The neurobiology of obsessive-compulsive disorder

SELECTED CASE AN 18-YEAR-OLD high school girl from a small town in Maine was brought to a psychiatrist by her mother because of her excessive showering and dressing rituals. Showers lasted two hours; it took a half hour to dress. Each act of dressing was counted and had to be repeated precisely 17 times. These behaviors had begun gradually at age 15 years, causing chronic tardiness at school; two months of counseling with the school psychologist was not helpful. When the psychiatrist was consulted, the patient's circle of friends and activities had narrowed, and she was missing school one or two days a week. She had been an outgoing, popular girl, with average grades, who had not previously exhibited unusual concern for neatness, expressed odd thoughts or preoccupations, or presented any behavioral problems of note. When interviewed, she was embarrassed discussing her washing and counting behaviors. She said she "knew