Obsessive-compulsive disorder (OCD) is rarely a standalone condition. Complex cases often present with comorbidities such as severe anxiety, depression, ADHD, ASD, Tic Disorders, eating disorders, personality disorders, and sometimes a combination of these and other conditions. In this presentation, we will explore the nuances of treating OCD in complex cases, highlighting the importance of clinical expertise in recognizing and addressing these comorbidities and adapting treatment. We will discuss tailored interventions that account for the interplay between conditions, ensuring more comprehensive and effective care for individuals facing these challenging symptom presentations and very complex cases.