh, Amanda S. Zvolensky, Michael J. and Schmidt, Norman B. 2014. An initial investigation of the relationships between hoarding and smoking. Psychiatry Research, Vol. 215, Issue. 3, p. 668.

    Colombo, S. Elisa and Prato, Previde Emanuela 2014. Animal hoarding - accumulo di animali: stile di vita, maltrattamento o psicopatologia? Una rassegna critica della letteratura. RICERCHE DI PSICOLOGIA, Issue. 4, p. 317.

    Shaw, Ashley M. and Timpano, Kiara R. 2016. An Experimental Investigation of the Effect of Stress on Saving and Acquiring Behavioral Tendencies: The Role of Distress Tolerance and Negative Urgency. Behavior Therapy, Vol. 47, Issue. 1, p. 116.


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)
  • DOI:
  • Published online: 19 May 2008

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.

G Bush , P Luu , MI Posner (2000). Cognitive and emotional influences in anterior cingulate cortex. Trends in Cognitive Science 4, 215222.

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.

JM de Brabander , JP de Bruin , CG van Eden (1991). Comparison of the effects of neonatal and adult medial prefrontal cortex lesions on food hoarding and spatial delayed alternation. Behavioral Brain Research 42, 6775.

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 , JF Mangin (2001). Motion correction algorithms may create spurious brain activations in the absence of subject motion. NeuroImage 14, 709722.

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.

RO Frost , G Steketee , LF Williams , R Warren (2000). Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls. Behaviour Research and Therapy 38, 10711081.

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

WK Goodman , LH Price , SA Rasmussen , C Mazure , RL Fleischmann , CL Hill , GR Heninger , DS Charney (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry 46, 10061011.

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

JR Grisham , TA Brown , CR Savage , G Steketee , DH Barlow (2007). Neuropsychological impairment associated with compulsive hoarding. Behaviour Research and Therapy 45, 14711483.

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.

M Hamilton (1960). A rating scale for depression. Journal of Neurological and Neurosurgical Psychiatry 23, 5662.

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.

RD Lane , EM Reiman , MM Bradley , PJ Lang , GL Ahern , RJ Davidson , GE Schwartz (1997). Neuroanatomical correlates of pleasant and unpleasant emotion. Neuropsychologia 35, 14371444.

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.

EA Maguire , CJ Mummery (1999). Differential modulation of a common memory retrieval network revealed by positron emission tomography. Hippocampus 9, 5461.

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 , S Cullen , K Lange , F Zelaya , C Andrew , E Amaro , MJ Brammer , SC Williams , A Speckens , ML Phillips (2003). Neural correlates of anxiety associated with obsessive-compulsive symptom dimensions in normal volunteers. Biological Psychiatry 53, 482493.

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.

GJ Mogenson , M Wu (1988). Disruption of food hoarding by injections of procaine into mediodorsal thalamus, GABA into subpallidal region and haloperidol into accumbens. Brain Research Bulletin 20, 247251.

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 (2003). Compulsive hoarding: current status of the research. Clinical Psychology Review 23, 905927.

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.

AP Yonelinas , JB Hopfinger , MH Buonocore , NE Kroll , K Baynes (2001). Hippocampal, parahippocampal and occipital-temporal contributions to associative and item recognition memory: an fMRI study. Neuroreport 12, 359363.

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? *