Rick, a 46-year-old lawyer from Houston, talks about becoming so overwhelmed by hoarding and checking—did I shut the refrigerator? Is water running in the shower?—that he had to stop working for a while. At the end of the day you begin to worry about what youve accomplished, he says, and the reality is you havent accomplished anything. When he finally got counseling and his support group came over to clean out his apartment, they loaded a truck with about 45 bags of junk. For others, merely lurking on the edges of a noisy room is a form of shock therapy. Its hard for me to be around crowds of people, so its hard for me to be here, says Cameron, a 20-year-old sufferer from San Antonio with extreme anxieties about airborne germs. I cant open doors. Well, I can, but I have to go like this—he wraps a shirt sleeve around his hand. While he talks, Cameron stands about four feet away from you, and he yanks his shirt over his nose and mouth in order to block out an imagined barrage of bacteria. So extreme is Camerons dread of germs that for a while he made a habit of searing his fingertips with a lighter.

For Spencer, a 17-year-old student from Kentucky, routines as simple as getting to class or finishing his homework have become complicated ordeals. When he walks down the hallway at his high school, he feels impelled to step on every single crack. If hes writing a paper, it takes him at least 30 seconds to inscribe the perfect capital A—I have to erase a lot, he says. With OCD there are countless forms and variations, and in parts of the Bible Belt, the disorder frequently takes on a Pentecostal tinge. My problem is scrupulosity, says George, a 32-year-old teacher from Tennessee. Its a religious obsession. I might have a thought flash through my mind that Im praying to Satan instead of God. Its illogical stuff, but it still distresses you. Even going to a church service, I never know whats going to pop into my head.

This kind of behavior, says Jeff Bell, is what distinguishes real OCD from garden-variety, check-the-gas-cap stuff. A lot of people who think they know what it is really dont understand the severity of the debilitating aspect of all this, Bell says. I have one of the neatest closets in America. I get great pleasure out of organizing my clothes. Ive got white hangers for short sleeves, blue hangers for long sleeves. This actually is not part of my OCD. The reason, Bell says, is that organizing his closet brings him a strange kind of bliss, whereas other habits—the ones he has trouble stopping—cause him agony. I would never be late for work because my closet wasnt neatly organized, Bell explains. Now, contrast that with my need to pick up rocks and twigs from sidewalks because Im convinced people will trip on them and die. Could I imagine being late for work because I didnt pick up a twig? Yes. I mean, its happened.