Case 7: A mother who cleans twice a day for fear of infection

Case 7: A mother who cleans twice a day for fear of infection

A 29-year-old mother who has become preoccupied with the fear that her children will catch an infection.

  • 2 min read
  • Checked 01 Nov 2026

The case

A 29-year-old woman has grown very worried that her children might catch an infectious disease. She cleans the house twice a day and has cut her children's contact with other people to a minimum, even for play. She also counts in her head, linking certain numbers with the risk of infection. Her hands are sore from detergent. She accepts that there is no real reason to fear contamination, and says she is ashamed of the thoughts.

Summary

Diagnosis

Obsessive-compulsive disorder, or OCD, with contamination obsessions and cleaning and counting compulsions.

What points to it

  • Obsessions: intrusive, repeated thoughts that her children will be infected.
  • Compulsions: cleaning twice a day and counting in her head, which ease the anxiety for a while.
  • Insight: she knows the fears are groundless, is embarrassed by them and tries to resist.
  • Harm and impairment: sore hands, and her children's lives restricted.

What else it could be

Obsessional symptoms can be part of depression, which is treated in its own right, so ask about mood and which came first. In generalised anxiety the worries are about real-life matters and are not resisted as senseless. A fixed belief of contamination held without insight suggests a psychosis. Anankastic personality traits are lifelong and felt as her own, without intrusive thoughts she fights.

Management

  • Explain the disorder. Involve the family, and ask them not to join in the rituals or keep giving reassurance.
  • CBT with exposure and response prevention: she faces the feared contact step by step without cleaning afterwards.
  • An SSRI, an antidepressant such as sertraline or fluoxetine, often at higher doses, given at least 12 weeks before judging it, and continued for at least a year once she is well.
  • Clomipramine if an SSRI fails or is not tolerated, then specialist care for more resistant illness.
  • Emollients for her hands.

Outlook

Often chronic, with ups and downs. Most people improve with treatment, but only about a quarter improve markedly, a fifth to a third stay unwell or get worse, and relapse is likely if medication stops.