It appears that a small number of hoarding cases may be true or primary OCD where the hoarding is secondary to OCD symptoms.  In other words, the hoarding behavior is driven entirely by OCD symptoms such as contamination fears or symmetry obsessions. There appear to be four things that characterize OCD-based hoarding.

Hoarding Occurs From Classic Obsessions

Among the most common of these are fears of contamination (for example, objects can’t be touched because they are contaminated and thus they accumulate on the floor or wherever they are dropped), superstitious thoughts (for example, unreasonable belief that throwing something away will result in a catastrophe of some kind), feelings of incompleteness (symmetry obsessions fall in this category), or persistent avoidance of onerous compulsions (for example, not discarding to avoid endless checking before discarding can occur).

OCD-Based Hoarding is Unwanted By the Hoarder

The hoarding behavior is unwanted and highly distressing and the person experiences no pleasure from it. Those with general hoarding disorder DO receive pleasure from hoarding.

The Individual Shows Little Interest in Saved Items

Especially not sentimental attachments or beliefs about the intrinsic value of possessions.

Excessive Acquisition is Usually Not Present in OCD-Based Hoarding

However, occasionally collecting occurs in the context of rituals associated with other OCD symptoms such as having to buy items in multiples of a certain number to ward off feared consequences, or having to acquire something because the person feels responsible for having contaminated it. In cases with these features, OCD should be the diagnosis and not hoarding.

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