Imagine having irrational thoughts, intense rituals of washing your hands repeatedly, for instance, and strong fears. Obsessive-Compulsive Disorder (OCD) can be a debilitating psychological illness if not treated, and it’s a disorder that affects millions of children, teens, and adults.

OCD was once categorized as an anxiety disorder; however in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is was given its own category along with other related disorders such as Body Dysmorphic Disorder and the not-so-well-known diagnosis of Trichotillomania (hair-pulling disorder), as well as two new disorders: Hoarding Disorder and Excoriation (skin-picking) disorder.

OCD specifically is made up of two parts: compulsions and obsessions. A compulsion begins when there is a loss of control and a teen ends up spending large amounts of time engaging in a behavior to the point where he or she is neglecting social, academic, or familial responsibilities. For instance, if an adolescent were washing her hands again and again in the morning with an inability to stop, it might cause her to be late for school or miss the bus or miss out on material presented in her first class. An obsession is a fixation like keeping everything in order or trying to stay free of germs.

Between the two – compulsions and obsessions – the disorder can get in the way of functioning in life. For instance, when a teen feels the need to perform rituals in the evening that might prevent completing homework, attendance to school, and concentration in class. This, in turn, can lead to stress and lack of sleep, and if this continues long term, it can result in physical illness.

Sadly, many teens will attempt to hide their illness. According to the International OCD Foundation, this is common among teens who have been diagnosed with OCD. Adolescents might feel the need to hide their OCD patterns, which might keep them from spending time with their peers and even lead to problematic social relationships. Hiding a diagnosis might also contribute to a teen’s low self-esteem and their process of finding a sense of self, which is the main psychological task of adolescence.

However, there are typical treatment methods used for OCD and that is medication (commonly antidepressants) and therapy. A form of therapy that has proven to be highly effective is Exposure with Response Prevention (ERP). This type of therapy would invite a teen to gradually face his or her fears in a controlled and safe environment and then attempt to not engage in any compulsive behaviors. Doing so would give him or her the chance to monitor internal responses to what triggers a fear while using healthy coping mechanisms. The point is that over time the distressful physiological responses to that trigger slowly go away. Eventually, a teen learns that the particular situation, person, or thing is not harmful and instead he or she develops a sense of control over that fear. Most importantly, he or she learns that the compulsive behavior isn’t necessary to control life or the fear.

For instance, Dr. Elizabeth McIngvale-Cegelski, with the International OCD Foundation, spent many years suffering from OCD in her adolescence. “As a teenager,” she wrote, “I struggled with various forms of OCD including contamination, scrupulosity, hyper-responsibility, harming fears, number and color issues, symmetry/ordering, and arranging. The majority of my fears were centered around the idea that something bad would happen to someone that I loved, so I performed various rituals to try to prevent that.”

The way that Dr. Elizabeth McIngvale-Cegelski worked with her teen Obsessive Compulsive Disorder was primarily through ERP. Today, she not only works for the International OCD Foundation, she also maintains OCD Challenge, a site that provides self-help information for teens and adults with OCD.