248 Obsessive-Compulsive and Related Disorders
Specifiers
With excessive acquisition. Approximately 80%–90% of individuals with hoarding
disorder display excessive acquisition. The most frequent form of acqu isition is excessive
buying, followed by acquisition of free item s (e.g., leaflets, items discarded by others).
Stealing is less common. Some individuals may deny excessive acquisition when first as-
sessed, yet it may appear later during the co urse of treatment. Individuals with hoarding
disorder typically experience distress if they are unable to or are prevented from acquiring
items.
Diagnostic Features
The essential feature of hoarding  disorder is persistent difficulties discarding or parting
with possessions, regardless of their actual value (Criterion A). The term persistent  indi-
cates a long-standing difficulty rather than more transient life circumstances that may lead
to excessive clutter, such as inheriting prop erty. The difficulty in discarding possessions
noted in Criterion A refers to  any form of discarding, including throwing away, selling,
giving away, or recycling. The main reasons given for these difficult ies are the perceived
utility or aesthetic value of the items or stro ng sentimental attachment to the possessions.
Some individuals feel responsi ble for the fate of their possessions and often go to great
lengths to avoid being wasteful. Fears of lo sing important information are also common.
The most commonly saved item s are newspapers, magazines, old clothing, bags, books,
mail, and paperwork, but virtually any item can be saved. The nature of items is not lim-
ited to possessions that most other people would define as useles s or of limited value.
Many individuals collect and save large numbers of valuable things as well, which are of-
ten found in piles mixed with other less valuable items.