This case presents the treatment of a seventeen-year-old male for anxiety disorder. The treatment focused on cognitive exposure therapy and in-vivo exposure for family and school-based concerns. Since the completion of treatment, the client has had success at a traditional boarding school and has had not been limited by anxiety. Background Information Jack arrived at WayPoint Academy at the age of 17 years and 6 months. He grew up as the only child of single mother, Mary. His biological father had a brief relationship with his mother but they never married. Jack's interaction with his father was intermittent and sporadic, as his father lived in a different state. There were times that Jack had no contact with his father for years. During the pregnancy, Mary reported her first episode with Obsessive Compulsive Disorder (OCD), which was evident primarily in contamination fears. Convinced the world around her was contaminated, Mary was propelled into a host of compulsive rituals. She thought the public water supply was contaminated and hence she purchased "pure" water in one-gallon bottles. The "pure" water usage ranged from personal hygiene (showers, brushing teeth) to washing dishes and drinking water for the family and the family pet. The cost of the "pure" water prevented the family members from taking regular showers and the timely washing of clothing and bedding, which, paradoxically contributed to the decline in overall hygiene of the home. Mary's contamination fear morphed into related obsessions. The "contaminated" outside air "forced" the family to stay indoors for long periods of time. Shopping trips were followed with elaborate "cleansing" rituals. Because of the rarity of outside shopping trips, the "pure" water supply was limited and dirty dishes, pots, and pans were found throughout the apartment. The same was true for items of clothing.

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