Hoarding Disorder 247
(apotemnophilia) (which is not a DSM-5 disord er) involves a desire to have a limb ampu-
tated to correct an experience of mismatch be tween a person’s sense of body identity and
his or her actual anatomy. However, the conc ern does not focus on the limb’s appearance,
as it would in body dysmorphic disorder. Koro,  a culturally related disorder that usually
occurs in epidemics in Southeastern Asia, consists  of a fear that the penis (labia, nipples, or
breasts in females) is shrink ing or retracting and will disa ppear into the abdomen, often
accompanied by a belief that death will result . Koro differs from body dysmorphic disor-
der in several ways, including a focus on death rather than preoccupation with perceived
ugliness. Dysmorphic concern  (which is not a DSM-5 disorder) is a much broader construct
than, and is not equivalent to, body dysmorphi c disorder. It involves symptoms reflecting
an overconcern with slight or imagined flaws in appearance.
Comorbidity 
Major depressive disorder is the most commo n comorbid disorder, with onset usually af-
ter that of body dysmorphic disorder. Comorb id social anxiety disorder (social phobia),
OCD, and substance-related disorders are also common.
Hoarding Disorder
Diagnostic Criteria 300.3 (F42)
A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress associated
with discarding them.
C. The difficulty discarding possessions results in the accumulation of possessions that
congest and clutter active living areas and substantially compromises their intended