You could always spot Noelle Lepore in her high school cafeteria. She was the girl who wouldn’t eat until all her prayers were done.
She would have loved not to be that odd kid out, but “I couldn’t not do it. And I couldn’t hide that I was doing it. Because if I hid what I was doing that was denying God.”
Lepore’s family were proud members of their local Armenian Catholic Church in the suburbs north of New York City. They went to services most Sundays and said grace before dinner. But they weren’t intensely religious. And, at heart, neither was she. The twists and turns in her mind weren’t a form of faith. They were symptoms of a type of obsessive-compulsive disorder (OCD) you may not have heard before—it’s called scrupulosity OCD.
Today, Lepore is a therapist with NOCD, helping others with all types of OCD escape its traps. Her own years with scrupulosity OCD have given her a lot of insight into what her patients with any kind of OCD go through—and the life-changing power of the treatment she offers.
Struggling to figure out what was wrong
Lepore was in middle school when she first noticed intense, intrusive thoughts that seemed to take over her mind. These obsessions pushed her to do things—compulsions—that made her feel better, though not for very long. And the compulsions mostly found themselves twisting around religious beliefs and rituals.
“I developed very specific prayer routines when I would go to sleep. I felt I needed to cover everyone I knew in my prayers, to protect them all. And then it expanded to anybody who might potentially be suffering. So this prayer process got very lengthy.”
For a while, her mother, father and brother didn’t know.
Like many people with OCD, Lepore felt she should hide her compulsive behaviors. In her case, she justified it on religious grounds. “You’re supposed to live right because that’s right,” she says. “If people are praising you for being pious, that’s boastful. So I decided I wasn’t going to tell anyone about all these things. After I was in bed all tucked in and alone, I would be quietly reciting.”
That made for a lonely vigil, but Lepore accepted it. “It didn’t occur to me that there was anything wrong with me,” she says. “I just thought, well, this is the plan God has for me. And that’s hard, but I can do it. I’m strong enough.”
As her high school years passed, her fears and compulsions became ever more numerous. “It morphed into, I have to brush every single side of every single tooth! So brushing took 10 minutes minimum. Otherwise I was being lazy—which was the sin of sloth,” she says. “And I had to fold all of my clothes perfectly, or I was being lazy.”
Her family finally found out when she was 15 or 16. Lepore was stalling on going to bed, because she knew she had a long set of rituals ahead. She explained to her mom that she was dreading having to brush every side of every tooth. “My mother just looked at me and said, ‘Listen, there’s this thing called obsessive-compulsive disorder, and you might have it.'”
Her mother gave her a book on OCD, The Boy Who Couldn’t Stop Washing. And Lepore realized, Oh my freaking God, I absolutely have this.
The downside of self-treatment
Lepore initially tried to tackle her OCD on her own. “I would do the complete opposite of all the things I had been doing,” she says. “I started going to bed without brushing my teeth at all. And since I thought clothes had to be folded perfectly with no wrinkles, I just stopped folding them at all, and shoved them in a drawer.”
For many years it worked. Lepore went on to study psychology and became a therapist (though she didn’t work with OCD). But then, in her mid-20s, “I had another flare up,” she says.
This time, instead of religion, OCD seized on her worries about health. “Then it was, Something is wrong with me. I’m going to have a heart attack. I’m going to have a stroke.“
Dealing with religious scrupulosity, she could just do the opposite of her compulsions. But these health-focused themes were “harder to fight,” Lepore says.
She saw a therapist, but not one trained in treating OCD. And after giving birth to twin girls in 2019, her symptoms came back with a vengeance. “My kids got a virus—nothing serious—and then I got it,” she says. “Suddenly, I was looking up symptoms and complications and thinking, Oh, my God, we’re gonna die. I was having a hard time making decisions. I was asking my mom to reassure me every day.”
Finally finding the right treatment
That’s when Lepore decided, “I need to treat my OCD the legit, proper way. So I found an ERP therapist.” She knew about this form of treatment, but hadn’t sought it out before.
ERP stands for Exposure and Response Prevention. It’s a way of training yourself not to respond to your OCD. Over time, ERP teaches you that you can let your obsessive thoughts appear and then watch them go away, without having them take up so much of your time and energy.
Guided by a therapist specially trained in ERP, Lepore made rapid progress, despite the challenges. She had to not respond to OCD when it told her to reach for the thermometer, go look in the mirror to see if her face was flushed, and look up symptoms online.
But ERP was also a relief. “There was that sensation of being given permission not to do my compulsive behaviors,” she says.
That success spurred her to seek training in ERP therapy with NOCD. It’s a rigorous program that all NOCD clinicians go through. This specialized ERP training qualifies her to help people with OCD get their lives back in a way that many therapists outside of NOCD aren’t equipped to do.
A passion for helping others
What Lepore had to improvise for herself, she now makes easier and safer for others, with methods backed up by decades of research. Studies have found that at least two-thirds of people who do ERP get more control of their OCD symptoms.
“I think having OCD myself helps a ton,” she says. “Because ERP is hard. And it helps to really understand that, when I’m asking you to do this, I know what I’m asking you to do. I know how terrified you are right now. And I also understand that you think it’s ridiculous that you’re terrified right now.”
ERP isn’t a miracle cure. It doesn’t make OCD go away. But it gave Lepore the tools to keep OCD from taking over her life—and that relief is what she wants to share with her clients.