The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes hoarding disorder (HD) in the group of obsessive-compulsive and related disorders (OCRD), which also includes trichotillomania, excoriation disorder, and body dysmorphic disorder. A person with a hoarding problem develops an unjustified attachment to their material belongings and finds it difficult to let go of them. The serious societal ramifications of this condition, which is all too frequently dismissed as a strictly medical problem, are still not well understood. At present, the prevalence of Hoarding Disorder (HD) is ambiguous as a result of methodological issues in the evidence base. Estimates have varied significantly, spanning from 1.5% to 6% of the general population.

Studies state that due to reality TV shows on hoarding, the public is more aware of it. Popular culture portrays hoarding as a simple problem with an easy solution: “Just clean it up.” Unlike these sensationalist depictions, hoarding disorder is a real mental condition that has been studied empirically in psychiatry, psychology, and related sciences for over 20 years. In 1947, Erich Fromm defined a “hoarding orientation” in which people felt secure by collecting and keeping goods. In 1962, Scandinavian psychiatrist Jens Jansen used the phrase “collector’s mania” to describe elderly persons who overfilled their dwellings. Hoarding was recognized as an OCD disorder by the American Psychiatric Association in 2013. Obsessive-compulsive disorder, or hoarding disorder, requires six diagnostic criteria. Two specifiers rate hoarding acquisition and insight. In 1996, Frost and Hartl defined hoarding as acquiring a large number of useless or low-value items and failing to discard them, living spaces that are too cluttered to allow normal activities, and significant distress or impairment in functioning. Starting with this description, hoarding disorder diagnostic criteria were created. Current definitions of hoarding include an excessive gathering of goods in the home and difficulty getting rid of things most people would not keep.

If you wish to know how Hoarding Disorder might manifest, check out this link to our storybook.

According to the DSM 5 TR, the following are the diagnostic criteria and features of hoarding disorder:

Diagnostic Criteria

A. Having persistent trouble getting rid of or leaving with things, no matter how valuable they are.

B. This is hard because people think they need to keep the things and it makes them feel bad to throw them away.

C. Because people have a hard time getting rid of things, they end up collecting things that make busy living places crowded and less useful for what they were meant for. Living areas are only clear because someone else did something about it, like family members, workers, or the police.

D. The hoarding causes clinically significant grief or impairment in social, professional, or other important areas of functioning, such as keeping myself and others safe.

E. The collecting isn’t caused by another health problem, like a brain injury, heart disease, or Prader-Willi syndrome.

F. A person is hoarding if their symptoms are not better explained by those of another mental disorder. For example, obsessions in OCD, low energy in MDD, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, and limited interest in autism spectrum disorder are all examples of mental disorders.

Specify if:

With too much acquisition: If having a hard time getting rid of things is followed by getting too many things that you don’t need or have room for.

Specify if:

With good or fair understanding, the person knows that their hoarding-related thoughts and actions (like having a hard time getting rid of things, having too much stuff, or buying too much) are not healthy.

With little insight: The person is mostly sure that hoarding-related beliefs and behaviors (like having trouble getting rid of things, having too much stuff, or buying too much) are not a problem, even though there is proof of the opposite.

Without understanding or delusional beliefs: The person is sure that hoarding-related beliefs and behaviors (like having trouble getting rid of things, having too much stuff, or buying too much) are not a problem, even though there is evidence of the opposite.

Diagnostic Features

• No matter how useful, collecting disorder is characterized by difficulty getting rid of or giving up goods (Criterion A).
• The phrase “persistent” alludes to a long-term issue, not a short-term occurrence like obtaining property.
• Criterion A states things are hard to get rid of.
• People say this is challenging since they love their possessions or think they are helpful or pretty.
• Some individuals are careful not to throw away their stuff because they feel accountable for their fate.
• Many worry about losing vital data.
• Newspapers, magazines, clothing, bags, books, mail, and paperwork are kept most, although nearly anything can be salvaged.
• Stuff includes more than just worthless or low-value stuff.
• People who collect and keep valuables sometimes stack them with less valuable items.
• Hoarding disorder patients actively preserve items and feel anxious, frustrated, regretful, unhappy, and guilty about abandoning them (Criterion B).
• The active preservation of goods distinguishes hoarding disorder from other psychopathologies that involve passive accumulation or little grief when possessions are removed.
• People collect many objects that clutter active living places and make their intended use impossible (Criterion C).
• The person may not be able to cook, sleep, or sit in a chair. Space can be exploited, but not easily.
• Clutter is a chaotic collection of mostly unconnected or somewhat related items on tabletops, floors, and hallways.
• Criterion C prioritizes the “active” living sections of the home over garages, attics, and basements, which are occasionally congested in non-hoarders’ homes.
• Hoarding disorder sufferers frequently have items that flow beyond active living areas and impede the usage of automobiles, yards, the workplace, and friends’ and relatives’ homes.
• Some living environments are only decluttered by third parties (family, cleaners, local authorities).
• People legally made to clean out their homes still have symptoms of hoarding disorder, even though their homes are not as cluttered because of outside help.
• Hoarding disorder is different from normal collecting behavior, which is planned and selected.
• However, the amount of things a person has may be similar to the amount that someone with a hoarding disorder accumulates.
• Normal collecting does not lead to the mess, stress, or problems that come with hoarding disorder.
• Symptoms (like having trouble getting rid of trash and clutter) must cause clinically significant anxiety or impairment in social, professional, or other important areas of functioning, such as keeping oneself and others safe (Criterion D).
• In some cases, especially when there is not enough understanding, the person may not say they are in pain, and only those close to them may notice the impairment.
• Third parties trying to get rid of or clear out the things, on the other hand, cause a lot of grief.