By Dr. Lori Butterworth, Child & Adolescent Psychotherapist
The first time I met Nick, he walked into my office with his hoodie sleeves pulled down over his hands. He was sixteen.
His mom came in with him because he couldn’t touch the doorknob.
He had been washing his hands so viciously that his skin was cracked and painful. By the time he came to see me, OCD had taken over nearly every part of his day. When he stopped going to school, his mom insisted it was time for therapy.
Kids like Nick are often described as “germaphobes” or “clean freaks,” but that misses what is really happening. Nick wasn’t choosing this. He was suffering. OCD had trapped him in the belief that deadly germs were everywhere.
But Emily’s mind was flooded with intrusive thoughts that horrified her. Violent images. Disturbing ideas. Thoughts completely out of line with her values.
She was riddled with shame and guilt, spending hours analyzing the thoughts, trying to push them away. She avoided any situation that might trigger a thought, constantly searching for reassurance that she wasn’t secretly a bad person.
The harder she tried to push the thoughts away, the stronger they became.
That’s the cruel paradox of OCD.
Thanks in part to the media, Obsessive Compulsive Disorder (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 kids and teens 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.
Instead of running from fear, we practice walking toward it.
Ryan started small. One of his first exposures was touching the arm of a chair in my office and waiting before washing his hands. His anxiety shot up immediately. His mind screamed that something terrible would happen.
But we stayed with it.
Time after time, minute by minute, as he 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, his world expanded.
Emily practiced something equally brave. Instead of arguing with the thoughts, she 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.
She discovered that a thought is just a thought, not a prediction, not a command, and not a reflection of who she is.
The other day I called Ryan to see how he was doing.
He 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.
Emily now lets intrusive thoughts drift by like background noise. They no longer control her life.
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 identifying details have been changed to protect privacy.
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Lori Butterworth is a child and adolescent psychologist and the founder of the Center for Child and Adolescent Mental Health and Jacob’s Heart Children’s Cancer Support Services. For more information about mental health support for your child and family, contact Lori at 831-222-0052 or visit CCAMH.org. The Center offers evidence-based youth mental health care and free resources for parents.