Early life stress in adults with hoarding disorder: A mixed methods study

Background: Traumatic life events are common among individuals with hoarding disorder (HD), though rates of posttraumatic stress disorder are no higher than in other groups. HD symptoms typically begin to appear in mid-childhood, and early life stress (ELS) is a known associated feature of negative mental health outcomes. The specifics of this relationship are still unclear. Methods: We obtained Early Life Stress Questionnaire (ELSQ) responses from 35 participants with HD, 22 participants with obsessive-compulsive disorder (OCD), and 23 non-clinical control participants. We combined these quantitative data with qualitative interviews exploring what role ELS experiences play in HD. Results: Per the ELSQ, individuals with HD reported significantly more ELS events than the non-clinical control participants. In qualitative interviews, HD participants described the ELS events that were most impactful in shaping their relationship to material possessions; these events tended to be long in duration and elicited feelings of scarcity of emotional support. Participants described relying on possessions in place of relationships and viewed possessions as potential sources of connection to peers. Conclusions: Our qualitative and quantitative results build on the cognitive behavioral model of HD, emphasizing early experiences of prolonged stress or scarcity of emotional support as a key contributing vulnerability factor. Specific differences are consistent with earlier research that people with HD experience absence of early warmth. They further suggest that screening for ELS experiences is important when working with individuals with HD, and that HD treatments may benefit from increased focus on social and emotional connection building.