Research published in the JAMA publication Archives of General Psychiatry found that people with a hoarding disorder had significant anxiety associated with decision-making.

Using functional magnetic resonance imaging (fMRI), scientists measured the neural activity of 107 adults when they were asked to make a decision about whether to keep or discard a possession.  Of the test subjects, 43 had hoarding disorder, 31 had obsessive-compulsive disorder and 33 were healthy.

The patients with hoarding disorder exhibited abnormal activity in the anterior cingulate cortex (ACC) of the brain when making decisions to discard an object, especially if the object belonged to them.