By Melanie Mannarino

Stephanie Cuzino never sets her alarm for 7:00 A.M. She sets it for 6:59 or 7:01; not 7:02 or even 7:10. For 18-year-old Steph, who has suffered from Obsessive-Compulsive Disorder (OCD) since she was 14, something as commonplace as even numbers are wrong. "Everything has to be an odd number," she explains. "If my class starts at eight o'clock, I'll get there like fifteen minutes early or arrive one minute late. If we get out of class at ten o'clock, I'll talk to the teacher for five minutes. It's stuff that nobody else notices ... but I do."

Steph's days are filled with tiny rituals such as this one: Wherever she goes, her obsession with odd numbers goes with her. During her meeting with seventeen, she counts how many steps it takes for her to walk from her car to the door of Chili's restaurant ... thirty-nine. If it had been forty steps, Steph says with a laugh, "I would've taken another [one] so that it would be an odd number."

Throughout lunch, Steph keeps pulling her long, light-brown hair into and out of a ponytail. She's feeling warm because her new medicine, Celexa, which she takes to alleviate the symptoms of her OCD, causes her to sweat a lot. As she talks animatedly about her experience with the disorder, Steph realizes that she's simultaneously counting the letters in a sign hanging over the bar. She says the counting fixation has become second nature. "It's so routine for me, I don't even realize that I'm doing it," she explains. "Then I catch myself in these rituals and think, Oh, OK, I was just doing that."

The National Mental Health Association (NMHA) estimates that one million children and teenagers have OCD ... an anxiety disorder that may have genetic origins and is believed to be caused by an imbalance of serotonin, a chemical that acts as a messenger between the orbital cortex (the front part of the brain) and the basal ganglia (deeper structures of the brain). When the serotonin levels are unbalanced, messages that go from one part of the brain to another part get messed up, resulting in repetitive thoughts.

These intrusive impulses (known as obsessions) drive people with OCD to act out time-consuming rituals or habits (compulsions).

The general public is probably most familiar with one of the compulsions exhibited by Jack Nicholson's character in the film "As Good As It Gets" ... excessive hand-washing due to an obsessive fear of germs. Yet while most people might think that OCD sufferers are fixated only on cleanliness, this complex disorder has many manifestations, which are divided into categories. People with OCD might fit into one behavioral category, but more likely they'll experience a variety of compulsions during a lifetime.

Hoarders collect items compulsively, even squirreling away scraps of paper in anticipation of needing them some day. Orderers need to keep their belongings perfectly aligned, and might arrange and rearrange objects on their desk for hours on end. Counters, like Steph, might concentrate on certain numbers or count anything from the number of steps in a flight of stairs to how many letters there are in a paragraph they're reading. Checkers obsess over something they think they've done ... like locking the front door ... and then recheck it numerous times. Washers feel contaminated by germs and repeatedly cleanse themselves, often developing dry, cracked, bleeding skin. And thinking ritualizers may recite words or prayers in their minds to keep their obsessions under control ... in turn, these repeated phrases become obsessions.

You might have quirks that you think border on the compulsive. Perhaps you've often been teased about your superneat locker, your ridiculous old-shoe collection or your insistence on bringing your own pillow when you sleep over at Grandma's house because you're afraid of germs. The thing is, OCD goes well beyond the strange habits that many people engage in. "It has to do with how much time and energy is taken up by the behavior," explains Michael Faenza, president of NMHA. "One person may keep a neat desk, but someone else may have a home or work environment where the ordering of things becomes ritualistic ... that's OCD."

Steph's OCD surfaced during a bout of depression. "I didn't go to school for about two months, and I couldn't even get out of bed," she recalls. "I hardly ate, and if someone came into my room to talk to me, I'd yell at them." She began to have obsessive thoughts and knew something was wrong with her, but she didn't know what. Out of frustration, Steph began cutting herself, with scissors, bobby pins ... even her fingernails. Four years later and after much therapy, she realizes that her self-mutilation was a manifestation of her OCD and a way of controlling herself. "Cutting was something I needed to do because I couldn't act out my rituals in public," she explains. Steph would cut her left arm most of the time, then blame the cat if anyone noticed the scars.

After reading an article on OCD, Steph was pretty sure she had it. She showed her mother the article, and they contacted the Obsessive-Compulsive Foundation (OCF), which coincidentally is based in Steph's hometown of Milford, Connecticut. At OCF they were given information about the disorder and information on support groups as well as referrals to doctors with experience in treating OCD. "It started the ball rolling," Steph says happily. "I was on my way to getting better."

Jessica Lewis developed an eating disorder at age 14 while dieting, but she soon learned that OCD had triggered it. Her reduced-calorie diet spiraled into a serious case of anorexia (at one point, she was eating only 300 calories a day), and Jessica, now an 18-year-old freshman at the University of Virginia, sought treatment. She credits her therapist with suspecting that OCD was behind her problems. "A lot of my eating disorder centered around the fact that I counted and recounted calories all day," she explains. "It wouldn't go out of my head; I did it all the time." Jessica was referred to a psychiatrist, who had her fill out what she describes as "a forty-page quiz that basically determines whether or not you are obsessive-compulsive."

Soon Jessica's other unusual behaviors were attributed to OCD. "I'd type out pages of the list of people I had to pray for every night," she says. But that wasn't her weirdest ritual. "I would count the number of letters that people said [in words] and figure out whether or not it was divisible by three," she explains.

Though their respective paths to diagnosis had their harrowing moments, both Steph and Jessica feel lucky to have been diagnosed while still in their teens. (The average age of diagnosis ranges from 19 to 25, and some OCD sufferers may reach their thirties and beyond before learning the true nature of their repetitive thoughts and actions.) The younger a child is, the harder it is for her or him to recognize there is a problem. That's where parents and older siblings can really help.

According to Faenza, an aware, supportive family can assist in getting the right help early on. "Often the symptoms of OCD and other mental disorders are not noted [by medical professionals], and that makes it even more important for families to get information from other sources," he explains. "The symptoms are relatively common, the disease is very real, and there is nothing to be ashamed of."

The family of Patrick Richmond, a ninth grader from Marietta, Georgia, took Patrick, then in fifth grade, to a doctor after he exhibited some potentially harmful behaviors. Patrick, now 15, knew something was wrong with him, even at age 11, but he convinced himself that he'd made a pact with God that certain good things would come from performing bizarre rituals. "I was jumping through doorways in my house," recalls Patrick. "I was jumping onto my bed from across the room ... fifty times a night. I dented my wall."

Trying to hide an illness like OCD or feeling guilty about it or embarrassed by it, says Faenza, is the last thing a teenager needs. "They're dealing with how their bodies are changing, the new roles and responsibilities they have to face in adulthood, and getting their balance as more independent people out in the world," he says. It can seem impossible for OCD sufferers to explain their illness to others ... even those closest to them.

"When I found out I had OCD, I was so down about it," says Steph. "I was preoccupied with it, and I didn't want anyone to know ... not even outside family or my closest friends." When she finally told her relatives, Steph offered them literature about the illness and invited them to her support-group meetings. Yet some still didn't get it. "I would talk to them on the phone and they'd say, 'Oh, are you feeling OK?'" Steph says, exasperated. "I would start to get short with them because it's like, don't call me up and ask me if I'm still sick!"

Though Patrick had been undergoing both drug and behavior therapy since elementary school, he didn't tell his classmates about his illness until he was in middle school. Once he explained it, Patrick says, "Some of them were supportive, some of them thought I was psycho." Patrick's family went through a period of adjustment after he was diagnosed. "I was in everybody's way," he acknowledges. "Most of them took it pretty well, but my brother got so mad, sometimes he'd yell at me."

Faenza stresses that placing blame on the teen is the wrong approach. "It's important for both teens and their families to understand that the thoughts and behaviors associated with OCD are in fact nobody's fault," he emphasizes.

But that's difficult for even the OCD sufferer to keep in mind. "OCD affects my relationship with my family," says 17-year-old Craig Teresi of Gilbert, Arizona, who was diagnosed with OCD three years ago. "I've gotten my parents into fights ... they never really fought before this." But while his parents have learned to take his excessive hand-washing rituals and constant questioning (another compulsion of his) in stride, Craig still feels guilty.