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Neural Mechanisms of Decision Making in Hoarding Disorder
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CONTEXT: Hoarding disorder (HD), previously considered a subtype of obsessive-compulsive disorder (OCD), has been proposed as a unique diagnostic entity in DSM-5. Current models of HD emphasize problems of decision-making, attachment to possessions, and poor insight, whereas previous neuroimaging studies have suggested abnormalities in frontal brain regions. OBJECTIVE: To examine the neural mechanisms of impaired decision making in HD in patients with well-defined primary HD compared with patients with OCD and healthy control subjects (HCs). DESIGN: We compared neural activity among patients with HD, patients with OCD, and HCs during decisions to keep or discard personal possessions and control possessions from November 9, 2006, to August 13, 2010. SETTING: Private, not-for-profit hospital. PARTICIPANTS: A total of 107 adults (43 with HD, 31 with OCD, and 33 HCs). MAIN OUTCOME MEASURES: Neural activity as measured by functional magnetic resonance imaging in which actual real-time and binding decisions had to be made about whether to keep or discard possessions. RESULTS: Compared with participants with OCD and HC, participants with HD exhibited abnormal activity in the anterior cingulate cortex and insula that was stimulus dependent. Specifically, when deciding about items that did not belong to them, patients with HD showed relatively lower activity in these brain regions. However, when deciding about items that belonged to them, these regions showed excessive functional magnetic resonance imaging signals compared with the other 2 groups. These differences in neural function correlated significantly with hoarding severity and self-ratings of indecisiveness and "not just right" feelings among patients with HD and were unattributable to OCD or depressive symptoms. CONCLUSIONS: Findings suggest a biphasic abnormality in anterior cingulate cortex and insula function in patients with HD related to problems in identifying the emotional significance of a stimulus, generating appropriate emotional response, or regulating affective state during decision making.
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“Because many individuals with HD experience intense distress and negative emotions during decision-making (Frost et al., 2016;Tolin et al., 2012), refusal to discard or make decisions about items may represent avoidance of negative emotions that are difficult to manage.”
From A naturalistic study of emotion regulation-enhanced cognitive-behavioral group therapy for hoarding disorder in a community setting (2022) · cites this paper as Tolin et al., 2012
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“On the other hand, Tolin et al.(102) found that when patients were deciding about items that belonged to them, regions including the ACC and insula showed excessive activation, while these areas showed lower activities when deciding about items that did not belong to them.”
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“Although the precise meaning of its diffuse influence on frontalstriatal connectivity is unclear at this point, compulsive hoarding behavior has been most consistently linked with a primary substrate involving the ventral medial frontal cortex in studies of neurological patients, as well as in OCD, particularly in rel…”
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“We also expanded upon previous imaging work that used symptom provocation paradigms (An et al., 2009; MataixCols et al., 2004; Tolin et al., 2009; Tolin et al., 2012), by finding that the intensity of various negative emotions (i.”
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“…of possessions (Frost and Hartl, 1996; Grisham et al., 2010; Tolin et al., 2008, 2012; Wincze et al., 2007), leading to the hypothesis that HD might be caused by underlying deficits in the executive functions that mediate decision making and other cognitive processes (Tolin et al., 2012).”
Hall, B. J., Tolin, D. F., Frost, R. O., & Steketee, G. S. (2012) · Depression and Anxiety · doi:10.1002/da.22015 · Cited by 71
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“Rather, based on previous studies not involving hoarding-related decisions (Saxena et al., 2004; Tolin et al., 2012b), it was expected that HD patients would show decreased activity, compared with the other two groups, in ACC, PCC, and insula.”
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Self-citationMy possessions need me: Anthropomorphism and hoarding
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Hoarding disorder and difficulties in emotion regulation
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“In addition to high baseline levels of anxiety and depression (Frost, Steketee, & Tolin, 2011; Wheaton, Timpano, Lasalle-Ricci, & Murphy, 2008), individuals with HD report strong feelings of anxiety and sadness elicited by the acts of sorting personal possessions in the laboratory (Grisham, Norberg, Williams, Certoma,…”
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“Consistent with this, neuroimaging has detected differences in activity in parts of the brain associated with decision making when hoarding patients are compared with OCD patients and healthy controls (Tolin et al., 2012).”
BackgroundAn investigation of doubt in obsessive–compulsive disorder
SAMUELS, J. F., Bienvenu, O. J., Krasnow, J., Wang, Y., Grados, M. A., Cullen, B., Goes, F. S., Maher, B. S., Greenberg, B. D., McLaughlin, N. C. R., et al. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.03.004 · Cited by 44
“, difficulty in choosing a course of action given more than one option, occurs in many individuals with OCD and is especially prominent in compulsive hoarding [18,19].”
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“Our results converge with the small number of recent neuroimaging studies that have directly compared individuals with HD and OCD and found differential neural abnormalities between these clinical populations (Tolin et al. 2012, 2014).”
ResultExecutive functioning in participants over age of 50 with hoarding disorder
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“…of novel objects, ACC activation was significantly lower in hoarding individuals than in healthy individuals and nonhoarding OCD individuals, 66 and during imaginal discarding of novel objects, hoarding-related distress correlated negatively with dorsal ACC and orbitofrontal cortex…”
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“When these individuals make decisions about what to discard, they tend to experience an increase in neural activity linked to the monitoring of errors under uncertainty (Tolin et al., 2012).”
BackgroundHoarding in children and adolescents with obsessive–compulsive disorder
SAMUELS, J. F., Grados, M. A., Riddle, M. A., Bienvenu, O. J., Goes, F. S., Cullen, B., Wang, Y., Greenberg, B. D., Fyer, A. J., McCracken, J. T., et al. (2014) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2014.08.001 · Cited by 36
“Previous studies have found a strong relationship between difficulty making decisions, deficits in executive functioning, and hoarding in adults (Morein-Zamir et al., 2014; Tolin et al., 2012).”
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“Consequently, they failed to provide a meaningful comparison with OCD because of an overall lack of activation in these patients (Tolin et al., 2012).”
BackgroundPerceived emotion regulation and emotional distress tolerance in patients with hoarding disorder
Worden, B. L., Levy, H. C., Das, A., Katz, B. W., Stevens, M. C. G., & Tolin, D. F. (2019) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2019.100441 · Cited by 27
“While several authors have posited potential neurobiological deficits in decision-making regarding possessions (e.g., Lawrence et al., 2006; Saxena et al., 2004; Tolin et al., 2012), what looks like behavioral indecisiveness may be the result of difficulty regulating/tolerating the emotional distress associated with d…”
BackgroundSelf-citationFunctional Neuroimaging Test of an Emerging Neurobiological Model of Hoarding Disorder
Stevens, M. C. G., Levy, H. C., Hallion, L. S., Wootton, B. M., & Tolin, D. F. (2019) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2019.08.010 · Cited by 27
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“The HDT was partially based on a symptom provocation paradigm developed by Tolin, Kiehl, Worhunsky, Book, and Maltby (2009), which has since been used in several investigations (Norberg et al., 2015; Timpano & Schmidt, 2013; Tolin et al., 2012).”
BackgroundMethodHoarding Disorder: Development in Conceptualization, Intervention, and Evaluation
Bratiotis, C., Muroff, J. R., & Lin, N. (2021) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20210016 · Cited by 21
A Review of the Diagnosis and Management of Hoarding Disorder
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Self-citationValidation of a Behavioral Measure of Acquiring and Discarding in Hoarding Disorder
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Toward a biopsychosocial model of hoarding disorder
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“Then, the parietal lobe including the angular gyrus might contribute to the cognitive deficit events of hoarding symptom such as the excessive acquisition of and inability to discard objects (Tolin et al. 2012).”
BackgroundHoarding in attention deficit hyperactivity disorder: Understanding the comorbidity
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“It is possible that this advanced central nervous system (CNS) sophistication is related to complex functions distributed over a wide range of frequency bands, in different cerebral structures, and in an efficient communication system integrating many information attributes.(3,6-9) The CNS considers 2 key aspects in d…”
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“SP has also been reported across the broader obsessive–compulsive spectrum, including: premonitory urges (PMUs) in TS/CTD [34, 82], incompleteness in BDD [27], NJREs in HD [139],and sensory over-responsivity and NJREs in TTM and SPD [18, 51, 75].”
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The Relationship between Hoarding Symptoms, Intolerance of Uncertainty, and Error-Related Negativity
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A narrative synthesis of possible causes and risk factors of hoarding behaviours
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“fMRI data were collected from an HD group (n = 17), an MDD group (n = 8), an HD+MDD group (n = 10), and an HC group (n = 18) as part of two research studies, the first examining brain function in HD (Tolin et al., 2012; Tolin et al., 2014) and the second investigating biomarkers of mood disorders (unpublished).”
BackgroundMethodResultInfluentialSelf-citationA multitrait-multimethod matrix investigation of hoarding
Meyer, J. F., Frost, R. O., Brown, T. A., Steketee, G. S., & Tolin, D. F. (2013) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2013.03.002 · Cited by 14
“Other evidence of its distinctiveness comes from genetic (Samuels et al, 2007a, 2007b), neuroimaging (An et al, 2009; Saxena et al., 2004; Tolin et al, 2009; Tolin et al, 2012), and treatment outcome studies (Abramowitz et al., 2003).”
BackgroundSelf-citationSelf-reported executive function and hoarding in adults with obsessive-compulsive disorder
SAMUELS, J. F., Bienvenu, O. J., Krasnow, J., Wang, Y., Grados, M. A., Cullen, B., Goes, F. S., Maher, B. S., Greenberg, B. D., McLaughlin, N. C. R., et al. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.11.009 · Cited by 14
Evaluating an Animal Model of Compulsive Hoarding in Humans
Andrews-McClymont, J. G., Lilienfeld, S. O., & Duke, M. P. (2013) · Review of General Psychology · doi:10.1037/a0032261 · Cited by 14
“Most recently, evidence for the role of the ACC in hoarding emerged in a study by Tolin et al. (2012), in which participants with hoarding disorder (n 43) showed significant abnormal activation patterns in both the ACC and the insula in response to decisions of whether to discard objects compared…”
BackgroundResultClinical characteristics of hoarding disorder in Japanese patients
Kuwano, M., Nakao, T., Yonemoto, K., Yamada, S., Murayama, K., Okada, K., Honda, S., Ikari, K., Tomiyama, H., Hasuzawa, S., et al. (2020) · Heliyon · doi:10.1016/j.heliyon.2020.e03527 · Cited by 13
Emotion dysregulation and hoarding symptoms: A systematic review and meta‐analysis
Akbari, M., Seydavi, M., Mohammadkhani, S., Turchmanovych, N., Chasson, G. S., Majlesi, N., Hajialiani, V., & Askari, T. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23318 · Cited by 12
The Association between Age and Experienced Emotions in Hoarding Disorder
Dozier, M. E., Wetherell, J. L., Amir, N., Weersing, V. R., Taylor, C. T., & Ayers, C. R. (2020) · Clinical Gerontologist · doi:10.1080/07317115.2020.1742833 · Cited by 12
“The tasks involved sorting only paper items (Levy et al., 2019a; Tolin et al., 2009, 2012), sorting only up to five items (Frost et al., 2016), or sorting using a computer task (Levy et al., 2019b); furthermore, several tasks took place in fMRI scanners (Levy et al., 2019b; Tolin et al.,…”
MethodResultInfluentialLevy, H. C., Nett, A., & Tolin, D. F. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.163 · Cited by 12
Self-citationGrisham, J. R., Yap, K., Isemann, S., Svehla, J., Briggs, N., & Norberg, M. M. (2022) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2022.100450 · Cited by 11
“Because many individuals with HD experience intense distress and negative emotions during decision-making (Frost et al., 2016; Tolin et al., 2012), refusal to discard or make decisions about items may represent avoidance of negative emotions that are difficult to manage.”
Self-citationHall, M. D., Gipson, K. S., Gipson, S. Y.-M. T., Colvin, M. K., Nguyen, S. T. T., & Greenberg, E. (2025) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000429 · Cited by 13
Psychological and electrophysiological indices of inattention in hoarding
Baldwin, P. A., Whitford, T. J., & Grisham, J. R. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.11.009 · Cited by 11
Deficits in physiological and self-conscious emotional response to errors in hoarding disorder
Zakrzewski, J. J., Datta, S., Scherling, C., Nizar, K., Vigil, O., Rosen, H. J., & Mathews, C. A. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.07.012 · Cited by 11
“temporal regions involved in emotion regulation, decision making, response inhibition, error processing, and decision making (Tolin et al. 2012), most consistently, the ACC, orbitofrontal cortex (OFC), and dorsolateral and medial prefrontal regions (Tolin et al.”
BackgroundShould I Keep It? Thoughts Verbalized During a Discarding Task
Bratiotis, C., Steketee, G. S., Dohn, J., Calderon, C. A., Frost, R. O., & Tolin, D. F. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10025-y · Cited by 11
Self-citationProfiling Hoarding Within the Five-Factor Model of Personality and Self-Determination Theory
Chan, J., Powell, C., & Collett, J. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.12.004 · Cited by 10
Perceived decision-making styles among individuals with obsessive-compulsive and hoarding disorders
Siev, J., Lit, K. R., & Leykin, Y. (2019) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2019.100472 · Cited by 10
State of the Science: Hoarding Disorder and Its Treatment.
Tolin, D. F., Worden, B. L., & Levy, H. C. (2025) · The Behavior Therapist · doi:10.1016/j.beth.2025.03.002 · Cited by 8
Self-citationTolin, D. F., Levy, H. C., Hallion, L. S., Wootton, B. M., Jaccard, J. J., Diefenbach, G. J., & Stevens, M. C. G. (2023) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000804 · Cited by 9
Self-citationElectrophysiological dynamics of visuocortical processing in hoarding disorder
Liu, N., Zakrzewski, J. J., Mathews, C. A., & Keil, A. (2020) · Psychophysiology · doi:10.1111/psyp.13711 · Cited by 9
Obsessive position: the new psychoanalytic approach of obsessive-compulsive disorder.
Csigó, K. (2021) · Current Psychology · doi:10.1007/s12144-021-01893-3 · Cited by 9
Sabel, I., Yap, K., & Grisham, J. R. (2024) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-024-10171-y · Cited by 8
“…with HD are known to be highly indecisive (Frost et al., 2011), and have been observed to have a decision-making style that is slower than controls (Tolin et al., 2012), more risk-averse (Siev et al., 2019) and highly elaborate (i.e., needing to think through all the possible uses of an item…”
Neural correlates of product attachment to cosmetics
Kikuchi, Y., Noriuchi, M., Isobe, H., Shirato, M., & Hirao, N. (2021) · Scientific Reports · doi:10.1038/s41598-021-03576-2 · Cited by 10
Worden, B. L., & Tolin, D. F. (2023) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2023.100588 · Cited by 8
Self-citationUnderstandingDSM-5 Hoarding Disorder: A Triple Vulnerability Model
Raines, A. M., Oglesby, M. E., Allan, N. P., Short, N. A., & Schmidt, N. B. (2016) · Psychiatry · doi:10.1080/00332747.2016.1167474 · Cited by 8
Anosognosia in hoarding disorder is predicted by alterations in cognitive and inhibitory control
van Roessel, P., Marzke, C., Varias, A. D., Mukunda, P., Asgari, S., Sanchez, C., Shen, H., Jo, B., Gunaydin, L. A., Williams, L. M., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-25532-4 · Cited by 8
An investigation of delay and probability discounting in hoarding disorder
Levy, H. C., Katz, B. W., Das, A., Stevens, M. C. G., & Tolin, D. F. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.11.019 · Cited by 8
“, 2011; Woody, Kellman-McFarlane, & Welsted, 2014) and affective/valuation (e.g., Lawrence et al., 2006; Tolin et al., 2012) difficulties, both at baseline and during decisionmaking about possessions.”
BackgroundSelf-citationObject attachment and decision-making.
Preston, S. D., & MacMillan-Ladd, A. D. (2020) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2020.07.019 · Cited by 6
Levy, H. C., Poppe, A. B., Hiser, J., Wootton, B. M., Hallion, L. S., Tolin, D. F., & Stevens, M. C. G. (2021) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2020.12.014 · Cited by 8
Self-citationEmotion Sensitivity of the Error-Related Negativity in Hoarding Individuals
Baldwin, P. A., Whitford, T. J., & Grisham, J. R. (2019) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-09716-9 · Cited by 8
An initial investigation of the relationships between hoarding and smoking
Raines, A. M., Unruh, A. S., Zvolensky, M. J., & Schmidt, N. B. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.01.001 · Cited by 7
“, 2009), experience distinct excessive activity in the lateral orbitofrontal cortex (Tolin et al., 2009; Tolin et al., 2012), it seems plausible that a failure to employ reward and punishment cues could guide smoking behaviors among those with hoarding.”
BackgroundKato, K., Tomiyama, H., Murayama, K., Mizobe, T., Matsuo, A., Nishida, N., Matukuma, K., Kang, M., Sashikata, K., Kikuchi, K., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1399062 · Cited by 7
Pardini, S., Olivetto, S., Fusina, F., & Novara, C. (2023) · PLoS ONE · doi:10.1371/journal.pone.0280933 · Cited by 6
“The information on the importance and distress intensity were evaluated with a Visual Analogue Scale (VAS) from 0 to 100, inspired by other studies investigating emotions and other features related to HD [27].”
MethodDavidson, E. J., Broadnax, D. V., Dozier, M. E., Pittman, J. O. E., & Ayers, C. R. (2021) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2021.100622 · Cited by 6
Hoarding Disorder: Models, Interventions, and Efficacy
Bratiotis, C., & Steketee, G. S. (2015) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.130202 · Cited by 6
Self-citationMueller, S. M. (2014) · International Neuropsychiatric Disease Journal · doi:10.9734/indj/2014/8102 · Cited by 6
“So far, an association has been shown for patients with checking and hoarding compulsions [26,37,38].”
BackgroundHoarding symptoms correlate with the endowment effect
Pushkarskaya, H., Lenkic, P., Stewart, B. A., Tolin, D. F., & Woody, S. R. (2020) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2020.06.002 · Cited by 5
Self-citationA virtual reality study of experiential avoidance, emotional experiences, and hoarding symptoms
McCabe‐Bennett, H., Provost-Walker, O., Lachman, R., Girard, T. A., & Antony, M. M. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100590 · Cited by 6
Hoarding disorder: Questions and controversies
van Roessel, P., Rodríguez, P. A. M., Frost, R. O., & Rodríguez, C. I. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100808 · Cited by 7
Self-citationHoarding revisited: there is light at the end of the living room
Pertusa, A., Gaston, R. L., & Choudry, A. H. (2018) · BJPsych Advances · doi:10.1192/bja.2018.39 · Cited by 5
“These findings were replicated by Tolin et al (2012), who compared 43 people with hoarding disorder with 31 individuals with non-hoarding OCD and 33 healthy controls.”
BackgroundAbnormal white matter structure in hoarding disorder
Mizobe, T., Ikari, K., Tomiyama, H., Murayama, K., Kato, K., Hasuzawa, S., Togao, O., Hiwatashi, A., & Nakao, T. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.01.031 · Cited by 5
Liu, T., Vickers, B. D., Seidler, R. D., & Preston, S. D. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1059051 · Cited by 6
“, 2010) and during discarding in HD (Tolin et al., 2012).”
BackgroundResultInfluentialTD: The case of Diogenes Syndrome—deficit or denial?
Ashworth, F., Rose, A., & Wilson, B. A. (2017) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2017.1391104 · Cited by 5
“Furthermore, a study investigating neural mechanisms of decision-making in those with hoarding problems also indicated abnormality in anterior cingulate cortex and insula function related to problems with identifying the emotional salience of a stimulus, generating an appropriate emotional response and regulating affe…”
BackgroundBiomarkers of Obsessive-Compulsive Disorder Subtypes: A Literature Review
Proshina, E. A., Gaidareva, A., Beskhizhko, M., Kazaryan, G., Bainbridge, E., & Khayrullina, G. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26178578 · Cited by 6
“…43 people with hoarding syndrome but not OCD, differences were noted in the activation of the anterior cingulate and bilateral insular cortex during decisions about keeping or giving up things when compared with OCD patients (most of whom had no hoarding symptoms) and healthy participants [92].”
Metadata
- Authors
- Tolin, D. F., Stevens, M. C., Villavicencio, A. L., Norberg, M. M., Calhoun, V. D., Frost, R. O., Steketee, G., Rauch, S. L., & Pearlson, G. D.
- Affiliations
- Boston University (US)
- ORCID
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2012-08-01
- Volume
- 69
- Issue
- 8
- Pages
- 832
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3506167
- OpenAlex
- W2099281977
- Cited by
- 174
- References
- 64
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 7 · 2023: 15 · 2022: 9 · 2021: 18 · 2020: 11 · 2019: 17 · 2018: 21 · 2017: 11 · 2016: 13 · 2015: 15 · 2014: 11 · 2013: 5 · 2012: 3
- FWCI
- 12.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Smith ScholarWorks (Smith College) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH074934)
- National Institute of Biomedical Imaging and Bioengineering (R01EB000840, R01EB020407, R01EB006841)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Perfectionism, Procrastination, Anxiety Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- hoarding disorder, decision-making, anterior cingulate cortex, insula, obsessive-compulsive disorder, indecision, emotion regulation, hoarding severity
- MeSH terms
- Hoarding Disorder, Adult, Brain Mapping, Cerebral Cortex, Decision Making, Evoked Potentials, Female, Gyrus Cinguli, Hospitals, Voluntary, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neural Pathways, Obsessive Behavior, Sickness Impact Profile, Expressed Emotion, Diagnostic and Statistical Manual of Mental Disorders
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