HOARDING DISORDER: HOLD YOUR HORSES! A NEURODIVERGENT AND SOCIALLY MEDIATED CONDITION REQUIRING RETHINK AND REFORM.

Background: Hoarding disorder (HD) is increasingly recognized as a distinct, multifactorial condition. Recent findings in neuroimaging, psychopathology, compulsive acquisition, suicidality, stigma, and social context call for a redefinition of HD beyond its traditional association with obsessive-compulsive disorder.

Subjects and methods: This narrative review synthesizes recent clinical, neurobiological, and sociocultural literature, including latent class analysis and resting-state fMRI studies, exploring cognitive dysfunction, comorbidities, suicidality, stigma, and environmental context.

Results: HD is characterized by impaired executive functioning, frequently comorbid with ADHD and compulsive buying-shopping disorder. Subtype profiles identified through latent class analysis reveal complex multisymptomatic presentations. High rates of suicidality, social exclusion, and stigma - especially among individuals hoarding purchased items - suggest a need for a broader clinical and public health framework.

Conclusions: HD should be conceptualized within a neurodivergent and socially mediated model. Treatment and policy should address neurocognitive deficits, emotional regulation, social determinants, and stigma through interdisciplinary and person-centered interventions.