A 15-year-old boy is referred to a psychiatrist by his counselor because of academic difficulty. Although he had always been an honors student, this past year his grades have quickly dropped, especially in mathematics. When questioned, he reveals the new onset of “superstitions” involving numbers. When presented with certain numbers, he feels compelled to count forwards and then back to and from that number. He becomes anxious about not completing this task, although he is unable to state a consequence. If interrupted, he must begin all over again.
He realizes that there is “no good reason” for his behavior but is unable to stop it. As a result of this, he not only feels “tortured,” but he may need to repeat this year in school. He denies any past psychiatric history. He had an appendectomy at age 15 and takes no medications. He does not drink alcohol or uses tobacco products or illicit…
