Ms A, a 34-year old, single white woman presented with a chief complaint of “I’m obsessed, and I have lots of compulsive behaviors.” Since age 15, she had been preoccupied with her nose, which she thought was huge, hideous, and horrendous looking.” Because of this concern, she sometimes missed school, avoided friends, and felt suicidal. She stated at times, she realized that her view of her appearance was “probably distorted,” but at other times, especially when she was around other people, she was “absolutely, 100% convinced” that her belief was correct. Ms A was also excessively concerned about germs. She washed her hands up to 50 times a day and avoided activities that she thought might lead to contamination. In addition, she reported a history of hair pulling, which in her 20’s had resulted in noticeable hair loss. The patient’s family history was notable for Tourette’s disorder in a brother.
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