Unusual obsessive–compulsive disorder presentations: A case series mapped to contemporary obsession dimensions

Obsessive-compulsive disorder (OCD) comprises distinct obsession dimensions rather than a unitary disorder, yet many unusual presentations remain unrecognized clinically. This case series evaluates three patients who exemplify rare OCD dimensions (superstition, taboo impulses, and transformation), identified from a sample of five consecutive clinical presentations. Dimensional mapping used factor-analytic and network-analytic frameworks derived from the dimensional yale-brown obsessive-compulsive scale (DY-BOCS). Case 1 illustrates superstition/magical-thinking OCD with poor insight; Case 2 shows taboo impulse obsessions misdiagnosed as psychosis; Case 3 demonstrates transformation/identity OCD in an adolescent gamer. Each case maps to under-recognized dimensions from contemporary eight-factor models. Dimensional assessment aids recognition of rare OCD presentations, prevents costly misdiagnosis (particularly psychotic misclassification), and guides mechanism-focused treatment. A dimensional approach is essential for clinical practice in tertiary care settings, particularly in Indian populations where certain dimensions may be culturally salient yet clinically overlooked.