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Fig. 1

DSM-5 criteria for HD. Individuals must meet all criteria to receive an HD diagnosis. Associated specifiers include (1) with excessive acquisition, (2) with good or fair insight, (3) with poor insight, or (4) with absent insight/delusional beliefs.

Fig. 2

Rule-out disorders and conditions relevant for differential diagnosis of HD. As pathological hoarding can emerge as a secondary feature of these rule-outs, HD would not be an appropriate diagnosis for these cases.

Fig. 3

Key etiological features of HD. These biological (green), psychological (orange), and environmental (pink) factors give rise to hoarding disorder, as well as contribute to the course and development of pathological hoarding. ACC, anterior cingulate cortex; FLPFC, frontolateral prefrontal cortex; HD, hoarding disorder; OCD, obsessive-compulsive disorder.

Fig. 4

Key components and features of cognitive behavioral therapy for HD.

Fig. 5

Evidence-based interventions that comprise and/or supplement cognitive behavioral therapy for HD.

Hoarding disorder (HD) was split from obsessive-compulsive disorder and categorized separately in the DSM-5, and since then research on its features has rapidly increased. To date, clinical and research studies have demonstrated that pathological hoarding can be characterized by unique diagnostic criteria, biopsychosocial features, and treatment responsivity. Evidence-based treatments for HD target various aspects of its symptomology, including cognitions, behaviors, and emotions (cognitive behavioral therapy) and associated brain chemistry (pharmacology). Given the medical and public health implications of pathological hoarding, further research on its etiology and treatment is warranted.

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