Maria, a 14-year-old Caucasian American female in the eighth grade, was referred for a consultation. At her initial evaluation, Maria stated that she was constantly bothered by thoughts of suffering brain damage and participating in immoral acts. In addition, she was spending a great deal of time trying to avoid activities that might suggest that she had brain damage and to minimize the chances that she would get brain damage. Although Maria had been a good student who enjoyed learning, she was currently having difficulty in school because of the above named symptoms. She also reported no longer reading for enjoyment, which was one of her favorite activities. Maria recalled that the symptoms first surfaced in the first grade when she experienced persistent concerns about germs that led to frequent hand-washing. These thoughts continued over the past several years.