In DSM-5, Hoarding Disorder is classified as a separate entity from OCD. Which feature most strongly supports this distinction?

• A Hoarding Disorder lacks intrusive obsessional thoughts driving compulsive collecting; the behaviour is often ego-syntonic and associated with positive emotions about possessions ✓
• B Hoarders experience their accumulation behaviour as ego-dystonic, like OCD
• C Hoarding Disorder responds better to SSRIs than to CBT
• D Hoarding Disorder has a higher comorbidity with schizophrenia than with OCD

Explanation

Hoarding Disorder in DSM-5 is characterised by persistent difficulty discarding possessions due to perceived need to save them and distress at discarding. Unlike OCD (where compulsions are ego-dystonic responses to obsessions), hoarding behaviour is often ego-syntonic — patients may not perceive the accumulation as problematic and may experience positive emotions about their possessions. There are no true obsessions driving the hoarding as a compulsive response. Additionally, hoarding responds poorly to SSRIs compared with standard OCD and shows better response to specialised CBT. Its neural correlates (medial prefrontal, cingulate) differ from those of OCD.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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