Investigating empathy in hoarding and its potential as a psychosocial treatment target

Abstract

Hoarding disorder (HD) is associated with social impairment, including isolation, loneliness, and reduced social support. Social factors also play a role in the maintenance of hoarding symptoms. However, current treatments for HD do not include an interpersonal component. One potential treatment target for hoarding is empathy. Empathy is fundamental to the development of successful social bonds, and disrupted empathy has been implicated in the social difficulties in other disorders. As such, the aim of this current thesis is to explore the relationship between hoarding and empathy and examine whether empathy could be an interpersonal target in hoarding treatment. In Study 1, I investigated the relationship between hoarding and empathy in an unselected sample. Hoarding was positively associated with emotional contagion, a core component of emotional empathy, and negatively related to cognitive empathy. Self-reported emotional empathy and a behavioural measure of cognitive empathy predicted hoarding beyond depression, and a clinical subgroup of participants showed mild-to-moderate impairments in the behavioural cognitive empathy task. Studies 2-4 expanded upon these findings to investigate empathy-related concepts in relation to hoarding. In Study 2, I examined the relationship between hoarding with social motivation and social support, two variables that represent a predecessor and consequence of normal empathy development, respectively. Hoarding was associated with greater social anhedonia, enjoyment of both positive and negative social rewards, and reduced social support. In Study 3, I aimed to investigate if those with high and low hoarding symptoms differ in prosocial behaviour, a common behavioural component of empathy. No significant differences were found between groups. In Study 4, I aimed to clarify if hoarding was associated with experiences and expressions of anger. Dysregulations in emotional and cognitive empathy may reflect in unhelpful emotional and cognitive experiences of anger. Moreover, aggression is a common behavioural consequence of dysregulated empathy, so was potentially relevant to hoarding. Hoarding was positively associated with angry feelings, hostility, and direct aggression, as well as related concepts of angry rumination and displaced aggression. Lastly, Study 5 was a pilot intervention investigating a social cognition intervention for individuals diagnosed with HD. Participants showed improvements in primary outcomes of cognitive empathy and hostility bias and secondary outcomes of hoarding symptoms and loneliness from pre- to post-treatment. This dissertation provides preliminary evidence that empathy may represent a promising construct to improve the understanding and treatment of psychosocial difficulties in hoarding.