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In a subgroup of patients, obsessive–compulsive disorder (OCD) is associated with organic conditions such as head injury. In general, different studies evaluating the efficacy and effectiveness of nonpharmacological and pharmacological interventions in patients with OCD exclude patients with OCD associated with organic conditions. Hence, there is little information about the difficulties faced in managing these patients. In this report, we present a young male who presented with OCD after the head injury, in whom it was not possible to carry out exposure and response prevention (ERP) therapy, as recommended due to the poor insight and associated cognitive impairment. We managed the patient with a combination of psychoeducation, ERP, using positive reinforcement and supportive therapy.