Case 5: This pattern is illustrated by the case of a 13 year old boy who was constantly preoccupied with the thought that he wanted to hurt other people. Whenever he saw someone asleep. he was struck by the thought that he had killed them. In his religious observances he felt compelled to make the sign of the cross three times instead of once as other people did. He refused to watch deaths portrayed in movies and television because he thought they were real. He also was afraid of bumping and hurting other people and for this reason he avoided crowds and all the usual boyhood sports.