The Epidemiology of the Proposed DSM-5 Hoarding Disorder: Exploration of the Acquisition Specifier, Associated Features, and Distress [CME]

Objective: Compulsive hoarding, characterized by the acquisition of and failure to discard a large number of possessions, is increasingly recognized as a significant public health burden. Many facets of the phenomenology, including an understanding of the population prevalence and associated features, are not yet fully understood. There is growing evidence that hoarding may warrant its own diagnosis in DSM-5, and it is therefore imperative to investigate the proposed cardinal symptoms along with correlated features that may be diagnostically relevant.

Method: The present investigation examined the point prevalence of hoarding disorder in a nationally representative sample from the German population (N = 2,512). The hoarding definition considered in this study was derived from the Hoarding Rating Scale (HRS) and informed by 3 of the proposed DSM-5 criteria. Several hypothesized core components of hoarding disorder were also assessed using questions from the HRS and the UCLA Hoarding Severity Scale, including types of acquisition, perfectionism, indecision, procrastination, distress, and impairment. Data were collected from May 16, 2009, to June 19, 2009.

Results: Analyses revealed a current population estimate of 5.8%. Hoarding prevalence did not differ between men and women. Hoarders were significantly more likely to buy items, acquire free things, and steal items they did not need, compared to nonhoarders (P < .001). Perfectionism, indecision, and procrastination were all uniquely and significantly associated with hoarding status (P < .001). Relationships between the proposed core features and distress/impairment are also detailed.

Conclusions: The current investigation identified the proposed hoarding disorder as a highly prevalent syndrome; however, it should be noted that we were not able to fully ascertain the DSM-5 criteria and that the current estimate may be higher than the actual population rate. Future research on the diagnostic criteria and associated features will be necessary to help clarify etiologic underpinnings, treatment efforts, and diagnostic nosology.

J Clin Psychiatry 2011;72(6):780-786

Submitted: July 2, 2010; accepted October 20, 2010 (doi:10.4088/JCP.10m06380).

Corresponding author: Kiara R. Timpano, PhD, Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146 (kiaratimpano@gmail.com).