250 Obsessive-Compulsive and Related Disorders
Culture-Related Diagnostic Issues
While most of the research has been done in  Western, industrialized countries and urban
communities, the available data from non-Western and developing countries suggest that
hoarding is a universal phenomenon wi th consistent clinical features. 
Gender-Related Diagnostic Issues
The key features of hoarding disorder (i.e., difficulties discarding, excessive amount of
clutter) are generally comparable in males an d females, but females tend to display more
excessive acquisition, particularly excessive buying, than do males. 
Functional Consequences  of Hoarding Disorder
Clutter impairs basic activities, such as moving through the house, cooking, cleaning, per-
sonal hygiene, and even sleepin g. Appliances may be broken, and utilities such as water
and electricity may be disconnected, as access for repair work may be difficult. Quality of
life is often considerably impaired. In severe cases, hoarding can put in dividuals at risk for
fire, falling (especially elderly individuals), po or sanitation, and other health risks. Hoard-
ing disorder is associated with occupational impairment, poor physical health, and high
social service utilization. Family relationsh ips are frequently under great strain. Conflict
with neighbors and local author ities is common, and a substa ntial proportion of individ-
uals with severe hoarding disorder have been  involved in legal eviction proceedings, and
some have a history of eviction. 
Differential Diagnosis
Other medical conditions. Hoarding disorder is not di agnosed if the symptoms are
judged to be a direct conseque nce of another medical condition (Criterion E), such as trau-
matic brain injury, surgical resection for trea tment of a tumor or seizure control, cerebro-