Dissociating compulsive washing and hoarding tendencies through differences in comorbidities and the content of concerns

Abstract

Clinical compulsive washing and hoarding are intercorrelated and share comorbidities even though they are distinct and appear to manifest through opposing extremes of cleanliness and disorder (respectively). We attempted to resolve this paradox by testing five hypotheses in online, non-clinical samples (N_{study 1} = 123, N_{study 2} = 177, N_{study 3} = 217). We replicated the intercorrelation of washing and hoarding tendencies in all studies, despite observing non-clinical individual differences. Both washing and hoarding were associated with anxiety, depression, and fears of social rejection and failure, but they were also distinguishable. Compulsive washing was associated with greater anxiety, disgust, perceptions of infection vulnerability, and the desire to organize a cluttered space, whereas hoarding was associated with reduced concerns about germs and full or cluttered spaces and higher concerns about assault, threats to safety, and insects. A third study tested and confirmed the hypothesis that washing and hoarding may be related because they are adaptive in combination during stressful conditions, like a global pandemic. During COVID-19, washing and hoarding tendencies were even more strongly interrelated, and disease-avoidant behaviors like wearing a mask and avoiding people increased with washing tendencies but decreased with hoarding tendencies. Overlapping psychopathological states can be distinguished even in non-clinical samples through psychopathological profiles and the content of concerns—that shift with one's context. Treatment may benefit from not only working to cease undesirable behaviors but also from ameliorating root fears and anxieties that are dissociable by condition and individual but not always linked to the behavioral expression.