Diagnostic Considerations

Hoarding can occur as part of obsessive-compulsive disorder (OCD) where individuals have obsessions in relation to certain items and compulsions to collect these objects. Pathological hoarding should also be distinguished from the collecting of objects in a systematic and organized way that doesn’t impair function (e.g., porcelain dolls, teddy bears). In addition to a high co-occurrence of depressive and anxiety disorders, hoarding disorder is also associated with a high rate of co-occurring attention-deficit hyperactivity disorder (ADHD).^[11]

Excessive accumulation of objects can also occur as part of organic states such as dementia, cerebrovascular accidents, or alcohol-related brain disorders. In these circumstances, the hoarding is relatively new in onset and much more disorganized with more prominent squalor.^[16]

Differential Diagnoses

Workup

American Psychiatric Association. Obsessive-Compulsive and Related Disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013. 247-251.
Pertusa A, Frost RO, Fullana MA, Samuels J, Steketee G, Tolin D, et al. Refining the diagnostic boundaries of compulsive hoarding: a critical review. Clin Psychol Rev. 2010 Jun. 30 (4):371-86. [QxMD MEDLINE Link].
Saxena S, Brody AL, Maidment KM, Smith EC, Zohrabi N, Katz E, et al. Cerebral glucose metabolism in obsessive-compulsive hoarding. Am J Psychiatry. 2004 Jun. 161 (6):1038-48. [QxMD MEDLINE Link].
Mataix-Cols D, Wooderson S, Lawrence N, Brammer MJ, Speckens A, Phillips ML. Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Arch Gen Psychiatry. 2004 Jun. 61 (6):564-76. [QxMD MEDLINE Link].
An SK, Mataix-Cols D, Lawrence NS, Wooderson S, Giampietro V, Speckens A, et al. To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder. Mol Psychiatry. 2009 Mar. 14 (3):318-31. [QxMD MEDLINE Link].
Frost RO, Gross RC. The hoarding of possessions. Behav Res Ther. 1993 May. 31 (4):367-81. [QxMD MEDLINE Link].
Grisham JR, Norberg MM, Williams AD, Certoma SP, Kadib R. Categorization and cognitive deficits in compulsive hoarding. Behav Res Ther. 2010 Sep. 48 (9):866-72. [QxMD MEDLINE Link].
Tolin DF, Meunier SA, Frost RO, Steketee G. Course of compulsive hoarding and its relationship to life events. Depress Anxiety. 2010 Sep. 27 (9):829-38. [QxMD MEDLINE Link].
APA. Hoarding Disorder. American Psychiatric Association. Available at https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder. Accessed: August 25, 2021.
Postlethwaite A, Kellett S, Mataix-Cols D. Prevalence of Hoarding Disorder: A systematic review and meta-analysis. J Affect Disord. 2019 Sep 1. 256:309-316. [QxMD MEDLINE Link].
Hartl TL, Duffany SR, Allen GJ, Steketee G, Frost RO. Relationships among compulsive hoarding, trauma, and attention-deficit/hyperactivity disorder. Behav Res Ther. 2005 Feb. 43 (2):269-76. [QxMD MEDLINE Link].
Nordsletten AE, Mataix-Cols D. Hoarding versus collecting: where does pathology diverge from play?. Clin Psychol Rev. 2012 Apr. 32 (3):165-76. [QxMD MEDLINE Link].
Illinois General Assembly. Humane Care for Animals Act. ILGA.gov. Available at http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1717. 2001; Accessed: February 29, 2016.
Patronek GJ. Hoarding of animals: an under-recognized public health problem in a difficult-to-study population. Public Health Rep. 1999 Jan-Feb. 114 (1):81-7. [QxMD MEDLINE Link].
Health implications of animal hoarding. Health Soc Work. 2002 May. 27 (2):125-36. [QxMD MEDLINE Link].
Snowdon J. Accumulating too much stuff: what is hoarding and what is not?. Australas Psychiatry. 2015 Aug. 23 (4):354-7. [QxMD MEDLINE Link].
Frost RO, Hristova V, Steketee G, Tolin DF. Activities of Daily Living Scale in Hoarding Disorder. J Obsessive Compuls Relat Disord. 2013 Apr 1. 2 (2):85-90. [QxMD MEDLINE Link].
Frost RO, Steketee G, Grisham J. Measurement of compulsive hoarding: saving inventory-revised. Behav Res Ther. 2004 Oct. 42 (10):1163-82. [QxMD MEDLINE Link].
Williams M, Viscusi JA. Hoarding Disorder and a Systematic Review of Treatment with Cognitive Behavioral Therapy. Cogn Behav Ther. 2016 Jan 21. 1-18. [QxMD MEDLINE Link].
Brakoulias V, Milicevic D. Assessment and treatment of hoarding disorder. Australas Psychiatry. 2015 Aug. 23 (4):358-60. [QxMD MEDLINE Link].
Tolin DF, Frost RO, Steketee G. An open trial of cognitive-behavioral therapy for compulsive hoarding. Behav Res Ther. 2007 Jul. 45 (7):1461-70. [QxMD MEDLINE Link].
Muroff J, Steketee G, Himle J, Frost R. Delivery of internet treatment for compulsive hoarding (D.I.T.C.H.). Behav Res Ther. 2010 Jan. 48 (1):79-85. [QxMD MEDLINE Link].
Brakoulias V, Eslick GD, Starcevic V. A meta-analysis of the response of pathological hoarding to pharmacotherapy. Psychiatry Res. 2015 Sep 30. 229 (1-2):272-6. [QxMD MEDLINE Link].
Saxena S, Sumner J. Venlafaxine extended-release treatment of hoarding disorder. Int Clin Psychopharmacol. 2014 Sep. 29 (5):266-73. [QxMD MEDLINE Link]. [Full Text].
Saxena S, Brody AL, Maidment KM, Baxter LR Jr. Paroxetine treatment of compulsive hoarding. J Psychiatr Res. 2007 Sep. 41 (6):481-7. [QxMD MEDLINE Link]. [Full Text].