Introduction
Some gifted students shine in bursts—moments of intense clarity, rapid output, and intellectual brilliance. But for some, these breakthroughs come at a cost. This case explores a twice-exceptional (2e) college student whose rituals and environmental sensitivities became both a strength and an obstacle. Beneath the surface of academic potential lies a deeper story of rigidity, overwhelm, and missed windows of opportunity.
“When everything is in place, I feel unstoppable. But if one thing is out of order, the whole day collapses.”
Background and Profile
The subject of this case is a 20-year-old college junior attending a competitive liberal arts university. Identified as profoundly gifted in early childhood, he demonstrated advanced verbal reasoning, spatial awareness, and pattern recognition. He also showed signs of executive functioning difficulty and sensory sensitivity, though no formal diagnosis was made until college.
Raised in a high-achieving academic household, he developed structured study routines that brought him success in high school. However, upon entering college and living with roommates, his need for a controlled environment clashed with the unpredictability of shared space. What began as “I need my desk clean to study” evolved into hours spent cleaning shared living areas before he could even begin his work.
Difficulties and Behavioral Patterns
- Rigid ritual dependency before initiating tasks
- Procrastination due to environment not meeting "just right" standards
- Obsessive need to clean or organize shared space before starting work
- High productivity in short time windows, often late at night
- Chronic exhaustion, frustration, and incomplete academic work
- Inability to recognize the pattern without external prompting
- Mounting anxiety and depression fueled by the exhausting and unsustainable loop
The client would often spend 3–4 hours organizing his space and preparing materials before being able to focus. On the rare occasions everything aligned perfectly, he could absorb complex material in one sitting and score in the top percentile. However, these “perfect days” were rare, and more often, he ended up studying late into the night in a state of stress and frustration.
“If the sink has dishes, I can’t read. If my roommate leaves a towel on the floor, I spiral.”
Diagnosis and Conceptualization
Based on the collected data—including our intake session, weekly therapy sessions, and academic reports—the client presented with:
- Twice-exceptionality: Giftedness co-occurring with traits of ADHD and obsessive-compulsive tendencies
- OCPD-like behaviors: Rigid standards, perfectionism, and overcontrol not formally diagnosed as OCD
- Executive dysfunction: Difficulty initiating tasks and managing time as well as difficulty tolerating and regulating distressing emotions
Psychodynamic and cognitive-behavioral frameworks revealed that the rituals functioned as a way to create internal safety and predictability. He was less anxious when everything external was "right." The problem was that the conditions for this state were rarely met.
Understanding the Role of Procrastination
As therapy progressed, one of the clearest blocks to academic momentum wasn’t just environmental chaos—it was procrastination. But it wasn’t procrastination in the typical sense. The client wasn't bored or lazy. Instead, he was stuck in a loop: he couldn’t begin work until every part of the process felt perfect. And when it wasn’t, the task got pushed later and later—sometimes until 2 or 3 a.m.
Procrastination in twice-exceptional teens often hides deeper dynamics:
- Perfectionism: “If I can’t do it perfectly, why even start?”
- Executive dysfunction: Trouble breaking assignments into manageable steps or transitioning into “work mode.”
- Emotional overwhelm: Avoidance rooted in anxiety, sensory overload, or fear of failure.
In this client’s case, the procrastination wasn’t idle avoidance—it was obsessive. He would rewrite essay intros over and over. Clean the same shelf multiple times. Start reading, then stop to reorder his desk again. These behaviors began to mirror OCD-like patterns.
“Sometimes I don’t even know what I’m avoiding. I just know if it’s not perfect, I can’t breathe.”
OCD-Based Procrastination vs. General Procrastination
| Symptom | General Procrastination | OCD-Driven Procrastination |
|---|---|---|
| Reason for delay | Lack of motivation, boredom, disinterest | Fear, intrusive thoughts, perfectionistic rituals |
| Behavior | Avoids task or distracts self | Over-checks, rereads, edits obsessively |
| Emotional pattern | Mild guilt or apathy | Panic, dread, temporary relief after ritual |
| Relief cycle | Relief once the task is done | May get new obsession even after completing the task |
| Effect on functioning | Inconsistent but often functional | Emotionally draining, impairs functioning |
What Helped
- ERP (Exposure and Response Prevention): To help break rituals like over-cleaning and repeated re-checking.
- CBT: To reframe catastrophic thinking and perfectionism.
- Values-based work: To reconnect with why he wanted to succeed, even when it felt messy or uncomfortable.
- Executive functioning coaching: To break tasks into smaller chunks and define “done is better than perfect” goals.
We began by creating a space where he could slow down and explore what was happening inside—without judgment. Together, we got to know the different parts within him: the one striving for perfection, and the one feeling exhausted and overwhelmed by that pursuit. Rather than treating them as enemies, we explored how each part was trying to help him succeed—just in very different ways. With curiosity and compassion, we recognized that both parts were working toward a shared goal: keeping him safe, capable, and aligned with his high standards.
As this clarity emerged, we were able to help him access his wiser, more integrated self—the version of him that could lead from values rather than fear. From that grounded place, we helped him shift out of the chronic fight-or-flight amygdala state. Using coping skills and assertive communication strategies, he learned how to regulate his body and nervous system when OCD patterns were triggered.
Once he could consistently access his executive functioning brain, we began layering in practical strategies:
“Procrastination wasn’t my problem—it was my shield. Once I put it down, I could finally move.”
Treatment Goals and Outcomes
Treatment goals were collaboratively defined as:
- Reduce time spent in pre-study rituals
- Increase tolerance for “good enough” environments
- Build emotional regulation when expectations are disrupted
- Reframe identity from “I’m only smart when everything is perfect” to “I can function under varied conditions”
By month four of therapy, the client was initiating academic work earlier in the day and feeling good about his schoolwork more days than not. He also advocated for clearer agreements with his roommates and began exploring meditation and physical movement as alternate transitions into focus. GPA stabilized, and the client expressed greater ease navigating daily stressors.
Conclusion
This case illustrates how giftedness can sometimes mask deeper rigidity or dysregulation patterns—especially in high-functioning individuals who are praised for results but quietly suffer in the process. Helping twice-exceptional students expand their internal flexibility allows their brilliance to flourish without being tethered to perfectionism or external control. Therapy was not about removing the ritual but giving the client a wider range of options and helping him feel safe enough to choose from them.
“Therapy gave me something I didn’t expect-
permission to let go.”
