ten found in piles mixed with other less valuable items. 
Individuals with hoarding disorder purpos efully save possessions and experience dis-
tress when facing the prospect of discarding them (Criterion B). This criterion emphasizes
that the saving of possessions is intentional,  which discriminates hoarding disorder from
other forms of psychopathology that are ch aracterized by the pa ssive accumulation of
items or the absence of distress  when possessions are removed. 
Individuals accumulate large numbers of items that fill up and clutter active living ar-
eas to the extent that their intended use is no longer possible (Criterion C). For example,
the individual may not be able to cook in the kitchen, sleep in his or her bed, or sit in a
chair. If the space can be used, it  is only with great difficulty. Clutter  is defined as a large
group of usually unrelated or marginally rela ted objects piled together in a disorganized
fashion in spaces designed for ot her purposes (e.g., tabletops,  floor, hallway). Criterion C
emphasizes the “active” living areas of the ho me, rather than more peripheral areas, such
as garages, attics, or basements, that are so metimes cluttered in homes of individuals with-
out hoarding disorder. However, individuals with hoarding disorder often have posses-
sions that spill beyond the active living areas and can occupy and impair the use of other
spaces, such as vehicles, yards, the workplace,  and friends’ and relatives’ houses. In some
cases, living areas may be uncluttered because of the intervention of third parties (e.g.,
family members, cleaners, loca l authorities). Individuals who have been forced to clear
their homes still have a symptom picture that meets criteria fo r hoarding disorder because