The main feature of hoarding disorder is a person’s irrational, persistent difficulty in discarding or parting with possessions — regardless of their actual value. This is a long-standing difficulty, not just something related to a one-time circumstance (such as having difficulty discarding property you inherited from a loved one). Discarding means that the person can’t seem to give away, throw away, recycle, or sell things they no longer need (or sometimes, even want).
There are many reasons people give for not wanting to discard or part with things in hoarding disorder. Some feel they are just being frugal and don’t want to be wasteful. Others have a sentimental attachment to their things, regardless of whether there is any actual history or sentiment that ordinarily one might have (such as a collection of old newspapers or magazines). Still others fear there is “important information” in the things that could be discarded, and they just need to “go through” them all to ensure that information is removed.
The inherent value of an object is not important in the definition of this disorder; people with hoarding disorder will keep many invaluable things alongside of valuable objects. People with this disorder make a conscious effort to save things; it is not the result of simply passive accumulation of stuff (due to, for instance, depression and the lack of energy to deal with organizing and getting rid of items that are no longer needed).
When faced with the prospect of discarding or parting with their things, a person with hoarding disorder will experience distress.
Last, a person with this disorder will usually collect so many things over a long period of time, that the actual use of any given item or even the person’s normal living space is next to impossible. The clutter collected over time impedes the person from living in their apartment or home in a normal manner. For instance, their bed may be so full of collected clothes or newspapers, they sleep on the floor; kitchen counters are so full of things, there is no place to prepare and cook food.
It is estimated that hoarding disorder affects somewhere between 2 and 6 percent of the population.
Specific Symptoms of Hoarding Disorder
1. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
2. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.
3. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, or the authorities).
4. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment safe for oneself or others).
5. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).
6. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, etc.).
Specify if: With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space. (Approximately 80 – 90 percent of individuals with hoarding disorder display this trait.)
With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.
With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.
With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.
This disorder is new to the DSM-5. Code: 300.3 (F42)