“There’s a façade,” Smith says. What’s underneath the façade is rituals, and they have become so rigid that the tiniest jolt to his routine can undo him. “Breakfast is at 7:30 exactly,” he says. “12:43 sharp for lunch. Dinner’s at 6:48 exactly. No deviations.” If he misses the right tick of the clock, he says, “I’ll punish myself and I won’t eat the full meal.” He drives only on certain roads. He shops at only one supermarket—Whole Foods. “If someone picks up my book, I’ll just toss it in the trash, because it’s useless,” he says. “It’s contaminated.” His grooming rites can devour two hours. “Shaving, brushing my teeth, putting on clothes, taking them off again, and then putting them back on so they feel right. If I miss my morning routine, I’ll call in sick to work, because I can’t function.” Physical relationships are almost impossible. “My problem,” he says, “is I get disgusted. I’ll be making out with a girl and I’ll just fixate on something about her that’s just nasty, like a zit. Or I’ll be like, God, her nose is disgusting, I can’t deal with this.” When Smith talks, the words gush forth, but when someone else is speaking, his tics emerge. He emits grunts of pent-up breath. Sometimes in private moments he squinches his face into a grimace and flicks out his tongue.

Like many of his fellow sufferers, Smith is swimming in an alphabet soup of treatments—acceptance and commitment therapy (ACT), exposure and response prevention (ERP)—and medication (“I’m on the highest dose of Zoloft you can have”). And although he quips that OCD has become “the new designer disorder,” that’s a good thing for anyone who wants relief from it. A couple of decades ago OCD sufferers had a hard time getting the right diagnosis and help, but now the disorder even has its own blonde, poised, 20-year-old spokesbabe, Elizabeth McIngvale. She gives one of the keynote speeches at the conference, along with Julian Swartz, a basketball star and coach from Wisconsin, and Jeff Bell, a popular San Francisco Bay Area news-radio anchor who’s just published Rewind, Replay, Repeat.

In the book, Bell, 43, describes himself as having been a “quirky, high-strung overachiever” in his early years, but when his extraordinary focus began to pay off and he’d established himself as a radio star in the early nineties, the disorder nearly wrecked it all. “I would spend hours fact-checking and grammar-checking and checking every possible comma and period of a 60-second story—I could barely get these things on the air,” Bell says. “Because I have this obsessive drive to get to the bottom of stories, it’s made me a pretty good investigative reporter. On the other hand, I get caught in this horrific cycle of having to check and recheck every minute detail about a story I’m working on. That’s the built-in irony of this. To a certain point, yes, it drives you. And then you cross some threshold, and now it’s holding you back.”