As long as she can remember, Annabelle Charbit has loathed “stuff.” She hated birthdays because birthdays meant gifts. And gifts meant finding a way to toss them.

At 5 years old, Charbit would sneak toys into her younger brother’s room. By age 10, she was stashing her belongings in alleys around her London neighborhood. At 13, she discovered charity stores, smuggling bags past her parents and out the door.

Living on her own in her twenties, Charbit, now 41, continued her spartan ways, eschewing even lamps. “I would be in semi-darkness,” she says.

Currently a neuroscience researcher at the University of California, San Francisco, Charbit was obsessively decluttering before the word really existed in popular culture. Google Ngram, which charts the use of certain words in book titles, shows that “declutter” first came into use in the 1970s, its popularity shooting up through the ’80s, ’90s, and the first decade of the 21st century. According to Oxford University Press, the term was only added to the 20-volume Oxford English Dictionary in June 2015. Today, women’s magazines routinely urge readers to purge; personal organizers offer to coach clients in their pursuit of minimalist perfection; earlier this year, Marie Kondo’s book The Life-Changing Magic of Tidying Up, which promises to help people achieve “the unique magic of a tidy home,” became a bestseller. But for some people, the cultural embrace of decluttering can provide cover for more problematic behavior.

“Do we just assume that decluttering is a good thing because it’s the opposite of hoarding?” says Vivien Diller, a psychologist in New York who has worked with patients like Charbit who compulsively rid themselves of their possessions. “Being organized and throwing things out and being efficient is applauded in our society because it is productive. But you take somebody who cannot tolerate mess or cannot sit still without cleaning or throwing things out, and we’re talking about a symptom.”

Unlike hoarding, which was officially reclassified as a disorder in 2013, compulsive decluttering doesn’t appear as its own entry in the Diagnostic and Statistical Manual (DSM); instead, it’s typically considered a manifestation of obsessive-compulsive disorder. “I see it all the time. People rarely come into my office because they have a problem with being too efficient or wanting to declutter,” Diller says, but the problem usually makes itself known in other ways: “They’re not sleeping at night and they’re feeling jittery and irritable … they’ll sit in my office and straighten my pillows. They’re not comfortable until everything is in order.”

Scientists still aren’t sure exactly what causes OCD, which is typically treated with therapy and medication. What they do know is that the condition causes sufferers to lock onto distressing thoughts (obsession), generating anxiety that can only be soothed by performing a particular act (compulsion). “By doing the ritual, you get temporary relief, and then that cements you into doing the ritual,” says Michael Jenike, a professor of psychiatry at Harvard Medical School and the founder of the OCD treatment program at Massachusetts General Hospital. “So you do it again and again.”

Diller’s compulsive-decluttering patients, she says, sometimes describe “this tightness in their chest if they see things that should be thrown out,” one that can be eased only by getting rid of the offending objects.

“Any behavior can technically become a problem when it starts having an obsessive and compulsive nature. Even [otherwise] healthy behavior,” says Jennifer Baumgartner, a clinical psychologist in the Washington, D.C. area who has worked with patients who suffer from obsessive-compulsive cleaning. Both cleaning and decluttering can be positive behaviors, she says, but become a problem when they’re driven by obsessive thoughts.

One day in 2010, Charbit, then a neuroscience graduate student at University College London, Googled “the opposite of hoarding” and “clutter phobia.” She was in the process of writing a novel about a woman who suffers from the same compulsions as Charbit herself (the novel, A Life Lived Ridiculously, was published in 2012) and wasn’t sure how to describe her character’s symptoms—there’s no official term for compulsive decluttering. “I was a grown adult, fully medicated, with plenty of insight … but with no name for [the behavior],” says Charbit, who began taking medication for OCD at age 18. Her search led her to an article on “obsessive-compulsive spartanism,” she recalls. Clicking it open, she immediately recognized her own experience.

For Charbit, the thoughts began within seconds of waking up each day. “You have a few seconds of peace,” she says. “Then it all comes flooding: The anxiety, the dread … It's that constant nagging. You never reach a point where you're satisfied.” Even now, after years of treatment, “I would rather throw something out and buy it again than keep it.” The medication helps, she says, but it hasn’t stopped her from discarding and re-buying a food processor three times. “And don’t even tell me to recount how many books I tossed, only to go to Amazon and repurchase them.”

The author Helen Barbour, who blogs at The Reluctant Perfectionist and wrote The A to Z of Normal, a novel about OCD, believes the cultural embrace of decluttering makes it harder for those who do it compulsively to seek help. “[People] see my tidy home and sigh about the fact that theirs is a dump,” says Barbour, who was diagnosed with OCD in 1995. “What they don’t realize  is how long it has taken me to order everything with millimeter precision, or the anxiety I feel at things being even slightly out of position.” Barbour lives alone, in part, she says, because her long-term partner is “the king of stuff.”

Barbour also found a supportive community online when she wrote a blog post about her compulsive decluttering last February. “Sorting and rearranging helps a little,” she wrote, “and getting rid of just one or two things can also temporarily alleviate the feeling.” Commenters responded with their own experiences: “I get a physical sensation as though I’m being crushed when I have too many things around me,” one wrote. “To say I hate clutter is an understatement … it literally feels like gears grinding in my head,” said another.

Lesley Turner, a 58-year-old woman from Wales, can relate. “I have to do these things,” she says, “or my head is in turmoil.” In 2013, she and her daughter Tuesday, now 25, appeared on the U.K. reality show Obsessive Compulsive Cleaners, in which people who suffer from compulsive decluttering clean the homes of people with hoarding disorder. Lesley says that the show’s producers pitched it to her and her daughter, both of whom suffer from OCD, as a chance to “push our boundaries,” but both women were dismayed with the episode that ultimately aired. “It made it look like a nice, fun, quirky thing to have, not the serious, completely life-consuming illness that it is,” Tuesday says. Earlier this year, after Lesley told the British newspaper Metro that the experience left them “traumatized,” the advocacy-organization OCD U.K. released a statement condemning the show and calling for its boycott.

All pathologies have a spectrum from normal to symptomatic, Diller says, and decluttering is no exception. Barbour considers herself on the “mild end of the spectrum.” Charbit, now married and the mother of a 2-year-old and a 4-year-old, says she’s able to cope with her family’s possessions by “creating little compartments in my life [that] are exactly as I want them to be,” like her closet: “I always, at any one time, have just three pairs of shoes,” she says. “One pair of sneakers, one pair of flats, and one pair of sandals.”

The Turners, who refuse to allow anyone in their house—“I just want my big, clean, sterile home,” Lesley says—are more severe cases. Lesley is currently taking medication; Tuesday is on a waiting list for OCD group therapy. Both women hope their TV experience will at the very least increase public awareness of their particular form of OCD.

“I think when you see someone who’s a hoarder,” Tuesday says, “you see that there’s [a disorder]. Whereas if they saw our house, they would see that there’s nothing in there; it’s really, really clean. And I think people would just think that it was a nice, clean house.”