Hoarding disorder — structured clinical viva

You are the psychiatry registrar. Community fire officers and housing refer a 61-year-old man whose unit has floor-to-ceiling clutter, one blocked exit, and 12 poorly cared-for cats. He has fair-to-poor insight, scores high on SI-R, and refuses any discarding but will discuss 'helping the cats.' Family demand a forced cleanout this week. Discuss diagnosis (HD vs OCD vs squalor/animal hoarding), risk hierarchy, capacity principles, specialised CBT components, limits of medication, and how you respond to the forced-cleanout demand.