Snapshot A 21-year-old college male student presents to your office on the insistence of his parents for worsening grades. He describes missing classes and deadlines as a result of an "embarrassing habit" in which he is convinced he has left his apartment unlocked. He details that the only way he knows that it's locked is to unlock the door. He repeats this process approximately 30 times every time he must leave the apartment, which he finds very distressing. He denies any family history of mental health problems. He denies substance use. The student agrees to intensive cognitive behavioral therapy sessions with the option to use medical therapy if necessary. Introduction Clinical definition two components obsessions recurring, intrusive thoughts that cause severe distress and impairment compulsions performance of repetitive actions (rituals) in an attempt to neutralize the obsessions e.g., hand washing, checking primary goal is to not lose control disorder is ego-dystonic behavior inconsistent with one's own beliefs and attitudes separates OCD from obsessive-compulsive personality disorder Associated conditions Tourette's disorder can treat with risperidone Evaluation Obsessions and/or compulsions must be present must be time-consuming (e.g. take > 1 hour per day) or cause clinically significant distress or social impairment are not due to medical or coexisting mental health condition Treatment First line: psychotherapy cognitive behavioral therapy Pharmacotherapy options SSRIs 12-16 week trials higher doses compared to those used in depression clomipramine augmentation therapy with antipsychotics