Hoarding disorder (HD) is an understudied psychiatric condition characterized by severe and compulsive difficulties with discarding and excessive acquisition, resulting in debilitating levels of clutter. HD is associated with profound personal and public health issues, including medical and psychiatric comorbidity, vast functional impairment, and increased risk for suicide. Hoarding symptoms have been associated with suicide plans and attempts, with metanalytic findings highlighting strikingly high rates of both suicide attempt (SA; 24%) and lifetime suicide ideation (SI; 38%) in HD. Alarmingly, studies report that fewer than one-third of patients achieve clinically significant change in treatment due in part to factors such as attrition and low treatment motivation. Currently, no FDA-approved pharmacological therapies for HD are available. Research into novel treatments is necessary to provide symptom relief, reduce risk, and improve quality of life.

Evidence implicates kappa opioid receptors (KOR) in motivation, emotion regulation, compulsive behaviors, and in pre-clinical models of hoarding. Results have potential to significantly impact HD treatment development. We seek to examine the role of KOR in the maintenance of HD symptomatology using PET imaging with the novel radiotracer [11]EKAP.

Our Goals

• Examine group differences in KOR availability in individuals with HD compared to demographically matched healthy controls (HC) using [11C]EKAP PET.

• Examine relationships between KOR availability and endophenotypic correlates (emotion dysregulation, stress reactivity, cognitive dysfunction) of HD.

• Examine KOR as a marker for negative outcomes associated with HD (social dysfunction, functional impairment, suicide behavior).