Years before Hoarding Disorder (HD) became a distinct DSM-5 diagnosis, hoarding behaviors exploded into popular culture, captivating television audiences with depictions of clutter, unsanitary living conditions, and staunch resistance to change—even in the face of severe consequences.

Hoarding is a type of behavior traditionally that has been viewed as a subtype of obsessive-compulsive disorder (OCD). About 25% to 30% of patients with OCD — develop hoarding behaviors. Three core features of compulsive hoarding: accumulation of a large number of possessions that seem useless to others; living spaces so cluttered that they are difficult to use; and significant impairment resulting from hoarding behaviors. According to this model, people who are compulsive hoarders also are prone to indecisiveness, perfectionism, disorganization, procrastination, and avoidance.

Diagnostic criteria for hoarding disorder include the following; Patients have persistent difficulty discarding or parting with possessions, regardless of their actual value. The difficulty discarding is due to the perceived need to save the items and to the distress associated with discarding them.

Hoarding disorder was only given its own diagnostic criteria in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, in 2013. “That was a big turning point,” says Carolyn Rodriguez, MD, PhD, director of the hoarding disorder research program and an associate professor at Stanford University.