The dramatic surge in diversity in the western world requires a commitment by pediatric providers to understand unique psychosocial presentations of distress, as well as to have an understanding of normative cultural values and health-seeking behaviors. We report a case of apparent recurrent abdominal pain that evolved into a unique culturally salient presentation of obsessive compulsive disorder in a 6-year-old young girl. Access to integrated mental health professionals assisted in the identification of this disorder, if not success in referral and treatment.