intermediateOCPDOCDpersonality disordersego-syntonicego-dystonicY-BOCSdifferential diagnosis
A 39-year-old male accountant presents for evaluation at his wife's request. She reports that he is excessively rigid about household rules, creates detailed spreadsheets for all family activities, insists on controlling the family budget down to the penny, and becomes angry when family members deviate from his organizational systems. He works 60-70 hours per week and rarely takes vacations, viewing leisure activities as unproductive. He acknowledges these patterns but states, "This is just who I am — I believe in doing things the right way." He denies intrusive unwanted thoughts, does not perform rituals to reduce anxiety, and does not find his behavioral patterns distressing. He reports that his organizational style has been consistent since his early twenties. His Y-BOCS score is 4. What is the MOST likely diagnosis?