Hoarding disorder

Hoarding disorder requires: (1) persistent difficulty discarding possessions regardless of actual value, (2) perceived need to save items and distress associated with discarding, (3) accumulation of possessions that clutter living areas and compromise their intended use, (4) clinically significant distress or functional impairment. This patient meets all criteria. The motivation ("I might need it") reflects perceived utility, not obsessional anxiety. The fire code violation demonstrates functional impairment.

OCD

In OCD, hoarding behavior is driven by typical obsessions (contamination fear, symmetry, fear of harm if discarded). In hoarding disorder, the difficulty discarding is driven by perceived utility or emotional attachment to the items, not by intrusive obsessional content. The DSM-5 separates hoarding disorder from OCD as a distinct diagnosis.

Major depressive disorder with hoarding behavior

Depression can cause clutter through neglect and amotivation, but this patient's hoarding is active (she intentionally keeps items, experiences distress at discarding) and her mood is euthymic.

Obsessive-compulsive personality disorder

OCPD involves perfectionism, rigidity, and orderliness — features that are the opposite of the functional impairment from disorganized clutter seen in hoarding disorder.