Little is known about OCD in people with learning disabilities (LD) in general and in terms of current and professional support. In this study, we examined caregivers' perceived challenges and strategies practiced in institutionalized settings in managing OCD in people with LD and derived implications for research and practice. We studied individual cases of people with LD (n = 7). Each case included group discussions (n = 28) and semistructured interviews with caregivers (n = 20). We used qualitative content analysis to analyze the data. Our findings reveal the following challenges for caregivers: recognizing and classifying ambiguous behaviors, recognizing emotional well-being and needs through nonverbal signals, finding and applying effective strategies, being unqualified regarding additional needs, managing inappropriate institutionalized conditions, and lacking external specialization. We identified five strategies for dealing with compulsive behavior: tolerating and allowing, accepting and supporting, involving, limiting the compulsive act, and stopping the act. Collaboration among psychiatric, therapeutic, and caregivers in institutionalized settings is critical for early identification and support of OCD. Challenges arise from caregivers' lack of training on the additional needs of people with LD and OCD, highlighting the urgent need for disorder-specific guidelines for identification and support.