Obsessive-compulsive disorder (OCD) spectrum includes conditions that bear features of but do not fit all of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for OCD. Habit-tic deformity, a common nail dystrophy induced by repeated picking at the proximal nail fold, illustrates how compulsion can be present in the absence of an obsessive component. The response of many OCD spectrum disorders to several medications, such as selective serotonin reuptake inhibitors or atypical antipsychotic agents (eg, risperidone), suggests a biochemical basis for these disorders. Even if a patient with a psychodermatologic complaint, such as habit-tic deformity, refuses to see a psychotherapist, any dermatology provider can help the patient with knowledgeable use of appropriate medications. This approach is likely to be more helpful than offering the patient no therapy at all.