#ocrd

All statistics are related to those with trichotillomania and what type of hair they pull out.

18.46% of people pull out their eyebrows

3.04% of people pull out their beard hair

4.75% pull at their arm hair

5.76% pull at their leg hair

31.48% pull out their scalp hair

17.56% pull out their eyelashes

14.67% pull out their pubic hair

4.38% pull other body hairs

(See my breakdown of the DSM-5 criteria here!)

Hoarding presents in different ways and in different levels of severity depending on the person. When writing a character who has hoarding disorder, it is absolutely necessary to determine how severe their behavior is.

As such, I’ve collected some useful resources to help y’all figure out what level of hoarding your character is dealing with.

ICD Clutter-Hoarding Scale:

While the numbers in the following images do not correspond to an exact scale of hoarding, they are still a useful guide to the severity of the problems.

The character needs to be focused on and worrying about at least one flaw in their physical appearance that the character thinks they have. This flaw has to be either not actually there, or barely noticeable to other people.

The character needs to have at some point done some kind of compulsive behavior or mental act in response to their worries about their flawed appearance (for example, checking a mirror, picking at their skin, asking others to reassure them, comparing their own appearance with that of others, etc).

The character’s worries about the flaw severely stresses them out or makes their life more difficult in some way.

The character’s worries aren’t better explained by an eating disorder.

One possible subtype of this disorder is:

With muscle dysmorphia: the character thinks their body is too small or not muscular enough.

You also should take note how the character reacts to their beliefs about their flaws.

With good or fair insight: the character realizes that their worries are probably not true.

With poor insight: The character thinks their beliefs are probably true.

With absent insight/delusional beliefs: The character is 100% convinced their worries about their flaw are true.

The character needs to consistently have trouble either throwing away or parting with their belongings, no matter how much they actually are worth.

The character’s difficulties throwing stuff away come from the feeling they need to save these items, and because they feel anxious or stressed while tossing them.

The character has such difficulty throwing stuff away that their living space is packed with stuff. Lots of stuff. So much stuff that they can’t even use the rooms how they’re supposed to be used. If the character’s living space is uncluttered, it’s only because someone else is keeping it clean.

The hoarding of stuff either makes the character stressed or causes them problems in some area of their life. (Note – this “problem” can be that they can’t maintain a safe living environment for themselves or others)

The hoarding isn’t caused by a medical condition (which can be an actual thing with brain injuries, cerebrovascular disease, and Prader-Willi Syndrome)

The hoarding isn’t better explained by a different mental illness.

Specify if:

With excessive acquisition – the character keeps bringing new, unneeded stuff into their home, even though there’s no space or use for the stuff they’ve bought or found.

You also should note if your character has:

With good or fair insight: The character knows their hoarding is a problem.

With poor insight: The character is mostly convinced that their hoarding isn’t really a problem.

With absent insight / delusional beliefs: The character is completely convinced that they don’t have a problem.

(2/2) Every time an MH professional has assessed my situation they’ve agreed that I don’t have a hoarding disorder. Other people often think I do, especially if they’ve known someone with a hoarding disorder before, because it looks similar. So it could be a plot point for someone to wrongly assume a hoarding disorder when there’s a different cause, or the other way around - someone assuming a different cause because they don’t notice the hoarding disorder.

I did mention in my Hoarding Demystifying the DSM-5 post that in order to be diagnosed with hoarding disorder, the symptoms cannot have been caused by a medical condition or other mental illness, but it bears repeating.

Here are some other explanations for hoarding behaviors that would not qualify for a diagnosis of hoarding disorder:

The character is too depressed to perform any cleaning behaviors or maintain their living area. Trash accumulates because they are unable to muster the energy to empty their trashcans.

The character is an avid collector who has no problems discarding or selling their less valuable possessions.

The character has Prader-Willi syndrome, a genetic disorder that causes hoarding behaviors in almost 60% of cases.

The character has temporarily taken in a great number of abused or unwanted pets, but gives them up to the appropriate shelters at the first opportunity.

The character is delusional and refuses to throw anything away because they believe that other people will collect DNA from anything the character has touched, and will use it for nefarious purposes.