Psych · General adult psychiatry — OCRD
Hoarding and related disorders
Also known as Hoarding disorder · Compulsive hoarding · Pathological hoarding · Animal hoarding · Diogenes syndrome · Severe domestic squalor · OCRD · SI-R · Clutter Image Rating
Exam-exhaustive fellowship reference on hoarding disorder — DSM-5-TR/ICD-11 OCRD criteria; vs OCD, ADHD, dementia and squalor; Frost–Hartl model; SI-R/CIR/ADL assessment; specialised CBT (waitlist RCT, meta-analysis); limited pharmacotherapy signals (paroxetine, venlafaxine XR); capacity, multiagency risk and forced-cleanout pitfalls. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Blocked exits, high fire load, or inactive smoke alarms — treat as environmental emergency; fire service liaison
- Falls risk in older adults with floor-to-ceiling clutter, long-lie risk, or inaccessible bathroom/kitchen
- Child or elder protection concerns when dependents live in unsafe, unsanitary, or inaccessible housing
- Severe domestic squalor with medical complications (infection, infestation, malnutrition, hypothermia)
- Animal hoarding with inadequate care — welfare reporting duties and public health risk
- Forced cleanout without engagement or therapy plan — high reaccumulation and rupture of trust; coordinate carefully
- Late new-onset accumulation with cognitive change — exclude dementia/FTD and organic causes before labelling primary HD
Meet the patient
A 68-year-old retired teacher is referred by the fire service. Her smoke alarm has been silent for two years because the battery sits behind a wall of newspapers. She sleeps in an armchair; the bed disappeared some time in 2019. There is a goat track from the front door to the kettle, and no path at all to the bath.[15][16]
She is articulate, warm and entirely lucid. When the housing officer offered a skip and two volunteers, she wept and cancelled the appointment. Asked why she keeps the newspapers, she says: "Because there might be something in them I need."[1][9]
Two questions are now live, and an examiner will ask both. Is this a psychiatric disorder or a housing problem? And what do you do first — the therapy or the exits? Everything below answers those two.[2][16]
References20ShowHide
- [1]Frost RO, Hartl TL A cognitive-behavioral model of compulsive hoarding Behav Res Ther, 1996.PMID 8871366
- [2]Mataix-Cols D, Frost RO, Pertusa A, et al. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety, 2010.PMID 20336805
- [3]Pertusa A, Fullana MA, Singh S, et al. Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both? Am J Psychiatry, 2008.PMID 18483134
- [4]Pertusa A, Frost RO, Fullana MA, et al. Refining the diagnostic boundaries of compulsive hoarding: a critical review Clin Psychol Rev, 2010.PMID 20189280
- [5]Postlethwaite A, Kellett S, Mataix-Cols D Prevalence of Hoarding Disorder: A systematic review and meta-analysis J Affect Disord, 2019.PMID 31200169
- [6]Nordsletten AE, Reichenberg A, Hatch SL, et al. Epidemiology of hoarding disorder Br J Psychiatry, 2013.PMID 24158881
- [7]Iervolino AC, Perroud N, Fullana MA, et al. Prevalence and heritability of compulsive hoarding: a twin study Am J Psychiatry, 2009.PMID 19687130
- [8]Frost RO, Steketee G, Grisham J Measurement of compulsive hoarding: saving inventory-revised Behav Res Ther, 2004.PMID 15350856
- [9]Frost RO, Steketee G, Tolin DF Diagnosis and assessment of hoarding disorder Annu Rev Clin Psychol, 2012.PMID 22035242
- [10]Steketee G, Frost RO, Tolin DF, et al. Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder Depress Anxiety, 2010.PMID 20336804
- [11]Tolin DF, Frost RO, Steketee G, et al. Cognitive behavioral therapy for hoarding disorder: a meta-analysis Depress Anxiety, 2015.PMID 25639467
- [12]Saxena S, Brody AL, Maidment KM, et al. Paroxetine treatment of compulsive hoarding J Psychiatr Res, 2007.PMID 16790250
- [13]Saxena S, Sumner J Venlafaxine extended-release treatment of hoarding disorder Int Clin Psychopharmacol, 2014.PMID 24722633
- [14]Ayers CR, Wetherell JL, Golshan S, et al. Cognitive-behavioral therapy for geriatric compulsive hoarding Behav Res Ther, 2011.PMID 21784412
- [15]Tolin DF, Frost RO, Steketee G, et al. The economic and social burden of compulsive hoarding Psychiatry Res, 2008.PMID 18597855
- [16]Snowdon J, Shah A, Halliday G Severe domestic squalor: a review Int Psychogeriatr, 2007.PMID 16973099
- [17]Snowdon J, Halliday G A study of severe domestic squalor: 173 cases referred to an old age psychiatry service Int Psychogeriatr, 2011.PMID 20678298
- [18]Muroff J, Steketee G, Bratiotis C, et al. Group cognitive and behavioral therapy and bibliotherapy for hoarding: a pilot trial Depress Anxiety, 2012.PMID 22447579
- [19]Frost RO, Hristova V, Steketee G, et al. Activities of Daily Living Scale in Hoarding Disorder J Obsessive Compuls Relat Disord, 2013.PMID 23482436
- [20]Rasmussen JL, Steketee G, Frost RO, et al. Assessing squalor in hoarding: the Home Environment Index Community Ment Health J, 2014.PMID 24292497