Bret S. Stetka, MD; Christoph U. Correll, MD


May 21, 2013

In This Article

Hoarding, Skin-Picking, and Rethinking OCD

New to the manual is a chapter grouping obsessive-compulsive disorder (OCD) with related disorders, including body dysmorphic disorder, and conditions formerly found in the "impulse control disorder (ICD) not elsewhere classified" section, including trichotillomania (pulling out one's hair). Two new diagnoses are included in this chapter: excoriation (skin-picking) disorder, characterized by repetitive and compulsive picking of skin resulting in tissue damage; and hoarding disorder, in which sufferers have persistent difficulty discarding with possessions regardless of their value.

The Implications

Distinguishing between OCD and disorders that were formerly included in the ICD section can be difficult, owing to symptom overlap. Skin-picking and other impulsive behaviors are sometimes seen as manifestations or symptoms of underlying OCD or anxiety, and therefore adding a new excoriation disorder diagnosis risks stigmatizing patients with 2 psychiatric diagnoses. However, a large body of research suggests that ICDs are distinct from OCD, both neurobiologically and clinically,[8,9] and data do support the new diagnostic criteria.[10] In addition, treatment effects also tend to differ.

The addition of the hoarding disorder diagnosis to the DSM-5 is supported by extensive research suggesting that although OCD and hoarding can co-occur, they are also neurobiologically and clinically distinct and may respond differently to therapy.[11] Patients with OCD and compulsive hoarding have a different pattern of cerebral glucose metabolism than that of nonhoarding patients with OCD.[12] Also, many patients who exhibit hoarding behaviors do not have other symptoms of OCD.[11,12]