Overcoming OCD: Managing Cleanliness Standards and Anxiety in Daily Life - Psychiatry

I have obsessive-compulsive disorder (OCD) with a focus on cleanliness. I have questions regarding improvement and standards of cleanliness?

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Hello, Doctor.
I am currently a university student.
I started experiencing obsessive cleanliness behaviors since the first year of junior high school.
I clearly remember researching how to wash my hands after using the restroom to ensure they were clean (I would rinse my hands ten times and wash them three times).
At that time, my hands were very clean, but I didn't have other obsessive behaviors.
In high school, I developed two additional habits: I began sitting down to urinate because I couldn't avoid splashing, and I would use toilet paper to dry the glans after urination (if I didn't, there would be residual moisture that could lead to odor).
My compulsive hand-washing behavior improved significantly during junior high; aside from being very particular about using soap or hand wash after using the restroom, my hand-washing frequency was not much different from that of an average person.
This situation persisted until about a year ago.
Although I knew I had obsessive cleanliness, it didn't significantly affect my daily life.
However, a year ago, due to issues at school, I stopped attending classes (I am currently considering applying for a leave of absence to retake my studies).
During this time, my obsessive cleanliness worsened, and I found it impossible to pick up and read textbooks (I even cried several times, wondering why I couldn't read them).
Earlier this year, I also experienced symptoms of autonomic nervous system dysregulation.
After nearly a year of self-adjustment and attempts, I can now read school-related materials normally (until last month, I could only read on the computer because I was afraid to touch physical books due to my cleanliness obsession).
However, my obsessive cleanliness has not improved much.
I started to notice a crisis a few months ago; even though I couldn't read textbooks during that period, I love reading, so I had no issues with general books.
However, a few months ago, I began to fear that the books I bought would become dirty, which led to a loss of interest in reading (I could only browse books in stores and couldn't buy them, as I was afraid to take them out to read).
My hand-washing frequency increased (I experienced typical obsessive cleanliness behaviors, such as feeling dirty if water splashed on my hands while washing, or feeling the need to wash my hands after touching public doorknobs).
I washed my hands until my skin peeled, and my shower time increased from about 20 minutes to over 40 minutes (sometimes even up to an hour and a half).
Although I haven't seen a psychiatrist yet, I have tried cognitive therapy, cognitive-behavioral therapy, and exposure response prevention.
Recently, I found a purpose in life, and my reading situation has normalized; at least I can now write on disposable paper with a pen.
I have several questions I would like to ask:
Question 1: I am unclear about what constitutes a "normal" standard for cleanliness.
While I understand that everyone's hygiene habits vary, there must be a range that can serve as a reference point for me to strive toward.
When I encounter anxiety, I ask family members how they handle similar situations.
If they consider their habits normal, I try to refrain from reacting.
Since I live in a shared apartment, I know I have obsessive cleanliness, but I wonder if my neighbors' hygiene habits exceed what I consider normal.
Neighbor A never uses toilet paper after defecating, only washing with water, but always leaves feces on the floor, and occasionally there is fecal residue on the sink.
Neighbor B (who has been diagnosed with bipolar disorder) uses toilet paper, but for some reason, feces still remains on the floor (there have also been instances of vomit), and he once accumulated an entire bucket of unknown black substance in his room.
I am unsure if it was feces, but when B later went to clean the bucket, the entire floor smelled like a sewage system (to the point where I almost vomited).
Given this situation, I am uncertain whether my concerns stem from my obsessive cleanliness or if it is simply that these two individuals have poor hygiene.
Question 2: As a normal male, I also engage in masturbation.
However, yesterday I accidentally ejaculated on the chair and the floor.
I am unclear about what the normal cleanliness standard is, and there are no examples to reference.
I would like to ask the doctor if my cleaning method was sufficient: I first wiped it up with toilet paper and then used antibacterial wet wipes.
Is this adequate for cleaning? (In the past, I have experienced ejaculation on my hands, and no matter how much I washed, there was still a lingering sensation and odor, leading me to feel it wasn't clean enough.
Is this a normal phenomenon, or is there a better cleaning method?) Although I am still using the chair, I am somewhat concerned.
Question 3: Although I have obsessive cleanliness, my fixation is primarily on areas that my body or hands and feet come into contact with.
My room is not particularly clean.
I have been trying exposure response prevention, but my hypothesis is that obsessive cleanliness may relate to trust in the environment.
After all, if a normal person were placed in an extremely dirty environment, such as a compost pile, anyone would feel anxious.
Therefore, if I were to focus my obsessive cleanliness energy on cleaning the overall environment, would this eventually lead to increased trust in the environment and naturally reduce my obsessive cleanliness?
Question 4: Similar to question 3, since my neighbors' hygiene habits exceed my understanding of what is normal, if this is indeed their hygiene issue, would moving out be more beneficial for improving my obsessive cleanliness symptoms?
Question 5: Since I currently do not plan to seek medical treatment, are there other self-improvement methods I can try?
Thank you, Doctor.

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Oda, 20~29 year old female. Ask Date: 2020/12/01