Mental health in late life, particularly in relation to Obsessive-Compulsive and Related Disorders (OCRDs), is a topic of growing significance given the increase in the elderly population. OCRDs encompass a range of conditions characterized by repetitive thoughts and behaviors that cause distress and interfere with daily functioning. This summary aims to provide an overview of OCD, hoarding disorder, body dysmorphic disorder, and trichotillomania in late life, exploring the prevalence, clinical features, and treatment options for each.
Obsessive-compulsive disorder (OCD) is a chronic condition that affects individuals of all ages, including older adults. It is marked by intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to alleviate anxiety caused by the obsessions. The prevalence of late-life OCD is estimated to be around 2%. However, due to cross-sectional studies and methodological limitations, the true prevalence remains unclear. Late-onset OCD has been associated with higher rates of comorbid psychiatric disorders, vascular risk factors, and cognitive impairment compared to early-onset OCD. Treatment for late-life OCD follows the same principles as in younger populations, including cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs).
Hoarding disorder (HD), characterized by the excessive acquisition and inability to discard possessions, is also prevalent among older adults. Despite being initially classified as an OCRD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), HD has been reclassified as a distinct disorder due to its unique features and treatment response. The prevalence of HD in the elderly population is estimated to be around 2-6%, with higher rates in older adults compared to younger individuals. Late-life HD is often associated with social isolation, physical limitations, and cognitive decline. Interventions for HD focus on cognitive-behavioral techniques and involve collaborative efforts with family members or caregivers.
Body dysmorphic disorder (BDD) is a disorder characterized by a preoccupation with imaginary or minor defects in physical appearance. Although BDD typically starts in adolescence, late-onset cases have been reported. The prevalence of late-life BDD is unknown, primarily due to its under-recognition and misdiagnosis. Older adults with BDD may have additional challenges, such as increased medical comorbidity and diminished social support. The treatment modalities for BDD include CBT, SSRIs, and surgical interventions in selected cases.
Trichotillomania, characterized by recurrent hair pulling resulting in noticeable hair loss, can also manifest in late life. Although prevalence rates are unknown for older adults specifically, trichotillomania onset is usually in childhood or adolescence. In older adults, trichotillomania may be associated with increased medical comorbidity, cognitive decline, and trichobezoar formation. Treatment options for trichotillomania include CBT, habit reversal training, and medication management.
In conclusion, OCD and related disorders, including hoarding disorder, body dysmorphic disorder, and trichotillomania, can manifest in late life and present unique clinical challenges. Despite some differences in clinical presentation and treatment response compared to younger populations, evidence supports the use of CBT and pharmacotherapy as effective interventions. However, further research is needed to better understand the prevalence, course, and optimal treatment approaches for OCRDs in late life. Clinicians should be aware of the specific needs and barriers faced by older adults with OCRDs and tailor treatment accordingly. Overall, addressing the mental health needs of older adults with OCRDs is essential for enhancing their quality of life and maintaining functional independence in later years.
