Other disorders and symptoms. Body dysmorphic disorder should not be diagnosed if the preoccupation is limited to discomfort with or a desire to be rid of one's primary and / or secondary sex characteristics in an individual with gender dysphoria or if the preoccu- pation focuses on the belief that one emits a foul or offensive body odor as in olfactory reference syndrome (which is not a DSM-5 disorder). Body identity integrity disorder (apotemnophilia) (which is not a DSM-5 disorder) involves a desire to have a limb ampu- tated to correct an experience of mismatch between a person’s sense of body identity and his or her actual anatomy. However, the concern does not focus on the limb’s appearance, as it would in body dysmorphic disorder. Karo, a culturally related disorder that usually occurs in epidemics in Southeastern Asia, consists of a fear that the penis (labia, nipples, or breasts in females) is shrinking or retracting and will disappear into the abdomen, often accompanied by a belief that death will result. Koro differs from body dysmorphic disor- der in several ways, including a focus on death rather than preoccupation with perceived ugliness. Dysmorphic concern (which is not a DSM-5 disorder) is a much broader construct than, and is not equivalent to, body dysmorphic disorder. It involves symptoms reﬂecting an overconcern with slight or imagined ﬂaws in appearance.
Major depressive disorder is the most common comorbid disorder, with onset usually af- ter that of body dysmorphic disorder. Comorbid social anxiety disorder (social phobia),
OCD, and substance-related disorders are also common.
Diagnostic Criteria 300.3 (F42)
A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.
C. The difficulty discarding possessions results in the accumulation of possessions that use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).
D. The hoarding causes clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning (including maintaining a safe environ- ment for self and others).
E. The hoarding is not attributable to another medical condition (e.g., brain injury, cere- brovascular disease, Prader-Willi syndrome).
F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).
Specify it:
With excessive acqulsition: If difficulty discarding possessions is accompanied by ex- cessive acquisition of items that are not needed or for which there is no available space.
Specify it:
With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.
With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter. or excessive acquisi- tion) are not problematic despite evidence to the contrary.
With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.
With excessive acquisition. Approximately 80%—90% of individuals with hoarding disorder display excessive acquisition. The most frequent form of acquisition is excessive buying, followed by acquisition of free items (e.g., leaﬂets, items discarded by others).