Q: According to the DSM-5, hoarding shouldn’t be diagnosed if the behavior can be better explained by Obsessive Compulsive Disorder (OCD). Is it possible for both hoarding and OCD to be diagnosed together?
A: Great question! Yes, a therapist can diagnose them together, but one should avoid diagnosing hoarding disorder (HD) if the behaviors are merely symptoms of a patient’s OCD.
Remember this differentiator: With OCD, the person feels distress about the obsessions and compulsions they experience; they garner no pleasure from the hoarding experience. They are merely fighting obsessive/compulsive urges and they may hoard odd things (e.g., finger nails, hair, used diapers). Keeping such odd items is less common (though not unheard of) with HD. Again, with OCD, the person wants to stop and doesn’t have emotional attachment to the items one will present with hoarding disorder.
Page 250 in the DSM-5 provides a nice overview of this, also.