Obsessive-compulsive and related disorders in older age

Abstract

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.