ABSTRACT
Angela is 9 years old. She has been anxious “her whole life” but her fears have increased in the past year. She has a myriad of negative thoughts and images, all with the underlying theme of harm or death to herself. Her fears include enclosed places, eating food without washing her hands, tornadoes, house fi res, her house sinking into the ground, and her heart stopping. In response to these obsessions, Angela engages in numerous rituals and avoidance behaviors including reassurance seeking, hand washing (three times per hour with dishwasher detergent), and refusing to eat certain foods and/or without washing her hands fi rst. As her fears have increased, her grades at school have decreased and there is increased family tension. Angela has been treated in the past, unsuccessfully, for specifi c phobias.
