Skip to main content

Obsessive-Compulsive and Related Disorders

  • Chapter
  • First Online:
Geriatric Psychiatry
  • 228 Accesses

Abstract

The Diagnostic and Statistical Manual of Mental Disorders-5th 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 disorders. Hoarding and excoriation disorders were 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 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 focuses on five main diagnoses: OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation (skin-picking) disorder. We will discuss their diagnoses, 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 workup and management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text revision ed. Washington, DC: American Psychiatric Association; 2022. https://doi.org/10.1176/appi.books.9780890425787.x06_Obsessive_Compulsive_and_Related_Disorders.

    Book  Google Scholar 

  2. Fawcett EJ, Power H, Fawcett JM. Women are at greater risk of OCD than men: a meta-analytic review of OCD prevalence worldwide. J Clin Psychiatry. 2020;81(4):19r13085. https://doi.org/10.4088/JCP.19r13085.

    Article  PubMed  Google Scholar 

  3. Dell’Osso B, Benatti B, Rodriguez CI, et al. Obsessive-compulsive disorder in the elderly: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Eur Psychiatry. 2017;45:36–40. https://doi.org/10.1016/j.eurpsy.2017.06.008.

    Article  PubMed  Google Scholar 

  4. Pauls DL. The genetics of obsessive-compulsive disorder: a review. Dialogues Clin Neurosci. 2010;12(2):149–63. https://doi.org/10.31887/DCNS.2010.12.2/dpauls.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Torres AR, Ramos-Cerqueira ATA, Ferrão YA, et al. Suicidality in obsessive-compulsive disorder: prevalence and relation to symptom dimensions and comorbid conditions. J Clin Psychiatry. 2011;72(1):17–26.

    Article  PubMed  Google Scholar 

  6. Fernández de la Cruz L, Rydell M, Runeson B, et al. Suicide in obsessive-compulsive disorder: a population-based study of 36 788 Swedish patients. Mol Psychiatry. 2017;22(11):1626–32.

    Article  PubMed  Google Scholar 

  7. Roane DM, Landers A, Sherratt J, Wilson GS. Hoarding in the elderly: a critical review of the recent literature. Int Psychogeriatr. 2017;29(7):1077–84. https://doi.org/10.1017/S1041610216002465.

    Article  PubMed  Google Scholar 

  8. Moreira Abreu L, Gama Marques J. Noah syndrome: a review regarding animal hoarding with squalor. Innov Clin Neurosci. 2022;19(7–9):48–54.

    PubMed  PubMed Central  Google Scholar 

  9. Grant JE, Dougherty DD, Chamberlain SR. Prevalence, gender correlates, and co-morbidity of trichotillomania. Psychiatry Res. 2020;288:112948. https://doi.org/10.1016/j.psychres.2020.112948.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Stewart E, Grunthal B, Collins L, Coles M. Public recognition and perceptions of obsessive compulsive disorder. Community Ment Health J. 2019;55(1):74–82. https://doi.org/10.1007/s10597-018-0323-z.

    Article  PubMed  Google Scholar 

  12. Sharma E, Sharma LP, Balachander S, et al. Comorbidities in obsessive-compulsive disorder across the lifespan: a systematic review and meta-analysis. Front Psychiatry. 2021;12:703701. https://doi.org/10.3389/fpsyt.2021.703701.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Preti A, Meneghelli A, Poletti M, Raballo A. Through the prism of comorbidity: a strategic rethinking of early intervention in obsessive-compulsive disorder. Schizophr Res. 2022;239:128–33. https://doi.org/10.1016/j.schres.2021.11.038.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hoehn-Saric R. Neurotransmitters in anxiety. Arch Gen Psychiatry. 1982;39:735–42.

    Article  CAS  PubMed  Google Scholar 

  16. Nutt D, Lawson C. Panic attacks: a neurochemical overview of models and mechanisms. Br J Psychiatry. 1992;160:165–78.

    Article  CAS  PubMed  Google Scholar 

  17. Whalley LJ. Drug treatments of dementia. Br J Psychiatry. 1989;155:595–611.

    Article  CAS  PubMed  Google Scholar 

  18. Hahm DS, Kang Y, Cheong SS, Na DL. A compulsive collecting behavior following an A-com aneurysmal rupture. Neurology. 2001;56:398–400.

    Article  CAS  PubMed  Google Scholar 

  19. Kim DD, Barr AM, White RF, Honer WG, Procyshyn RM. Clozapine-induced obsessive–compulsive symptoms: mechanisms and treatment. J Psychiatry Neurosci. 2019;44(1):71–2. https://doi.org/10.1503/jpn.180087.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tolin DF, Gilliam CM, Davis E, et al. Psychometric properties of the hoarding rating scale-interview. J Obsess Compuls Relat Disord. 2018;16:76–80. https://doi.org/10.1016/j.jocrd.2018.01.003.

    Article  Google Scholar 

  21. Dozier ME, Ayers CR. Validation of the clutter image rating in older adults with hoarding disorder. Int Psychogeriatr. 2015;27(05):769–76.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. 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.

    Article  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Pomerleau VJ, Sekhon H, Bajsarowicz P, Demoustier A, Rej S, Myhr G. Do older adults respond to cognitive behavioral therapy as well as younger adults? An analysis of a large, multi-diagnostic, real-world sample. Int J Geriatr Psychiatry. 2023;38(6):e5953. https://doi.org/10.1002/gps.5953.

    Article  PubMed  Google Scholar 

  27. 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 Psychiatry. 2015;72(10):1012–20.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ayers CR, Dozier ME, Twamley EW, et al. Cognitive rehabilitation and exposure/sorting therapy (crest) for hoarding disorder in older adults: a randomized clinical trial. J Clin Psychiatry. 2018;79(2):16m11072. https://doi.org/10.4088/JCP.16m11072.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wetherell JL, Gatz M, Craske MG. Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychol. 2003;71:31–40.

    Article  PubMed  Google Scholar 

  30. 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.

    PubMed  Google Scholar 

  31. FDA Drug Safety Communication: Revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses. http://www.fda.gov/Drugs/DrugSafety/ucm297391.htm.

  32. 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.

    Article  CAS  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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 Psychiatry. 2013;70(11):1190–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Carmi L, Tendler A, Bystritsky A, et al. Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. Am J Psychiatry. 2019;176(11):931–8. https://doi.org/10.1176/appi.ajp.2019.18101180.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  CAS  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. Mathew AS, Davine TP, Snorrason I, Houghton DC, Woods DW, Lee HJ. Body-focused repetitive behaviors and non-suicidal self-injury: a comparison of clinical characteristics and symptom features. J Psychiatr Res. 2020;124:115–22. https://doi.org/10.1016/j.jpsychires.2020.02.020.

    Article  PubMed  Google Scholar 

  40. Guide to clinical preventive services, 2021. Recommendations of the U.S. Preventive Services Task Force. Rockville: AHRQ; 2021.

    Google Scholar 

  41. 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 

  42. Bates S, Chang WC, Hamilton CE, Chasson GS. Hoarding disorder and co-occurring medical conditions: a systematic review. J Obsess Compuls Relat Disord. 2021;30:100661.

    Article  Google Scholar 

  43. Ayers CR, Iqbal Y, Strickland K. Medical conditions in geriatric hoarding disorder patients. Aging Ment Health. 2014;18(2):148–51.

    Article  PubMed  Google Scholar 

  44. Lebert F. Diogenes syndrome, a clinical presentation of fronto-temporal dementia or not? Int J Geriatr Psychiatry. 2005;20(12):1203–4.

    Article  PubMed  Google Scholar 

  45. Mitchell E, Tavares TP, Palaniyappan L, Finger EC. Hoarding and obsessive-compulsive behaviours in frontotemporal dementia: clinical and neuroanatomic associations. Cortex. 2019;121:443–53. https://doi.org/10.1016/j.cortex.2019.09.012.

    Article  PubMed  Google Scholar 

  46. 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.

    Article  CAS  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Sordo Vieira L, Guastello A, Nguyen B, et al. Identifying psychiatric and neurological comorbidities associated with hoarding disorder through network analysis. J Psychiatr Res. 2022;156:16–24. https://doi.org/10.1016/j.jpsychires.2022.09.037.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Puja Chadha .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chadha, P., Suo, S. (2024). Obsessive-Compulsive and Related Disorders. In: Hategan, A., Bourgeois, J.A., Hirsch, C.H., Giroux, C. (eds) Geriatric Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-031-47802-4_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-47802-4_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-47801-7

  • Online ISBN: 978-3-031-47802-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics