The study aimed to investigate the prevalence and the factors influencing hoarding based on path analysis of hoarding among college students from various perspectives. 4.5% of college students in our sample engaged in hoarding behavior, confirming previous studies showing that hoarding is highly represented among Chinese college students (4.22% meets diagnostic criteria for HD)[13]. Hoarding can occur for a variety of reasons, such as items that contain important information or may be useful in the future, and some people believe that hoarding is motivated by a sense of responsibility and the need to be prepared to prevent harm to the items[37]. Interestingly, our binary logistic regression shows heightened neurotic personality traits and exposure to life events, coupled with high levels of obsessive-compulsive symptoms, seem to act as risk factors for hoarding. Finally, path analysis was utilized to investigate the mode of action of the four components of life events, neurotic personality traits, obsessive-compulsive symptoms, and hoarding, while controlling for depression levels. The results revealed that life events and neurotic personality traits can directly influence hoarding symptoms. Moreover, both life events and neurotic personality traits can also indirectly affect hoarding through obsessive-compulsive symptoms. These findings highlight the complex interplay between various factors in the development of hoarding symptoms and underscore the importance of considering multiple variables in the assessment and treatment of this condition.
Age was found to exhibit a significant difference in the univariate analysis, despite the fact that the difference between the means of the two groups was not significant. Some studies suggest that hoarding tends to occur at a younger age, and that increasing age may decrease the risk of hoarding[17]. A meta-analysis found that the mean age of onset of hoarding symptoms was 16.7 years[14]. Difficulties in discarding associated with hoarding symptoms typically manifests prior to the age of 20 years. However, it is not until the average age of 35.5 years that this difficulty in discarding reaches clinical levels. Some studies suggest this may be related to a decline in physical function that inhibits a person's ability to access or lack of financial support (Dozier & Ayers, 2014). We believe that this phenomenon can be attributed to the fact that hoarding behavior typically manifests during adolescence, when individuals may face constraints in terms of finances and space, and the severity of their hoarding behavior does not yet qualify as a disorder. With advancing age, however, hoarding behavior tends to intensify and may interfere with an individual's daily functioning or meet the diagnostic criteria for a hoarding disorder. These findings suggest that early intervention at or soon after the onset of hoarding symptoms may lead to improved treatment efficacy, or even prevent symptoms from worsening later in life. However, some patients also develop symptoms at an older age with a bimodal distribution of onset[14]. Studies have shown that the prevalence of clinically significant hoarding disorder is greater than 6% in individuals older than 55 years of age, which is significantly higher than the prevalence reported in the general population [38]. It is important to note that our sample primarily comprises of students, and as such, our findings may not necessarily be representative of older age groups. Therefore, future studies examining hoarding behaviors in older age groups are warranted to shed light on this matter.
In contrast, no significant difference in the prevalence of hoarding disorder was noted among college students based on gender, which is inconsistent with the findings of Yanan Zheng et al.[13] that indicated that male students hoarded more than female students in China. This difference may stem from the fact that this study was limited to Teachers’ university, which have a large difference in the proportion of male and female students, with relatively fewer men and more women.
The mediating effect of obsessive-compulsive symptoms in the relationship between neurotic personality traits and hoarding observed in the present study is consistent with previous research. Prior studies have associated hoarding symptoms in the context of OCD with high levels of neuroticism personality traits, prior to classifying hoarding as a separate disorder[39]. Neuroticism is the tendency to increase vulnerability to stress and negative emotions and is associated with various types of psychopathology, including anxiety and depression [40], which are relatively common comorbidities of hoarding [41]. High levels of neuroticism have consistently been associated with the expression of OCD. Individuals with high neuroticism may be more sensitive to fear and more responsive to threat assessment than those with low neuroticism levels. Therefore, it is possible that high neuroticism may contribute to the development and maintenance of hoarding symptoms through its association with OCD and obsessive-compulsive symptoms. Although OCD is different from hoarding, there is an association between the two[15]. This finding may be related to the intolerance of uncertainty shared by compulsions and hoarding, i.e., the tendency of individuals to consider the possibility of negative events as unacceptable, regardless of the likelihood of their occurrence[42]. Avoiding the decision to keep or discard an item reduces the pain of uncertainty about the future utility of the item and uncertainty about the probability of error[42].As neuroticism personality traits increase, the risk of hoarding also increases. This finding is consistent with the findings of Dozier et al., who suggested a link between hoarding behavior and increased neuroticism traits[43]. A German study in May 2020 (in the context of a nationwide lockdown due to the epidemic in March-April 2020) based on a questionnaire found that neuroticism could be a predictor of increased hoarding behavior[44]. This finding underscores the importance of mental health education for college students with regards to hoarding behaviors. Such education programs may help students identify and manage compulsive tendencies, which in turn may mitigate the impact of personality traits on hoarding.
The present study found that obsessive-compulsive symptoms play a mediating role in the relationship between life events and hoarding symptoms. Specifically, life events can affect an individual's hoarding symptoms through obsessive-compulsive symptoms. Stressful life events, accidental exposure to pollutants, and trauma have all been associated with the onset of OCD, and may similarly contribute to the development and exacerbation of hoarding symptoms through their impact on obsessive-compulsive symptoms[45]. Rosso et al. found that approximately 60% of the 329 participants in their study developed OCD after experiencing a stressful life event [46]. In a study of 473 individuals with OCD, people with hoarding scored significantly higher on the Y-BOCS. The researchers believe this finding may be related to the nature of hoarding symptoms and may also be related to the fact that individuals with hoarding generally recognize more OCD symptoms[47]. Life events can also directly affect hoarding. David F. et al. studied 751 adults who reported hoarding symptoms and investigated the severity of their hoarding behaviors concerning the prevalence of stress and life events. Stress and life events were common in these samples, and changes in interpersonal relationships were temporally associated with symptom onset [48]. Grisham et al. also found a significant association between hoarding behaviors and life events, with 55% of participants reporting stressful life events at the onset of hoarding symptoms[16]. Hoarding behaviors may start with a stressful event in the past or an event that individuals with hoarding has difficulty coping with. Here, symptoms appear shortly after the event[49]. Moreover, hoarding may fill the emotional void created by the event[50]. Collectively, these findings emphasize the need for a comprehensive approach to hoarding that takes into account multiple factors, including individual traits, environmental stressors, and mental health education.
Our finding has some implications for family education, schooling, and treatment of hoarding and related research. However, there are some limitations to this study. First, the impact of negative childhood experiences and low social support on hoarding did not align with our initial expectations, as the findings did not reveal an increased risk of hoarding in individuals with negative childhood experiences and low social support. However, it is possible that this unexpected result may be due to whole-group sampling which was not used in this survey, and the differences in the hoarding phenomenon among college students at different levels and in different regions were not examined and the absence of standardized instruments to measure childhood experiences. Thus, it is necessary to conduct future studies on a broader cohort to fully consider the sample representativeness and a more specific and detailed examination of negative childhood experiences may help identify a potential relationship with hoarding. Second, the surveys were all completed using self-report questionnaires, and the Hawthorne effect may be present. Thus, the relevance of these findings may be somewhat limited[51]. Finally, the self-rated questionnaire HRS-I and separating the hoarding and non-hoarding groups with a threshold score of 14 along with a score of 4 or higher for primary symptoms of clutter in the home and difficulty discarding is not necessarily equivalent to the DSM-5 diagnosis of hoarding disorder. Given the cross-diagnostic nature of hoarding and its association with emotional dysregulation, it is crucial to investigate individuals' awareness of hoarding and their understanding of emotions, as well as their ability to regulate impulsive behaviors in the context of negative emotions. Future studies may also explore other factors related to emotional dysregulation that may be associated with hoarding, such as tolerance of uncertainty and difficulty tolerating pain. The present study provides valuable insights into the nature of hoarding behaviors, but larger sample sizes and longitudinal studies are necessary to further elucidate the factors that influence hoarding and to develop more targeted psychotherapies in the future.