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The changes in the DSM-5 bring these challenges to light, in allowing OCD to be specified as having absent insight or delusional beliefs. This can be especially distressing for caregivers, who play a major role in treatment, especially among youth. We present a case of a 16-year-old male presenting to care in his first episode of psychosis with overlapping obsessive-compulsive features, later found to have OCD. We discuss diagnostic and treatment approaches for someone presenting with overlapping psychotic and obsessive-compulsive features and highlight the underrecognized, but indisputably important role of caregivers throughout the process.<\/jats:p>","DOI":"10.1177\/13591045261417452","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T11:32:56Z","timestamp":1768563176000},"page":"582-590","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["OCD or Psychosis? 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