This third chapter explores obsessive-compulsive disorder (OCD) within high-performance settings, focusing on the story of Steven Mitchell, a registered nurse navigating OCD in a demanding hospital environment. Steven’s symptoms, centred on contamination, precision, and responsibility, highlight the paradox faced by individuals who thrive under structure yet struggle with uncertainty. While attentiveness and perfectionism are often rewarded in healthcare, they can fuel compulsive behaviours that compromise wellbeing and efficiency. The chapter differentiates OCD from perfectionism and obsessive-compulsive personality disorder and outlines diagnostic criteria based on the DSM-5-TR, alongside tools including the OCI-R and OCD Distress Scale. A personalised intervention model is presented, integrating exposure and response prevention, cognitive reframing, and emotion regulation strategies such as breathwork and somatic anchoring. Steven’s case illustrates how structured coping, from task preparation to post-task reflection, can transform OCD-related traits into functional strengths. The approach aims not to eliminate high standards or discomfort but to cultivate flexible, adaptive responses that reduce compulsions and enhance resilience. This chapter showcases the potential for individuals with OCD to perform effectively in high-responsibility roles when supported by targeted interventions and promoting self-awareness.