When stuff gets in the way of life: hoarding and the DSM-5

We've all got boxes of old letters, clothes and other keepsakes we've collected over our lifetime. Sometimes these boxes or shelves seem to take over spare rooms and garages. But while we might joke that we're 'a bit of a hoarder', there's a big difference between holding onto important mementos and compulsive hoarding. Hoarding is the persistent difficulty discarding or parting with possessions and their ultimate stockpiling---regardless of their value. Possessions may include objects or animals, with the resulting clutter rendering living spaces unusable, unsafe or unhygienic. Aside from problems discarding objects, people with hoarding difficulties report excessive acquisition, whether through compulsive buying or free procurement. With prevalence estimates of around 2% to 5% of the population, somewhere between 400,000 and 1 million Australians are likely to have hoarding problems that cause them or others significant distress and conflict. Hoarding problems most commonly begin before early adulthood, although they most commonly present to services when affected individuals are much older. Hoarding affects people from all social classes and educational backgrounds, though it commonly presents alongside depression, obsessive compulsive disorder (OCD), attention deficit disorder, other anxiety problems, compulsive buying, other impulse control problems, and other serious mental health problems. The degree of self-awareness in individuals with hoarding problems varies, and is generally poorer than that in those with OCD.