Hoarding was once treated mainly as a symptom associated with obsessive-compulsive disorder. That changed in 2013, when Hoarding Disorder was formally recognised as a separate diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
What is the DSM?
The Diagnostic and Statistical Manual of Mental Disorders, usually abbreviated to DSM, is a classification system published by the American Psychiatric Association.
It provides agreed descriptions and diagnostic criteria that healthcare professionals and researchers can use when discussing mental-health conditions.
The fifth edition, known as DSM-5, was published in 2013.
How was hoarding viewed before DSM-5?
Before 2013, severe hoarding was commonly discussed in connection with obsessive-compulsive disorder, or OCD.
Older research frequently used terms such as compulsive hoarding and examined hoarding as a possible symptom or subtype of OCD.
As more research accumulated, however, researchers increasingly found that many people with significant hoarding difficulties did not fit the typical pattern of OCD.
Hoarding also appeared to have its own characteristic features, course and treatment challenges.
What changed in DSM-5?
DSM-5 formally recognised Hoarding Disorder as a separate condition.
This was significant because it reflected a growing body of research showing that persistent difficulty discarding and the resulting accumulation of possessions formed a recognisable pattern in their own right.
It was no longer necessary to treat hoarding simply as an aspect of OCD.
What are the central features of Hoarding Disorder?
The modern description focuses on persistent difficulty discarding or parting with possessions, regardless of their actual value.
The person experiences a perceived need to save the items and distress associated with discarding them.
As possessions accumulate, they can congest living areas and interfere with their normal use.
The broader pattern must also cause significant distress or impairment in important areas of life.
Why is difficulty discarding so important?
A cluttered home alone does not establish Hoarding Disorder.
There are many reasons somebody may temporarily or chronically live with clutter.
The distinctive issue in Hoarding Disorder is the persistent difficulty involved in letting possessions go.
A person may believe an item:
- will be useful in the future
- contains important information
- has sentimental significance
- would be wasteful to discard
- might be needed by somebody else
- cannot be replaced if discarded
The decision can therefore carry much more emotional weight than the object’s apparent value might suggest.
The role of clutter
Accumulation is another important part of the picture.
Possessions may gradually occupy areas that were originally intended for ordinary living.
For example:
- a dining table may no longer be usable
- a bed may become partly covered with belongings
- chairs and sofas may be used mainly for storage
- kitchen work surfaces may become inaccessible
- pathways through rooms may become increasingly narrow
That is different from simply owning many possessions in an organised and usable home.
What about excessive acquiring?
Many people with hoarding difficulties also experience excessive acquiring, although this is not identical to difficulty discarding.
Items may enter the home through shopping, collecting free objects, accepting other people’s unwanted possessions or feeling unable to leave potentially useful things behind.
When possessions continually enter the home while very little leaves, clutter can increase rapidly.
Why was separating hoarding from OCD important?
The change helped researchers and clinicians focus more directly on the particular difficulties associated with hoarding.
OCD generally centres on intrusive obsessions and repetitive compulsions.
Hoarding Disorder centres more specifically on difficulty discarding, accumulation, attachment to possessions and interference with living space.
The two conditions can occur together, but one does not automatically imply the other.
Read more in our Hoarding and OCD: What Is the Difference? article.
What did the change mean for research?
Recognising Hoarding Disorder separately made it easier for researchers to study people whose primary problem was hoarding rather than combining them automatically with broader OCD populations.
Research has since continued into areas including:
- decision-making
- attachment to possessions
- organisation and categorisation
- difficulty tolerating uncertainty
- acquiring behaviour
- avoidance
- family impact
- treatment outcomes
Our Hoarding Disorder Research page looks at this history in more detail.
Does recognising these signs mean someone has Hoarding Disorder?
No.
People can experience clutter, difficulty organising or attachment to possessions without meeting diagnostic criteria for Hoarding Disorder.
A formal diagnosis considers the overall pattern, severity, duration, impact and whether another condition could better explain what is happening.
An online questionnaire or article cannot make that determination.
Is clutter becoming a problem in your life?
Our self-reflection assessment explores difficulty discarding, acquiring possessions, clutter and the effect these patterns may be having on everyday life.
Take the Hoarding & Clutter Assessment
For education and personal reflection only. It does not diagnose Hoarding Disorder, OCD or any other condition.
Why old articles sometimes use different terminology
If you read older material about hoarding, you will often encounter phrases such as compulsive hoarding, OCD hoarding or references to hoarding as an OCD symptom.
That does not necessarily mean the old research has no value.
It reflects how the subject was classified at that time.
The move to a separate Hoarding Disorder diagnosis was part of the gradual development of the research rather than an overnight discovery.
Further reading
- What Is Hoarding Disorder?
- Early Research Into Compulsive Hoarding
- Hoarding and OCD
- Hoarding Disorder Research
- Hoarding Disorder: Signs, Symptoms and Assessment
Inner Thought Group (ITG) provides educational information and self-reflection tools. Our content and assessments are not medical advice and do not provide a clinical diagnosis.