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For the publication of DSM‐5, obsessive‐compulsive disorder (OCD) was the subject of significant revisions to its classification and diagnostic criteria. One of these significant changes was the placement of OCD in a new category, “Obsessive‐Compulsive and Related Disorders (OCRDs),” which also includes body dysmorphic disorder (BDD), trichotillomania (hair‐pulling disorder), excoriation (skin‐picking) disorder, hoarding disorder, substance/medication‐induced OCRD, OCRD due to another medical condition, and other specified OCRDs. Changes in the diagnostic criteria and grouping of these disorders may have significant clinical implications, and will be reviewed in this article.

Background Hoarding disorder (HD) is currently being considered for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), yet remains poorly understood. Consensus is building that hoarding may constitute a separate disorder, although comorbidity remains high and complicates the diagnostic picture. The purpose of this investigation was to explore patterns of comorbidity among people who engage in hoarding behavior in order to better understand its clinical presentation and phenomenology. Methods Data were collected from a large internet sample (N = 363) of people who self‐identified as having hoarding problems, met criteria for clinically significant hoarding, and completed all measures for this study. Participants self‐reported their symptoms of disorders commonly co‐occurring with hoarding (obsessive‐compulsive disorder [OCD], depression, and attention deficit hyperactivity disorder [ADHD]), along with other clinical problems. Results Latent class analysis results indicated that the participants were grouped into three classes: “non‐comorbid” hoarding (42%), hoarding with depression (42%), and hoarding with depression and inattention (16%). Conclusions Depression symptoms were the most commonly co‐occurring symptom in this sample. Contrary to previous theory relating to hoarding etiology, OCD symptoms were not significantly co‐occurring and a large percentage of the study participants were free from comorbid symptoms of OCD, depression, and ADHD. This suggests that HD is not primarily the consequence of other psychiatric conditions. Implications for DSM‐5, clinical treatment, and future research directions are discussed.

Hoarding is often described as a medical disorder, defined by a persistent difficulty in discarding possessions and associated high levels of emotional distress when forced to part with these. This article will discuss how having a different view of hoarding, seeing hoarding as a daily occupation which provides value, purpose, and meaning and with a relationship to self-identity and life purpose, could offer alternate interventions to support an individual who hoards. The article will consider the components of hoarding activity and how these relate to health and wellbeing and doing, being, belonging, and becoming as understood by occupational therapists. The article will consider what occupational therapy, a profession which considers a person’s daily occupations, the things that occupy their time and which give meaning to their existence, could offer as an alternative to current hoarding interventions. Proposals for occupational therapy interventions will be suggested which would support occupational choice, support engagement in activities which have more positive outcomes on a person’s health, and seek to address barriers which limit engagement and occupational performance in activities within the person’s home environment.

A new diagnostic category, hoarding disorder (HD), has been proposed for inclusion in DSM-5. This study field-tested the validity, reliability and perceived acceptability of the proposed diagnostic criteria for HD. Method Fifty unselected individuals with prominent hoarding behavior and 20 unselected, self-defined 'collectors' participated in thorough psychiatric assessments, involving home visits whenever possible. A semi-structured interview based on the proposed diagnostic criteria for HD was administered and scored by two independent raters. 'True' diagnoses were made by consensus according to the best-estimate diagnosis procedure. The percentage of true positive HD cases (sensitivity) and true negative HD cases (specificity) was calculated, along with inter-rater reliability for the diagnosis and each criterion. Participants were asked about their perceptions of the acceptability, utility and stigma associated with the new diagnosis. Twenty-nine (58%) of the hoarding individuals and none of the collectors fulfilled diagnostic criteria for HD. The sensitivity, specificity and inter-rater reliability of the diagnosis, and of each individual criterion and the specifiers, were excellent. Most participants with HD (96%) felt that creating a new disorder would be very or somewhat acceptable, useful (96%) and not too stigmatizing (59%). The proposed HD criteria are valid, reliable and perceived as acceptable and useful by the sufferers. Crucially, they seem to be sufficiently conservative and unlikely to overpathologize normative behavior. Minor changes in the wording of the criteria are suggested.

The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience.

Background This review provides an overview of obsessive‐compulsive disorder (OCD) symptoms, including the four partially distinct subtypes of the disorder, current diagnostic criteria, and common comorbidities. Critically, it focuses on the etiology of OCD, including its underlying neuropathology, and examines cognitive dysfunction in OCD. Methods This review study was conducted by library method. Results We show how dysfunction in cortico‐striato‐thalamo‐cortical (CSTC) circuits may underpin symptoms; and shed light on the putative neurochemistry within these loops such as the role of serotonin, dopamine, and glutamate systems. We also show how OCD is characterized by cognitive dysfunction including problems in cognitive flexibility, visuospatial memory, response inhibition, and goal‐directed behavior, linked to aberrant activity within CSTC circuits. Conclusions In brief, research questions we shed light on include (1) what are the symptoms in OCD; (2) what is the etiology of the disorder and do existing models explain OCD; and (3) what are key cognitive deficits in OCD and do these improve with treatment? This review provides an overview of obsessive‐compulsive disorder (OCD) symptoms, etiology, and examines cognitive dysfunction in OCD.

Compulsivity and impulsivity are cross-cutting, dimensional symptom domains that span traditional diagnostic boundaries. We examine compulsivity and impulsivity from several perspectives and present implications for these symptom domains as they relate to classification. We describe compulsivity and impulsivity as general concepts, from the perspectives of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Research Planning Agenda, and from the DSM-5 workgroups, literature reviews, and field trials. Finally, we detail alternative modes of classification for compulsivity and impulsivity in line with the Research Domain Criteria (RDoC) and International Classification of Diseases (ICD-11).

Obsessive–compulsive disorder (OCD) is a heterogeneous mental illness characterized by a variety of clinical manifestations and underlying neurobiological mechanisms. Modern research highlights the importance of identifying subtypes of OCD—separate categories that are characterized by specific phenotypic manifestations. This review provides a systematic integration of multi-level biomarker data (genetic, neuroimaging, neuropsychological) specifically aligned with the most consistently replicated, symptom-based subtypes of OCD. Our findings demonstrate that distinct OCD subtypes are underpinned by divergent neurobiological pathways, involving dysregulation across glutamatergic, serotonergic, dopaminergic, and neurotrophic systems, as well as distinct patterns of brain region engagement. The most extensive body of evidence currently exists for the contamination/cleaning and symmetry/ordering OCD subtypes. In contrast, other subtypes require more rigorous investigation. The findings from this study can provide theoretical prerequisites for future experimental studies involving larger cohorts of OCD patients, who can then be classified based on their detected biomarkers and tested accordingly.

The hoard can grow so large that it causes structural damage, increases fire risk, and, in the event of an emergency, responders might not be able to access parts of the residence.According to the Royal College of Psychiatrists, hoarding disorder affects one or two people in 100.“People start to see any available space as a potential area for hoarding; a bath is no longer a bath, a chair is no longer a chair—they are storage units”, explains Stuart Whomsley, a National Health Service clinical psychologist and coauthor of the British Psychological Society guidelines on treating individuals with hoarding disorders.

Background To determine possible dimensions that underlie obsessive–compulsive personality disorder (OCPD) and to investigate their clinical correlates, familiality, and genetic linkage. Methods Participants were selected from 844 adults assessed with the Structured Instrument for the Diagnosis of DSM‐IV Personality Disorders (SIDP) in the OCD Collaborative Genetics Study (OCGS) that targeted families with obsessive–compulsive disorder (OCD) affected sibling pairs. We conducted an exploratory factor analysis, which included the eight SIDP‐derived DSM‐IV OCPD traits and the indecision trait from the DSM‐III, assessed clinical correlates, and estimated sib–sib correlations to evaluate familiality of the factors. Using MERLIN and MINX, we performed genome‐wide quantitative trait locus (QTL) linkage analysis to test for allele sharing among individuals. Results Two factors were identified: Factor 1: order/control (perfectionism, excessive devotion to work, overconscientiousness, reluctance to delegate, and rigidity); and Factor 2: hoarding/indecision (inability to discard and indecisiveness). Factor 1 score was associated with poor insight, whereas Factor 2 score was associated with task incompletion. A significant sib–sib correlation was found for Factor 2 (rICC = .354, P < .0001) but not Factor 1 (rICC = .129, P = .084). The linkage findings were different for the two factors. When Factor 2 was analyzed as a quantitative trait, a strong signal was detected on chromosome 10 at marker d10s1221: KAC LOD = 2.83, P = .0002; and marker d10s1225: KAC LOD = 1.35, P = .006. Conclusions The results indicate two factors of OCPD, order/control and hoarding/indecision. The hoarding/indecision factor is familial and shows modest linkage to a region on chromosome 10.