A 45 year old man keeps having intrusive thoughts about having dirt under the bed. He can’t keep himself from thinking about these thoughts. If he tries to resist, he starts having palpitations. What is the most likely diagnosis?

The key is B. OCD. [Obsessive-Compulsive Disorder (OCD) is a disorder in which a person has

uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the

urge to repeat over and over. Here patient’s thoughts are obsession and though no compulsive act is

described (like repeated cleansing of dirt) but his nature of thought like inability to resist the thinking or

getting palpitation on trying to avoid thinking can be regarded as compulsion of thought. CBT is 1st line

treatment and antidepressants (SSRIs) are tried if no response to CBT. More severe OCD may require a

longer course of therapy and/or medication].