The first time I met Katie, she walked into my office with her hoodie sleeves pulled down over her hands. She was seventeen.
His mom came in with her because she couldn’t touch the doorknob.
She had been washing her hands so viciously that her skin was cracked and painful. By the time she came to see me, OCD had taken over nearly every part of her day. When she stopped going to school, her mom insisted it was time for therapy.
Kids like Katie are often described as “germaphobes” or “clean freaks,” but that misses what is really happening. Katie wasn’t choosing this. She was suffering. OCD had trapped her in the belief that deadly germs were everywhere.
William was the last person you would expect to struggle with OCD. He is kind, thoughtful, handsome, and cool, the kind of person who tries to be good and do the right thing.
But William’s mind was flooded with intrusive thoughts that horrified him. Violent images. Disturbing ideas. Thoughts completely out of line with his values.
He was riddled with shame and guilt, spending hours analyzing his thoughts, questioning his worth, trying to push them away. He avoided any situation that might trigger a thought, constantly searching for reassurance that he wasn’t secretly a bad person.
But the harder he tried to push the thoughts away, the stronger they became.
That’s the cruel paradox of OCD.
Thanks in part to the media, OCD is widely misunderstood. TV and movies portray people with OCD as quirky, neat freaks, and people joke, “I’m so OCD,” when they mean they like things tidy.
But real OCD is very different.
OCD is not about neatness or organization. It is a painful, debilitating disorder where intrusive, unwanted thoughts (obsessions) pop into the mind, and repetitive behaviors or mental rituals (compulsions) are repeated to reduce the distress. The relief is brief, and the cycle grows stronger.
By the time many families arrive in my office, they are exhausted. OCD has stolen time from school, friendships, hobbies, and family life.
But there is also something hopeful about these stories.
OCD is treatable.
The gold-standard treatment for OCD is Exposure and Response Prevention (ERP). ERP helps people gradually face the situations or thoughts that trigger anxiety while learning to resist the compulsions.
In ERP, instead of running from fear, we practice walking toward it.
Katie started small. One of her first exposures was touching the arm of a chair in my office and waiting before washing her hands. Her anxiety shot up immediately. Her mind screamed that something terrible would happen.
But we stayed with it.
Minute by minute, time after time, as she tolerated the anxiety, it slowly started to fall.
Over time, the exposures got harder, touching the doorknob, sitting at a desk, walking through school without washing repeatedly. Little by little, Katie’s world expanded.
William practiced something equally brave. Instead of arguing with the thoughts, he learned to let them be there without fighting them. At first, it felt unbearable.
But eventually something remarkable happened: the thoughts began to lose their power.
He discovered that a thought is just a thought, not a prediction, not a command, and not a reflection of who he is.
The other day, I called Katie to see how she was doing.
She answered the phone and said, “Dr. B, I’m eating a burrito and putting gas in my car.”
A simple, ordinary teenage moment. One that used to feel impossible.
William now lets intrusive thoughts drift by like background noise. They no longer control his life; he’s living according to his values.
OCD still whispers sometimes. But it’s no longer in charge.
Freedom from OCD isn’t about eliminating fear. It’s about facing it head-on. Learning that you can tolerate discomfort, break free, and take your life back.
* names and some details are changed to protect patient identity.
Dr. Lori Butterworth is the founder of the three successful, youth-serving nonprofit organizations: The Center for Youth Mental Health, The Children’s Hospice & Palliative Care Coalition, and Jacob’s Heart Children’s Cancer Support Services. Visit her website here.