One variety of obsessive-compulsive disorder (OCD) is characterized by hoarding, saving, and collecting. It may have a distinct genetic pattern and is often unresponsive to standard treatments for OCD. Understanding associated brain functioning could lead to better treatment. Saxena et al. (p. 1038) compared brain metabolism in OCD patients with hoarding-related symptoms, OCD patients without hoarding, and healthy comparison subjects. The hoarding patients, but not the other OCD patients, had lower metabolism in the posterior cingulate cortex and cuneus than the comparison subjects. The nonhoarding patients showed higher metabolism in the caudate and thalamus than comparison subjects, but the hoarders did not. Also, the hoarding patients had lower metabolism in the dorsal anterior cingulate gyrus than the other OCD patients. Hoarding severity was inversely related to metabolism in the dorsal anterior cingulate gyrus. Lower activity in both the anterior and posterior cingulate gyrus may help explain the decision-making, attentional, and other cognitive problems of compulsive hoarders. Deficits in these regions have also been associated with poor response to treatment.