vascular disease, infections of the central ne rvous system (e.g., herpes simplex encephalitis),
or neurogenetic conditions such as Prader -Willi syndrome. Damage to the anterior ven-
tromedial prefrontal and cingulate cortices ha s been particularly associated with the ex-
cessive accumulation of objects. In these individuals, the hoarding behavior is not present
prior to the onset of the brain damage and a ppears shortly after the brain damage occurs.
Some of these individuals appear to have li ttle interest in the accumulated items and are
able to discard them easily or do not care if  others discard them, whereas others appear to
be very reluctant to discard anything. 
Neurodevelopmental disorders. Hoarding disorder is not diagnosed if the accumula-
tion of objects is judged to be a direct co nsequence of a neurodevel opmental disorder, such
as autism spectrum disorder or  intellectual disability (intellectual developmental disorder).
Schizophrenia spectrum and other psychotic disorders. Hoarding disorder is not di-
agnosed if the accumulation of objects is judged  to be a direct consequence of delusions or
negative symptoms in schizophrenia sp ectrum and other psychotic disorders.
Major depressive episode. Hoarding disorder is not diagnosed if the accumulation of
objects is judged to be a dire ct consequence of ps ychomotor retardation, fatigue, or loss of
energy during a major depressive episode. 
Obsessive-compulsive disorder. Hoarding disorder is not diagnosed if the symptoms
are judged to be a direct consequence of typical obsessions or compulsions, such as fears
of contamination, harm, or feelings of inco mpleteness in obsessive-compulsive disorder
(OCD). Feelings of incomplete ness (e.g., losing one’s identity , or having to document and
preserve all life experiences) are the most frequent OCD symptoms associated with this