congest and clutter active living areas and substantially compromises their intended
use. If living areas are uncluttered, it is only because of the interventions of third parties
(e.g., family members, cleaners, authorities).
D. The hoarding causes clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning (including maintaining a safe environ-
ment for self and others).
E. The hoarding is not attributable to another medical condition (e.g., brain injury, cere-
brovascular disease, Prader-Willi syndrome).
F. The hoarding is not better explained by the symptoms of another mental disorder (e.g.,
obsessions in obsessive-compulsive disorder, decreased energy in major depressive
disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in
major neurocognitive disorder, restricted interests in autism spectrum disorder). 
Specify if:
With excessive acquisition:  If difficulty discarding possessions is accompanied by ex-
cessive acquisition of items that are not needed or for which there is no available space.
Specify if:
With good or fair insight: The individual recognizes that hoarding-related beliefs and
behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are
problematic.
With poor insight : The individual is mostly convinced that hoarding-related beliefs
and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisi-
tion) are not problematic despite evidence to the contrary.
With absent insight/delusional beliefs:  The individual is completely convinced that
hoarding-related beliefs and behaviors (pertaini ng to difficulty discarding items, clutter,
or excessive acquisition) are not problematic despite evidence to the contrary.