For Emily Hawling, the problem was ritual behaviors. She'd spend eight to 10 hours a day doing the same thing over and over, fearing she'd be a bad person if she didn't.
Kailey Schlosser's terror was contamination. She washed her hands of germs until they were raw. Alissa Welker was captive to her fear of throwing up. She was so terrified of food poisoning she barely ate at all.
All three were diagnosed with obsessive-compulsive disorder as girls. Now young adults, their friendship over the past four years has helped them contain the urges that used to dominate their daily lives.
"They understand in a way that I don't think anybody else can," Hawling, of Ontario, Canada, said in a recent Skype chat. "No matter how hard you explain it to friends, it will seem abnormal."
Historically, OCD has been viewed as an adult anxiety syndrome, but research now suggests it often begins in childhood. Estimates suggest 1% to 2% of children and teens have the disabling condition -- at least a few in every U.S. elementary and high school.
"We're just beginning to understand what's going on with kids in OCD," says Jeff Szymanski, executive director of the International OCD Foundation. Its new website, ocfoundation.org/ocdinkids, aims to educate families about the disorder.
OCD has a genetic component, particularly among those diagnosed at a young age, says S. Evelyn Stewart, associate professor of psychiatry at the University of British Columbia. But there are also environmental factors, perhaps a stressor such as a divorce, a school change or a biological transition, like puberty, that push normal fears too far.
Many kids with OCD grow into adults with OCD. But most don't have to, experts say. Treatments are effective up to 85% of the time, if the right ones are used.
Although vulnerability to OCD remains, about half of kids will achieve a complete remission after a few months of appropriate treatment, says Eric Storch, associate professor at the University of South Florida. Another 30% to 35% see significant improvements after that time. In 15% to 20%, treatment will probably help only a little.
If a parent helps a child give in to fears, it can reinforce them and potentially make them worse, says John Piacentini, director of the UCLA Childhood OCD, Anxiety and Tic Disorders Program. The reverse is also true, though. When people learn to break their fearful associations, by slowly confronting the object of their alarm in a controlled, safe environment, their OCD can be controlled, experts say.
Hawling, 20, Welker, 17, and Schlosser, 18, say their treatment and the support they get from one another have pushed their compulsions into the background -- like a "nagging mom," Welker says.
But the three do get annoyed when people make light of their disorder. Says Hawling, "It's not a joke."
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