Hoarding disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis
- David Mataix-Cols, PhD
David Mataix-Cols, PhD
- Professor of Child and Adolescent Psychiatric Science
- Karolinska Institutet
- Lorena Fernández de la Cruz, PhD
Lorena Fernández de la Cruz, PhD
- Assistant Professor
- Karolinska Institutet
Individuals with hoarding disorder experience persistent difficulty discarding or parting with possessions, regardless of their value, due to a perceived need to save these items and distress associated with discarding them. Possessions thus congest and clutter their living areas, compromising use of these spaces, interfere with the individual’s daily life and cause clinically significant distress.
Hoarding disorder was newly included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , replacing its conceptualization in DSM-IV as a form of obsessive-compulsive disorder (OCD) . The point prevalence of hoarding disorder has been estimated to be approximately 1.5 percent among adult men and women .
The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of hoarding disorder are described here. The treatment of hoarding disorder in adults is described separately. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis, and treatment of OCD in adults are also described separately. (See "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Pharmacotherapy for obsessive-compulsive disorder in adults" and "Psychotherapy for obsessive-compulsive disorder in adults".)
In DSM-IV, “extreme” hoarding was described as a manifestation of obsessive-compulsive disorder (OCD), leading to the widespread conceptualization of hoarding as a symptom dimension of OCD. Research, however, has found that most individuals who show hoarding behavior do not endorse other symptoms of OCD and has further delineated the differences between the two constructs. This culminated in the inclusion of hoarding disorder in DSM-5, separate from OCD . As a recently specified mental disorder, there is less research on its presentation, course, causes, or treatment compared with many other disorders.
Community surveys, primarily in Europe and the United States, have estimated the point prevalence of clinically significant hoarding to be approximately 2 to 6 percent among adults  and 2 percent among adolescents . The only study that used strict DSM-5 criteria, however, found a lower prevalence, 1.5 percent, in both men and women in England . Individuals with hoarding disorder tend to be older, more frequently unemployed, and more often unmarried, separated, or divorced compared with individuals from the general community .
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