Accuracy of self and informant reports of symptom severity and insight in Hoarding Disorder

• Good correspondence was found between self- and informant-rated hoarding severity.
• Relatives under-estimated insight of those with HD compared to clinicians.
• Those who do not self-identify with HD have more severe symptoms and lower insight.
• Concentrated efforts are needed to engage those who do not self-identify with HD.
• Expert clinicians should guide assessment of HD using a multi-informant approach.

BackgroundPrevious literature on Hoarding Disorder (HD) has largely recruited individuals with self-identified hoarding difficulties or informant-ratings of individuals who are not seeking help. Little is known about the reliability of self- and informant-ratings of hoarding severity and insight, and whether individuals who self-identify with HD differ from those who do not.MethodTwenty-four pairs of individuals meeting criteria for HD and their relatives took part in the study, plus 40 relatives of individuals meeting likely criteria for HD who did not agree to participate. All participants completed a clinician-administered diagnostic interview for HD and online questionnaires assessing hoarding severity, squalor and insight.ResultsGood correspondence was found between self- and informant-ratings of hoarding severity, although informants gave significantly higher squalor ratings. Relative to clinician-ratings, informants under-estimated the insight of HD individuals. Higher hoarding severity and lower insight informant-ratings were made for individuals with HD who did not agree to participate, compared to those who did.ConclusionsA multi-informant approach guided by expert clinicians is desirable for the assessment of HD, particularly in low-insight individuals. When individuals do not seek help for HD, family members may benefit from education and support to help them understand how best to assist their relatives.