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...Challenges in treating hoarding midlife and older adults gail steketee phd msw aaswsw boston university school of social work catherine r ayers ph d abpp research service psychology va san diego healthcare system department psychiatry ucsd manifestations acquisition saving disorganization dsm criteria for disorder hd an oc spectrum condition a persistent difficulty discarding or parting with possessions regardless their actual value b this is due to perceived need save the items distress associated them c symptoms result accumulation that clutter active living areas substantially compromise intended use if are uncluttered it only because interventions third parties e g family members cleaners authorities causes clinically significant impairment occupational other important functioning including maintaining safe environment self others not attributable another medical brain injury cerebrovascular disease prader willi syndrome f better accounted by obsessions obsessive compulsive decreas...