Thinking back, when my son was 2 or 3 years old, my mom mentioned how she never saw a little boy wash his hands so much.
Fast forward to age 13 - we figure puberty was setting in, but my son actually didn't hit the growth spurt, hair growth, etc. until 16 years old (which in my family is common for the boys - his older brother, my brothers, my cousins, etc.)
We began to notice him touching things evenly. If you bumped his arm, you had to touch it with the other. We began to notice then when riding in a car, he would play with the air/heat vents in front of him. He would touch it with one hand, then the other. It always had to be even. That was our first red flag.
When playing hockey, he always had a ritual before the center ice faceoff (he was the center who took the faceoff). He had to stretch one way and then the other before the referee dropped the puck.
At school, he got in trouble for looking out the window during a test. The teacher thought he was cheating - but turns out, he had looked out the window once, so he had to again - to make it even - even though the teacher had warned him not to look out again.
He has a real phobia about germs - still does. He will not hold onto the handrail of escalators, has a hard time using public restrooms, has to have a straw when drinking anything at a restaurant, as he won't put his lips on the glass, etc. Not quite as bad as the movie, "As Good as it Gets", but you get the idea.
One night, when I went to tuck him in and kiss him goodnight, I noticed he was out of breath. When I asked him about it, he didn't want to tell me - but very reluctantly finally said that he says his prayers to himself when he gets into bed. He was holding his breath while he did, or something bad would happen.
The next day, I called the psychiatrist, who suggested a psychologist who specialized in Obsessive Compulsive Disorder (OCD) behavior.
I was very happy with the therapy sessions - which at first, were once a week for the first few months. The therapist worked with him to first of all, become aware of all his rituals and obsessions, and then to work on getting rid of them.
They tried one medication, which I can't be sure - but I think it was zoloft. Then they tried prozac at 20 mg - and we had to keep increasing it each week till he hit 80 mg - which is the dosage found to be a success with Obsessive Compulsive Disorder (OCD) patients. That medication has worked for my son, and he has been on the same dosage since age 13.
Sorry so long - but it was a process we went through, and yes, I have to say he had good results.