Hoarding Disorder 249
particularly when there is poor insight, the individual may not report distress, and the im-
pairment may be apparent only to those arou nd the individual. However, any attempts to
discard or clear the possessions by third pa rties result in high levels of distress. 
Associated Features Supporting Diagnosis
Other common features of hoarding disorder include indecisiveness, perfectionism,
avoidance, procrastination, di fficulty planning and organizing tasks, and distractibility.
Some individuals with hoarding disorder live in unsanitary conditions that may be a log-
ical consequence of severely cluttered spaces and/or that are related to planning and or-
ganizing difficulties. Animal hoarding  can be defined as the accumulation of a large number
of animals and a failure to provide minimal st andards of nutrition, sanitation, and veter-
inary care and to act on the de teriorating condition of the an imals (including disease, star-
vation, or death) and the en vironment (e.g., severe overcrowding, extremely unsanitary
conditions). Animal hoarding may be a spec ial manifestation of ho arding disorder. Most
individuals who hoard animals also hoard inan imate objects. The mo st prominent differ-
ences between animal and object hoarding are the extent of unsanitary conditions and the
poorer insight in animal hoarding. 
Prevalence
Nationally representative prevalence studies of hoarding disorder are not available. Com-
munity surveys estimate the point prevalence of clinically significant hoarding in the
United States and Europe to be approximately 2%–6%. Hoarding disorder affects both
males and females, but some epidemiological studies have reported a significantly greater
prevalence among males. This contrasts with clinical samples, which are predominantly
female. Hoarding symptoms appear to be almost three times more prevalent in older