ADHD Clinical Update, July 21, 2011

Inattentive attention deficit hyperactivity disorder (ADHD) was diagnosed in 28% of patients with hoarding disorder (HD), compared to only 3% of patients with obsessive compulsive disorder (OCD), according to a recent study published in Depression and Anxiety.

According to researchers headed by Randy O. Smith, PhD, a professor in the department of psychology at Smith College, HD is currently under consideration for inclusion as a distinct disorder in DSM-5 (1).

“Few studies have examined comorbidity patterns in people who hoard, and the ones that have suffer from serious methodological shortcomings, including drawing from populations already diagnosed with obsessive compulsive disorder, using outdated definitions of hoarding, and relying on inadequate assessments of hoarding,” the authors wrote.

“The present study is the first large-scale study of comorbidity in a sample of people meeting recently proposed criteria for HD and relying on validated assessment procedures.”

The researchers compared psychiatric comorbidity in a large HD sample (N=217) to 96 participants meeting criteria for OCD without HD. High comorbidity rates were observed for major depressive disorder (MDD) as well as acquisition-related impulse control disorders (compulsive buying, kleptomania, and acquiring free things). Fewer than 20% of HD participants met criteria for OCD, and the rate of OCD in HD was higher for men than women.

Rates of MDD and acquisition-related impulse control disorders were higher among HD than OCD participants. “No specific anxiety disorder was more frequent in HD, but social phobia was more frequent among men with HD than among men with OCD. Inattentive ADHD was diagnosed in 28% of HD participants and was significantly more frequent than among OCD participants (3%),” the authors concluded. “These findings form important base rates for developing research and treatments for hoarding disorder.”

Problems of Self-Concept in a Patient Sample of Hypersexual Men with ADHD

Clinicians should exercise caution in assuming that common characteristics of attention deficit hyperactivity disorder (ADHD), such as impulsivity and hyperactivity, exert the strongest influence on hypersexual behavior, according to research published recently in the Journal of Addiction Medicine.

Earlier evidence has suggested comorbid ADHD among those seeking treatment for hypersexual behavior. This study, which was headed by Rory C. Reid, PhD, a research psychologist at the University of California, Los Angeles, examined which facets of ADHD symptoms are most strongly associated with hypersexual behavior among a patient sample of men (N=81).

ADHD diagnosis was made by two clinicians, and symptom characteristics were measured using the Conners’ Adult ADHD Rating Scale and the Sexual Compulsivity Scale.

The researchers found that among ADHD symptoms, inattentive features were most prevalent. A stepwise regression analysis revealed that the Problems with Self-Concept subscale of the Conners’ Adult ADHD Rating Scale was the strongest predictor of scores on the Sexual Compulsivity Scale. Surprisingly, subscales that measured traits of impulsivity, inattention, memory problems, and hyperactive restlessness did not contribute additional predictive variance in the statistical model.

“The results of these findings suggest that clinicians should exercise caution in assuming that common characteristics of ADHD, such as impulsivity and hyperactivity, exert the strongest influence on hypersexual behavior,” the researchers wrote. “Rather, our results provide evidence that the associated features of ADHD, such as problems with low self-esteem, might be more salient factors in influencing hypersexuality severity among patients with comorbid hypersexual behavior and ADHD.”

SourcesStudy Finds ADHD to be a Comorbidity in Hoarding Disorder [Depression and Anxiety]

Problems of Self-Concept in a Patient Sample of Hypersexual Men with ADHD [Journal of Addiction Medicine]