Does a patient with obsessive cleaning behaviors, limited to her own home, and no concern for others' homes, meet the diagnostic criteria for obsessive-compulsive disorder (OCD)?

Does This Patient Have OCD?

No, this patient does not meet diagnostic criteria for OCD based on the information provided—her cleaning behaviors appear to be ego-syntonic preferences for personal tidiness rather than ego-dystonic, anxiety-driven compulsions that cause marked distress or functional impairment.

Critical Diagnostic Features Missing

The key distinction lies in whether these behaviors are ego-dystonic (experienced as intrusive, unwanted, and excessive) versus ego-syntonic (consistent with personal values and preferences) 1.

What You Need to Assess:

Ego-dystonicity Assessment:

• Does she experience her cleaning thoughts as intrusive, unwanted, and anxiety-provoking? 1
• Does she recognize these behaviors as excessive and wish she had more control over them? 2
• Most OCD patients are keenly aware their compulsive symptoms are excessive 2

True Compulsions vs. Preferences:

• Are the cleaning behaviors performed rigidly to neutralize specific fears (e.g., contamination obsessions) or reduce anxiety? 1
• Does she experience marked distress if unable to clean? 3
• OCD compulsions are repetitive behaviors performed in response to obsessions to manage distress or prevent harm 3

Time and Functional Impairment:

• Do symptoms consume more than 1 hour daily? 1
• Is there substantial distress or disability affecting work, relationships, or daily functioning? 1

The Differential: Obsessive-Compulsive Personality Disorder

This presentation is more consistent with Obsessive-Compulsive Personality Disorder (OCPD) or simply personal preference:

• OCPD involves pervasive patterns of perfectionism, orderliness, and control that are ego-syntonic 1
• Unlike OCD, OCPD patients do not experience intrusive, unwanted obsessions or feel driven to perform compulsions 1
• OCPD patients typically do not recognize their patterns as excessive and lack the insight and distress seen in OCD 1
• The fact she only cares about her own home (not others') suggests personal preference rather than anxiety-driven contamination obsessions 1

What Would Indicate OCD Instead

If she had contamination-dimension OCD, you would expect:

• Obsessions: Intrusive concerns about dirt, germs, or contamination 2
• Compulsions: Washing, showering, or cleaning rituals performed to reduce contamination anxiety 2
• Avoidance: Curtailing activities to avoid triggering obsessions 2
• Distress: Significant anxiety when unable to perform cleaning rituals 3
• Generalization: Contamination fears would likely extend beyond just her home 2

Structured Assessment Approach

Use the Yale-Brown Obsessive Compulsive Scale (Y-BOCS):

• Scores ≥14 indicate clinically significant OCD requiring treatment 1, 4
• This quantifies whether symptoms reach pathological threshold 4

Key Questions to Ask:

1. "Do thoughts about cleaning your home feel intrusive or unwanted, or do they feel like normal preferences?" 1
2. "What happens if you cannot clean when you want to—do you experience significant anxiety or distress?" 1
3. "Do you feel driven to clean to prevent something bad from happening?" 1
4. "How much time per day do you spend on cleaning-related thoughts and behaviors?" 1

Common Pitfall to Avoid

Do not confuse high standards or preferences for cleanliness with OCD. The critical distinction is that OCD involves anxiety-driven, ego-dystonic obsessions and compulsions that cause marked distress, whereas preferences (even strong ones) are ego-syntonic and do not cause the same level of functional impairment 1. The fact that she is unconcerned about others' homes strongly suggests this is a personal preference rather than a contamination obsession that would generalize across contexts 2.