Development of an Operational Protocol for Animal Hoarding: A Conceptual Proposal Based on Multidisciplinary Field Experience

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear author,
The article is really interesting and well organised. I have no suggestions to offer regarding the structure, but I did notice a few minor spelling corrections.
- Line 215: the initial “i” is missing.
- Line 284: insert a space between “literature” and “[13...”.
- Line 359: in the parentheses ‘including illness, malnutrition, or death’, I would remove the comma after ‘malnutrition’

Author Response

Comment 1:
The article is really interesting and well organised. I have no suggestions to offer regarding the structure, but I did notice a few minor spelling corrections.

• Line 215: the initial “i” is missing.
• Line 284: insert a space between “literature” and “[13...”.
• Line 359: in the parentheses ‘including illness, malnutrition, or death’, I would remove the comma after ‘malnutrition’.

 Response:
We sincerely thank the Reviewer for the careful reading and kind appreciation.
All suggested minor corrections have been implemented in the revised version of the manuscript as follows:

• Line 215: the missing “In” has been restored.
• Line 284: a space has been added between “literature” and the reference.
• Line 359: the comma after “malnutrition” has been removed as recommended.
  We are grateful for these precise observations that helped refine the final text.

Reviewer 2 Report

Comments and Suggestions for Authors

The present manuscript proposes an operational protocol for the hoarding of animals in Italy based on the 48 documented cases. The topic is very timely and novel which will have wide implications. The language is clear and easy to understand. The hypothesis is sound and well established.

1. Abstract: Appropriate
2. Keywords: May add operational protocol

• L32: please detail or define the HD

1. L33; This is a global issue
2. L215: n should be IN
3. L349: Please add details of the basis of selection of cases. I would recommend to add further detailing of the data analysis.

• Some issue are well emphasized in the manuscript such as Lack of coordination among local regulations and national regulations is properly emphasized.
• The operational protocol is well presented.

Author Response

Commento generale:
Il presente manoscritto propone un protocollo operativo per l'accumulo compulsivo di animali in Italia, basato su 48 casi documentati. L'argomento è di grande attualità e novità, con ampie implicazioni. Il linguaggio è chiaro e di facile comprensione. L'ipotesi è solida e ben consolidata.

Risposta:
Ringraziamo sinceramente il Revisore per aver riconosciuto la pertinenza, la novità e la chiarezza del nostro lavoro.
Siamo particolarmente lieti che il modello operativo proposto sia stato ritenuto coerente e significativo per l'implementazione pratica.

Commento 1 – Abstract:
Appropriato.

Risposta 1:
Ringraziamo il revisore per questo feedback positivo.

Commento 2 – Parole chiave:
è possibile aggiungere il protocollo operativo.

Risposta 2:
La parola chiave “protocollo operativo” è stata aggiunta per migliorare l’indicizzazione e la chiarezza tematica (pagina 1, sezione Parole chiave ).

Commento 3 – Riga 32:
Si prega di specificare o definire l'HD.

Risposta 3:
Il termine Disturbo da Accumulo (HD) è stato già definito al momento della sua prima menzione nell'Introduzione come "una condizione psichiatrica definita nel DSM-5, caratterizzata da una persistente difficoltà a liberarsi dei beni, indipendentemente dal loro valore effettivo". Ciò garantisce l'accessibilità a lettori con background disciplinari diversi.

Commento 4 – Riga 33:
Questo è un problema globale.

Risposta 4:
La frase è stata rivista di conseguenza per sottolineare la dimensione globale del fenomeno ( Introduzione , righe 33–35).

Commento 5 – Riga 215:
“n” dovrebbe essere “In”.

Risposta 5:
Corretto come suggerito ( sezione Metodi ).

Commento 6 – Riga 349:
Si prega di aggiungere dettagli sulla base della selezione dei casi. Consiglierei di aggiungere ulteriori dettagli sull'analisi dei dati.

Risposta 6:
Abbiamo aggiunto una descrizione dettagliata dei criteri di selezione dei casi e delle procedure di analisi dei dati nella Sezione 4.3 ( Metodi di raccolta dati ).
Il paragrafo rivisto ora specifica che i 48 casi sono stati selezionati sulla base di criteri diagnostici e comportamentali coerenti con le definizioni del DSM-5 e confermati attraverso una valutazione multidisciplinare (professionisti veterinari, sociali e delle forze dell'ordine).
L'approccio analitico è descritto come una sintesi qualitativa volta a identificare modelli clinici, relazionali e ambientali ricorrenti.

Commento 7 – Generale:
Alcune questioni sono ben evidenziate nel manoscritto, come la mancanza di coordinamento tra le normative locali e nazionali, che è opportunamente evidenziata. Il protocollo operativo è ben presentato.

Risposta 7:
Ringraziamo sinceramente il Revisore per aver riconosciuto la chiarezza di questi aspetti.
La mancanza di coordinamento normativo e la necessità di un modello operativo unificato sono state infatti motivazioni centrali per lo sviluppo del protocollo proposto, come sottolineato sia nell'Introduzione che nelle Conclusioni .

Reviewer 3 Report

Comments and Suggestions for Authors

This is a highly interesting and well-written account of an approach to standardize and quantify the evaluation of individuals who hoard animals to their detriment.  I have a few general comments which the authors may wish to integrate into their publication or ignore, at their discretion,

Is animal hoarding specific or do these hoarders tend to hoard other objects as well? Does this depend on the individual's motivation (e.g., belief the animals are rescued)?

How does this problem differ from society's general failure to treat mental health issues?

The authors present their experience from a geographically restricted region of Italy.  Italy is a rather regionally diverse country, and it would be interesting to know if there are differences in the incidence of animal hoarding across regions or between urban and rural areas.  In this regard, is the proposed instrument useful across regions of Italy, or for that matter in other regions of the world?

Line 215: "In" Italy...

Author Response

General Comment:
This is a highly interesting and well-written account of an approach to standardize and quantify the evaluation of individuals who hoard animals to their detriment. I have a few general comments which the authors may wish to integrate into their publication or ignore, at their discretion.

Response:
We warmly thank the Reviewer for the generous evaluation and for providing insightful suggestions that helped strengthen the scientific and conceptual consistency of the manuscript.

Comment 1:
Is animal hoarding specific or do these hoarders tend to hoard other objects as well? Does this depend on the individual's motivation (e.g., belief the animals are rescued)?

Response 1:
To address it, we have slightly revised Section 3 (Psychopathological Framework of Animal Hoarding) by adding a clarifying sentence specifying that, although AH is recognized as a specific manifestation of Hoarding Disorder (HD), it can coexist with object hoarding but differs in the nature of its emotional and motivational dynamics.
The revised paragraph explicitly highlights this distinction.

Comment 2:
How does this problem differ from society's general failure to treat mental health issues?

Response 2:
A short discussion has been added in Section 6 (Discussion) to address this point. The revised text highlights that, while animal hoarding shares underlying causes with the broader systemic failures of mental health care, it fundamentally differs in its social and public health impact, as it simultaneously affects animals, neighbors, and communities.
Therefore, unlike other untreated psychiatric conditions, AH requires coordinated, cross-sectoral interventions rather than clinical care alone.

Comment 3:
The authors present their experience from a geographically restricted region of Italy. Italy is a rather regionally diverse country, and it would be interesting to know if there are differences in the incidence of animal hoarding across regions or between urban and rural areas. In this regard, is the proposed instrument useful across regions of Italy, or for that matter in other regions of the world?

Response 3:
We appreciate this thoughtful suggestion.To address it, a clarifying sentence has been added at the end of Section 6 (Discussion), acknowledging the geographical limitation of the study and specifying that the analyzed cases derive from a limited area (ASL Roma 1 and ASL Roma 4).
The added statement notes that the observed clinical and behavioral patterns are consistent with findings from the international literature (Italy, Brazil, Portugal, England) and emphasizes that, although developed within a specific regional context, the proposed protocol is conceptually adaptable to different socio-cultural settings.
It also highlights the need for further research on possible regional and urban–rural differences.