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Diagnostic features of Hoarding Disorder Cheat Sheet (DRAFT) by [deleted]

Diagnostic features of Hoarding Disorder

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Indivi­duals with hoarding disorder (HD) typically experience signif­icant impairment in several aspects of daily functi­oning, including psycho­social, occupa­tional, and family domains. Clinic­ally, HD must be distin­guished from other neurop­syc­hiatric disorders. It should be noted that while HD can occur indepe­ndently of other disorders, up to 75% of indivi­duals with HD have at least one other co-occ­urring psychi­atric condition. These may manifest with prominent hoarding behaviors described here in the differ­ential diagnosis for hoarding symptoms

1. Hoarding Disorder

Malada­ptive beliefs that posses­sions being accumu­lated are necessary; often, emotional attachment to objects or need to keep objects to “aid memory”; positive emotions for collec­tin­g/a­cqu­iring reinforce the behavior; distress is associated with having to discard items, not urge to control thoughts; insight is variable, from good to very poor; symptom onset is in adoles­cence; impairment typically begins in later adulthood

2. Obsessive Compulsive Disorder

Hoarding behaviors often associated with OCD themes such as contam­ination or fear of harm; distress arises from need to perform hoarding compul­sions or associated hoarding obsessions rather than from difficulty discar­ding; symptoms are typically egodys­tonic; insight typically good (although can vary); symptom onset and impairment typically coincide

3. Schizo­phr­eni­a/P­syc­hosis

Item accumu­lation is the result of delusions or other negative symptoms; items collected likely serve a specific purpose in these delusions, even if it is not the intended use of the object; insight typically poor.

4. Mood Disorders

Clutter is the result of low energy and lack of motivation to clean and/or organize rather than a result of difficulty discar­ding; excessive acquiring not likely present

5. Neuode­vel­opm­ental Disorders

Difficulty discarding is typically due to extreme attachment to specific objects or types of objects rather than genera­lized difficulty with discarding

6. Neuroc­ogn­itive Disorders & other Med conditions

Cognitive inability to properly organize object­s/d­iscard; may also see collec­tio­nismof specific objects (eg, cigarette butts, bottles, etc); onset is later in life, although can precede neuroc­ogn­itive dysfun­ction

Cognit­ive­-Be­hav­ioral Therapy (CBT)

Cognit­ive­-be­hav­ioral therapy (CBT) is considered the first-line treatment for HD and focuses on:
• Confro­nting malada­ptive belief patterns and behaviors related to hoarding
• Managing emotional distress related to discarding
• Exposures aimed at actively discarding objects and avoiding acquis­ition of new objects
• In some cases, addressing problems related to inform­ation processing


Pharma­cot­herapy for HD has been even less well studied than the therapies. The majority of the available data are based on studies that invest­igated the treatment response of hoarding symptoms in OCD. Interp­ret­ation of these studies has also been limited by the lack of random­ized, double­-blind, controlled trials.