Obsessive-Compulsive and Related Disorders in Older Age

  • Shannon Suo
  • Puja Chadha


The Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) took obsessive-compulsive disorder (OCD) and its related disorders out of anxiety disorders and created a new category to reflect evidence of their differences from anxiety. Hoarding and excoriation disorders are new diagnoses added to DSM-5, having been recognized as separate disorders rather than symptoms of other anxiety or personality disorders since the publication of DSM-IV. OCD and hoarding disorder are among the more commonly recognized psychiatric problems by the general public. Popular television shows now feature characters with these diseases, and reality shows like Hoarders center around the all-too shocking problems that such behaviors can create. While these disorders occur less frequently in geriatric patients, the impact these disorders can have on older adults can be more devastating than in younger adults. Older patients are more medically and physically vulnerable, more prone to social isolation, and problems such as hoarding can reach such devastating proportions as to result in the loss of house and home or severe medical consequences. This chapter will focus on five main diagnoses: OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation (skin-picking) disorder. We will discuss their diagnosis, disease course, and management. At the end of the chapter, we focus on two case studies intended to highlight how someone with the featured disorder may present along with important considerations in their work-up and management.


Obsessive-compulsive disorder (OCD) Body dysmorphic disorder Trichotillomania Hoarding disorder Excoriation disorder Skin-picking disorder 


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013. p. 235–64.CrossRefGoogle Scholar
  2. 2.
    Carey G, Gottesman II. Twin and family studies of anxiety, phobic and obsessive disorders. In: Klein DF, Rabkin J, editors. Anxiety: new research and changing concepts. New York: Raven Press; 1981. p. 117–36.Google Scholar
  3. 3.
    Nestadt G, Samuels J, Riddle M, Bienvenu OJ 3rd, Liang KY, LaBuda M, Walkup J, Grados M, HoehnSaric R. A family study of obsessive-compulsive disorder. Arch Gen Psychiatry. 2000;57:358–63.CrossRefPubMedGoogle Scholar
  4. 4.
    Lindesay J. Phobic disorders in the elderly. Br J Psychiatry. 1991;159:531–41.CrossRefPubMedGoogle Scholar
  5. 5.
    Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety. 2010;27(2):190–211.CrossRefPubMedGoogle Scholar
  6. 6.
    Schirmbeck F, Zink M. Comorbid obsessive-compulsive symptoms in schizophrenia: contributions of pharmacological and genetic factors. Front Pharmacol. 2013;4:99. Scholar
  7. 7.
    Ayers CR, Saxena S, Golshan S, Wetherell J. Age at onset and clinical features of late life compulsive hoarding. Int J Geriatr Psychiatry. 2010;25(2):142–9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hoehn-Saric R. Neurotransmitters in anxiety. Arch Gen Psychiatry. 1982;39:735–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Nutt D, Lawson C. Panic attacks: a neurochemical overview of models and mechanisms. Br J Psychiatry. 1992;160:165–78.CrossRefPubMedGoogle Scholar
  10. 10.
    Whalley LJ. Drug treatments of dementia. Br J Psychiatry. 1989;155:595–611.CrossRefPubMedGoogle Scholar
  11. 11.
    Hahm DS, Kang Y, Cheong SS, Na DL. A compulsive collecting behavior following an A-com aneurysmal rupture. Neurology. 2001;56:398–400.CrossRefPubMedGoogle Scholar
  12. 12.
    Schirmbeck F, Rausch F, Englisch S, Eifler S, Esslinger C, Meyer-Lindenberg A, Zink M. Differential effects of antipsychotic agents on obsessive–compulsive symptoms in schizophrenia: a longitudinal study. J Psychopharmacol. 2013;27(4):349–57.CrossRefPubMedGoogle Scholar
  13. 13.
    Frost RO, Steketee G, Grisham J. Measurement of compulsive hoarding: saving inventory-revised. Behav Res Ther. 2004;42(10):1163–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Dozier ME, Ayers CR. Validation of the clutter image rating in older adults with hoarding disorder. Int Psychogeriatr. 2015;27(05):769–76.CrossRefPubMedGoogle Scholar
  15. 15.
    Stanley MA, Wilson NL, Novy DM, et al. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. JAMA. 2009;301:1460–7.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    |FCO|Hyperlink, Wetherell JL, Hopko DR, Diefenbach GJ, et al. Cognitive-behavioral therapy for late-life generalized anxiety disorder: who gets better? Behav Ther. 2005;36:147–56. |FCC|.Google Scholar
  17. 17.
    Stanley MA, Wilson NL, Amspoker AB, et al. Lay providers can deliver effective cognitive behavior therapy for older adults with generalized anxiety disorder: a randomized trial. Depress Anxiety. 2014;31:391–401.CrossRefPubMedGoogle Scholar
  18. 18.
    Stanley MA, Beck JG, Novy DM, et al. Cognitive-behavioral treatment of late-life generalized anxiety disorder. J Consult Clin Psychol. 2003;71:309–19.CrossRefPubMedGoogle Scholar
  19. 19.
    Brenes GA, Danhauer SC, Lyles MF, et al. Telephone-delivered cognitive behavioral therapy and telephone-delivered nondirective supportive therapy for rural older adults with generalized anxiety disorder: a randomized clinical trial. JAMA Psychiat. 2015;72(10):1012–20.CrossRefGoogle Scholar
  20. 20.
    Wetherell JL, Gatz M, Craske MG. Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychol. 2003;71:31–40.CrossRefPubMedGoogle Scholar
  21. 21.
    Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164(7 Suppl):5–53.PubMedGoogle Scholar
  22. 22.
    FDA Drug Safety Communication: Revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses.
  23. 23.
    Dold M, Aigner M, Lanzenberger R, Kasper S. Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: an update meta-analysis of double-blind, randomized, placebo-controlled trials. Int J Neuropsychopharmacol. 2015;18(9):1–11.CrossRefGoogle Scholar
  24. 24.
    Tenneij NH, van Megen HJ, Denys DA, Westenberg HG. Behavior therapy augments response of patients with obsessive-compulsive disorder responding to drug treatment. J Clin Psychiatry. 2005;66:1169–75.CrossRefPubMedGoogle Scholar
  25. 25.
    Simpson HB, Foa EB, Liebowitz MR, et al. A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. Am J Psychiatry. 2008;165:621–30.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Simpson HB, Foa EB, Liebowitz MR, et al. Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiat. 2013;70(11):1190–9.CrossRefGoogle Scholar
  27. 27.
    Kisely S, Hall K, Siskind D, et al. Deep brain stimulation for obsessive-compulsive disorder: a systematic review and meta-analysis. Psychol Med. 2014;44(16):3533–42.CrossRefPubMedGoogle Scholar
  28. 28.
    de Koning PP, Figee M, van den Munckhof P, et al. Current status of deep brain stimulation for obsessive-compulsive disorder: a clinical review of different targets. Curr Psychiatry Rep. 2011;13(4):274–82.CrossRefPubMedGoogle Scholar
  29. 29.
    Guide to clinical preventive services, 2014. Recommendations of the U.S. Preventive Services Task Force. Rockville: AHRQ; 2014.Google Scholar
  30. 30.
    Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006 (DHHS Publication No. PHS 2008–1250). Hyattsville: U.S. Dept. of Health and Human Services/Centers for Disease Control and Prevention/National Center for Health Statistics; 2008.Google Scholar
  31. 31.
    Barbour KE, Helmick CG, Theis KA, Murphy LB, Hootman JM, Brady TJ, et al. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2010–2012. Morb Mortal Wkly Rep. 2013;62(44):869–73.Google Scholar
  32. 32.
    Ayers CR, Iqbal Y, Strickland K. Medical conditions in geriatric hoarding disorder patients. Aging Ment Health. 2014;18(2):148–51.CrossRefPubMedGoogle Scholar
  33. 33.
    Hwang JP, Tsai SJ, Yang CH, Liu KM, Lirng JF. Hoarding behavior in dementia: a preliminary report. Am J Geriatr Psychiatry. 1998;6(4):285–9.PubMedGoogle Scholar
  34. 34.
    Lebert F. Diogenes syndrome, a clinical presentation of fronto-temporal dementia or not? Int J Geriatr Psychiatry. 2005;20(12):1203–4.CrossRefPubMedGoogle Scholar
  35. 35.
    Bathgate D, Snowden JS, Varma A, Blackshaw A, Neary D. Behaviour in frontotemporal dementia, Alzheimer’s disease and vascular dementia. Acta Neurol Scand. 2001;103(6):367–78.CrossRefPubMedGoogle Scholar
  36. 36.
    Ayers CR, Wetherell JL, Schiehser D, Almklov E, Golshan S, Saxena S. Executive functioning in older adults with hoarding disorder. Int J Geriatr Psychiatry. 2013;28(11):1175–81.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of California DavisSacramentoUSA

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