A 56-year-old man presents to the PMHNP, stating he was sent by his wife. He explains he used to own a video rental store, and as a result, he has a large collection of VHS tapes. He continues to collect these "antiques" and does not see any problem with this because they are valuable. He admits he never watches them, because he can never decide which one to watch, and he doesn't have a lot of time. He has started running out of space to keep the tapes, and he admits many of them are probably ruined because they have been housed outside in a hot storage unit. Which diagnosis is most appropriate?

Choice A reason: Obsessive-compulsive disorder involves intrusive thoughts and repetitive behaviors performed to reduce anxiety. While hoarding can be associated with OCD, in OCD the behavior is driven by anxiety reduction, not by difficulty discarding items or accumulation without functional use. Choice B reason: Delusional disorder involves fixed false beliefs that are not aligned with reality. Collecting VHS tapes due to perceived value does not meet criteria for delusions; the patient recognizes their condition but has difficulty discarding items, making delusional disorder inappropriate. Choice C reason: Normal collecting behavior involves purposeful accumulation of items for enjoyment or hobby. The patient’s inability to discard, neglect of living space, and potential risk to health or function surpass normal collecting. Choice D reason: Hoarding disorder is characterized by persistent difficulty discarding possessions, regardless of actual value, leading to clutter that interferes with living spaces or functioning. This patient’s behaviors, including accumulation of unused, potentially ruined VHS tapes and inability to organize or discard them, fit the diagnostic criteria for hoarding disorder.