To the Editor: We found the recent Clinical Case Conference by Jennifer E. Pate, M.D., and Glen O. Gabbard, M.D. (1), fascinating and illuminating. A similar case has also been described in a compendium of "interesting cases"(2). Recently, we had the opportunity to treat a patient with similar thoughts and symptoms. This patient had a higher level of psychiatric morbidity than the patient of Drs. Pate and Gabbard, and some clinicians involved felt that his symptoms were best explained by an obsessive-compulsive disorder (OCD) spectrum illness.