title: Prevalence, comorbidity and heritability of hoarding symptoms in adolescence: a population based twin study in 15-year olds.
abstract: BACKGROUND
  Hoarding Disorder (HD) is often assumed to be an 'old age' problem, but many individuals diagnosed with HD retrospectively report first experiencing symptoms in childhood or adolescence. We examined the prevalence, comorbidity and etiology of hoarding symptoms in adolescence.
  
  
  METHODS
  To determine the presence of clinically significant hoarding symptoms, a population-based sample of 15-year old twins (N = 3,974) completed the Hoarding Rating Scale-Self Report. Co-occurring Obsessive Compulsive Disorder (OCD), Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) were estimated from parental report. Model-fitting analyses divided hoarding symptom scores into additive genetic, shared, and non-shared environmental effects.
  
  
  RESULTS
  The prevalence of clinically significant hoarding symptoms was 2% (95% CI 1.6-2.5%), with a significantly higher prevalence in girls than boys. Exclusion of the clutter criterion (as adolescents do not have control over their environment) increased the prevalence rate to 3.7% (95% CI 3.1-4.3%). Excessive acquisition was reported by 30-40% among those with clinically significant hoarding symptoms. The prevalence of co-occurring OCD (2.9%), ASD (2.9%) and ADHD (10.0%) was comparable in hoarding and non-hoarding teenagers. Model-fitting analyses suggested that, in boys, additive genetic (32%; 95% CI 13-44%) and non-shared environmental effects accounted for most of the variance. In contrast, among girls, shared and non-shared environmental effects explained most of the variance, while additive genetic factors played a negligible role.
  
  
  CONCLUSIONS
  Hoarding symptoms are relatively prevalent in adolescents, particularly in girls, and cause distress and/or impairment. Hoarding was rarely associated with other common neurodevelopmental disorders, supporting its DSM-5 status as an independent diagnosis. The relative importance of genetic and shared environmental factors for hoarding differed across sexes. The findings are suggestive of dynamic developmental genetic and environmental effects operating from adolescence onto adulthood.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. volen.ivanov@ki.se
authors.forename: Volen Z
authors.initials: VZ
authors.lastname: Ivanov
authors.forename: David
authors.initials: D
authors.lastname: Mataix-Cols
authors.forename: Eva
authors.initials: E
authors.lastname: Serlachius
authors.forename: Paul
authors.initials: P
authors.lastname: Lichtenstein
authors.forename: Henrik
authors.initials: H
authors.lastname: Anckarsäter
authors.forename: Zheng
authors.initials: Z
authors.lastname: Chang
authors.forename: Clara Hellner
authors.initials: CH
authors.lastname: Gumpert
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lundström
authors.forename: Niklas
authors.initials: N
authors.lastname: Långström
authors.forename: Christian
authors.initials: C
authors.lastname: Rück
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications; D002659:Child Development Disorders, Pervasive / Q000150:complications / Q000453:epidemiology; D015897:Comorbidity; D004200:Diseases in Twins / Q000453:epidemiology*; D005260:Female; D000067836:Hoarding Disorder / Q000453:epidemiology* / Q000235:genetics*; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000453:epidemiology; D011153:Population; D015995:Prevalence; D057566:Self Report