# The heterogeneity of hoarding behavior: characterizing disorder diversity to distinguish etiology and longitudinal symptom course

> **NIH NIH F31** · UNIVERSITY OF FLORIDA · 2023 · $39,336

## Abstract

Project Summary/Abstract
Hoarding disorder (HD) is a debilitating neuropsychiatric and public health problem that affects up to 4% of the
general population and 6% of older adults. Despite formal recognition as an independent diagnosis in the fifth
edition of the Diagnostic and Statistical Manual of Mental Disorders, HD remains frequently underdiagnosed and
effective treatment is limited. To date, multiple challenges have precluded the development of effective HD
detection and intervention efforts, including problems arising from wide-ranging heterogeneity in HD symptom
presentation. Efforts to better understand this heterogeneity are lacking, though evidence from other psychiatric
disorders indicates extensive utility in identifying dimensional symptom subgroups defined by distinct risk factors
and requiring unique prevention and intervention needs. The identification of common symptom patterns may
improve our ability to detect clinically meaningful hoarding behaviors and quickly navigate patients to
personalized treatment. Thus, the overall goal of this project is to distinguish heterogeneity in HD
symptomatology, through which I will establish unique profiles of HD symptoms and assess the utility of symptom
subgroups for elucidating variability in disorder etiology and longitudinal course. I will achieve this goal through
three specific aims. First, I will identify and characterize HD subgroups on the basis of symptom profile and
clutter-related functional impairment and safety concerns. In this aim, I will conduct data-driven analyses using
self-report symptom data collected from more than 35,500 individuals who have completed assessments of
hoarding and clutter in the Brain Health Registry (BHR), an internet-based research registry of adult participants
who semi-annually complete comprehensive self-report assessments of health history and behavior. This rich,
epidemiologic data source allows for comprehensive and innovative investigation of HD on a population-level.
Second, I will investigate variation in HD etiology following classification of subjects into hoarding symptom
subgroups. In this aim, I will employ a social-ecological framework for quantifying subgroup diversity in
intrapersonal, interpersonal, and community-level risk factors for HD. Finally, I will assess the differential impact
of HD subgroups on the longitudinal course of hoarding symptom severity. In this aim, linear mixed-effects
models will be used to assess the predictive ability of HD subgroups for distinguishing symptom trajectory. This
work will enrich knowledge of symptom presentation in HD and its relationship to disorder etiology and
longitudinal symptom course, thus enhancing efforts to effectively identify and treat hoarding behavior, all the
while strengthening my technical and professional skills to support my ultimate career goal as an independent
investigator.

## Key facts

- **NIH application ID:** 10603152
- **Project number:** 1F31MH130109-01A1
- **Recipient organization:** UNIVERSITY OF FLORIDA
- **Principal Investigator:** Sara Nutley
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $39,336
- **Award type:** 1
- **Project period:** 2023-04-21 → 2025-04-20

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10603152

## Citation

> US National Institutes of Health, RePORTER application 10603152, The heterogeneity of hoarding behavior: characterizing disorder diversity to distinguish etiology and longitudinal symptom course (1F31MH130109-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10603152. Licensed CC0.

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