ReviewNeuropsychiatric disease and treatment2026
Does Neurobiological Evidence Support the Diagnostic Distinction Between Hoarding Disorder and OCD? A Critical Narrative Review of Genetic, Neuroimaging, and Neuropsychological Findings.
Review in Neuropsychiatric disease and treatment, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hoarding symptoms were long regarded as one dimension of obsessive-compulsive disorder (OCD), but DSM-5 (2013) classified hoarding disorder (HD) as a separate diagnosis. This review asks whether neurobiological evidence, including studies published after the reclassification, adequately supports that decision. Methods: This critical narrative review searched PubMed and Web of Science (January 2010 to July 2026, plus foundational studies found by citation tracing) and was structured according to the SANRA criteria. Genetic, neuroimaging, and neuropsychological evidence was judged against four questions: is hoarding a separable trait within OCD; do groups differ biologically on average; is any difference specific to hoarding; and can the evidence classify an individual patient? Main Findings: Twin studies suggest that hoarding-related traits have a heritability of about 26%-48%, and one genome-wide association study reported an SNP-based heritability of 11%. These estimates come from different models and are not directly comparable; they are compatible with a heritable, polygenic trait but do not by themselves show a disorder-specific genetic architecture. A small number of PET, structural MRI, functional MRI, and EEG studies report differences associated with hoarding, including seven direct HD-OCD comparisons, but samples are small, diagnostic criteria vary, and findings have not converged. An exploratory computational study has compared genetic signals for the two phenotypes, but no direct comparison of risk variants exists. Neuropsychological findings were inconsistent: the most recent systematic review found no significant impairment on most cognitive tests in HD. Conclusions: Current neurobiological evidence provides only supplementary, not definitive, support for the diagnostic distinction between HD and OCD. It points to group-level biological heterogeneity, but it does not establish a distinct etiology or individual-level diagnostic utility. Larger studies using standardized DSM-5 criteria and direct HD-OCD comparisons are needed.
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