Amara, a 19-year-old first-year student, has started arriving late to almost every class this semester. She explains, somewhat embarrassed, that she has repeated, unwanted thoughts about having left her dorm room's hot plate on, even on days she hasn't used it, and feels she has to go back and check it multiple times before she can leave, sometimes returning to her room three or four times in a single morning. She says, "I know it's probably fine, I even remember unplugging it, but the thought won't let go until I check again." This checking now takes over ninety minutes most days and has caused her to miss the beginning of two exams this semester. She also mentions feeling generally anxious about a range of things -- her course load, whether her roommate is annoyed with her, an upcoming family visit -- but says this worry, while unpleasant, doesn't involve the same repeated urge to perform a specific action the way the hot-plate checking does. She has never experienced any unusual beliefs about being watched or monitored, and her friends describe her as easy to talk to and emotionally present, just visibly stressed lately.
Step 1
Read Presenting Info
Read the presenting information above carefully, then continue when ready.
Step 2
Identify Salient Features
Select the features from this vignette that are most diagnostically salient.
Step 3
Identify Possible Families
Which disorder families should be considered as possible explanations for this presentation?
Step 4
Select Relevant Evidence
Select the pieces of evidence that most directly support the leading formulation.
Step 5
Consider Competing Explanations
Select the explanations that are legitimate competing possibilities worth weighing, even if ultimately less supported.
Step 6
Choose Best Formulation
Which formulation is best supported by the full pattern of evidence?
Step 7
Explain Reasoning
In 2-4 sentences, explain which evidence most strongly supports your formulation and why you ruled out the alternatives. Use hedged, professional language.
Step 8
Review Expert Explanation
Compare your reasoning to the expert explanation below.
Expert reasoning
This vignette is most consistent with Obsessive-Compulsive Disorder: Amara describes a specific, recurring intrusive thought (the hot plate) followed by a repetitive checking behavior aimed at relieving the distress it causes -- the core obsession-compulsion cycle -- consuming over ninety minutes most days and causing clear functional impairment (missed exam time). Her preserved insight, explicitly saying she "knows it's probably fine" while still feeling compelled to check, is an important piece of evidence distinguishing this from a delusion, where conviction is typically held despite -- rather than alongside an acknowledgment of -- contrary evidence. Her general worry about course load, her roommate, and an upcoming visit is worth weighing as a possible sign of co-occurring generalized anxiety, but she herself distinguishes it from the specific, ritualized relief-seeking pattern tied to the hot-plate thought, which is the feature most specifically diagnostic of OCD rather than GAD. As with any brief vignette, a full clinical picture would require further assessment before any conclusion could be treated as more than a working hypothesis.