Ben Alger is 25 years old. He has a daughter, a new apartment in Waynesboro and a fiancee whom he intends to marry within a year. He is quiet, but quick with a smile, reserved, but warm. On the outside, Alger looks like a typical twenty-something. Only his hands betray the inner distress. They are raw and cracked. Dried blood laces his knuckles and small abrasions line his palms. They are the results of Obsessive Compulsive Disorder. On bad days, Alger may wash his hands 100 times. Monnica Terwilliger, a University psychology graduate student, knows the turmoil OCD inflicts on people like Alger. She sees it in her work at Gilmer Hall's Mary D. Ainsworth Psychology Clinic, where she works with sufferers of the disorder. Terwilliger says OCD is "a condition where a person has recurring or persistent thoughts, and then engages in ritualistic behavior to alleviate the attendant anxiety." For Alger, hand washing brings as much relief as pain. It helps him deal with an overpowering sense of unclean, a sense that draws him to the sink several times a day. There he washes each finger seven times with troubling determination. His is a mild case. "There are usually five or six recognizable themes associated with OCD," Terwilliger said. "Washing, checking, religious obsession, sexual obsession, counting and violent obsession tend to be most commonly observed, but the exact nature of the problem varies considerably among these broad categories." She says that washing, the compulsion Alger has, accounts for the majority of OCD cases. Checking and counting also are common. "Some people will count to a certain number before bed, or they will count the number of steps they take or objects they pass on their way someplace. Others might check to make sure that the stove is off or their car is locked - a hundred times," she said. For some, OCD can be completely disabling. Terwilliger once observed a nurse who believed office soap became contaminated in her absence. This, the nurse believed, threatened sickness among her patients. "She would go back into work at all hours of the day and night just to replace the soap so that nobody would be harmed," she said. "Eventually, her husband told her if she did it again, he would leave." Until recently, effective treatment has eluded sufferers of OCD. The first successful therapy program was published in medical literature in the 1960s but was not adopted on a widespread basis until the 1980s. Previously, people with the condition were told they could not be helped. Psychologists now combat OCD with a combination of behavioral therapy and medication, a program that is shown to significantly reduce the frequency and severity of symptoms related to the disorder. "From the medical community's point of view, anti-depressant drugs - Selective Serotonin Reuptake Inhibitors - and cognitive behavioral therapy are the two main lines of approach in treating OCD," said Psychology Professor Thomas Oltmanns, who specializes in OCD treatment. "Sometimes, we'll have a patient make a list of things that bring him discomfort. We may even make a tape recording of the patient describing their fears, and then have them listen to it each day. It is based on the theory that you can't be anxious forever," Terwilliger added. But for some, the anxiety brought on by OCD does not go away. Approximately 25 percent of patients do not respond to either medication or behavioral therapy. For those who do benefit from treatment, the improvement can be significant. Very few people, however, report total release from their symptoms. According to Terwilliger, OCD diagnosis can be as problematic as the treatment. She says, "On average seven years pass before someone with OCD receives the correct diagnosis." She attributes part of the problem to poor training in the medical community. Though OCD affects between 1 to 3 percent of the United States population, many clinicians are not familiar with its symptoms. Additionally, self-administered tests, which can often be the basis for identifying OCD, are not always dependable. Terwilliger found through statistical analysis that many of the tests ignore cultural differences, resulting in "false-positives" among African Americans. "We are looking at some of the tests because they don't seem to work as well for minorities. We are trying to identify differences in the way that minorities respond to these questions," Terwilliger said. On the Padua Inventory, one of the tests under her scrutiny, African Americans and Hispanics without OCD test more strongly on certain questions than people with it. Terwilliger hopes to compile a list of "self-report" questions that reliably indicate the presence of OCD regardless of ethnic background. Alger, meanwhile, would just like to stop washing his hands. With cold weather on the way, he knows they will suffer. "In winter my hands get a lot worse," he said. "I'll wear gloves, and that won't keep them from bleeding. They hurt a lot more too . But I'll still wash them." Over a hundred times a day.