Unlike many mental health professionals, I don’t pay much attention to the labels in the Diagnostic and Statistical Manual (DSM). Although hoarding is no longer considered in the category of OCD (Obsessive – Compulsive Disorder), it is by all means a compulsive behavior. Hoarders feel compelled to keep items, even if intellectually and rationally they know they probably won’t need them in a practical sense. The “need” is a powerful emotional one, however.
Many of the hoarders I have helped over the years do not (at first, anyway) acknowledge their hoarding as a problem. Some even pride themselves on being great collectors of various types of objects. They are certainly aware that others around them regard their behavior as abnormal, but they may or may not agree. It often takes a near or actual catastrophe (such as fire, divorce, house condemned) to motivate a hoarder to change, but even then it’s not easy. Great levels of anxiety may arise even when letting go of an item that the average person regards as garbage.