Obsessive-compulsive disorder (OCD) is defined in part by the Merck
Manual as “anxiety provoking thoughts and urges.” While the publication
(a staple in the medical field for years) notes that symptoms are not
often prominent in the elderly, caregivers may disagree.
Early stage Alzheimer’s patients may obsess about minor issues, such as
the garbage being taken out. In some cases, it may become a “chicken or
the egg” question as to which came first, the OCD or Alzheimer’s.
Since part of OCD involves performing repetitive tasks that balance the
anxiety (using hand sanitizer repeatedly to avoid germs), it may not be
immediately visible that there is an obsessive component to the elder’s
thought process. Grandma may spend twenty minutes wiping out the
bathroom sink after she has gone to the bathroom. Part of her extended
cleaning out of the sink may be due to poor vision, or remembering
something from a past not known by current family.
Elder folks who can identify “habits” begin to disassemble the cycle of
worry that accompanies OCD. Dorothy, who is well into her seventies and
a former nurse, mentions that she has several “habits” that have cropped
up since her husband passed away. “I’ll just go right to the
refrigerator in the middle of the night, not turning on the light.
That’s a HABIT.” She’s noted others, such as waking up several times in
the middle of the night. During family visits, she wakes hardly at all,
and concludes she’s conditioned herself to associating being alone with
needing to wake up.
A bright woman who applied much rational thought and association in her
nursing career, she is still able to do so today. Dorothy emphasizes
that recognizing a habit is one thing. “Doing something about it, well
It’s evident that the key to her dealing with these habits is making a
connection; but more importantly, she has removed the anxiety
component. Acceptance of these behaviors and the knowledge that she
will break them when she chooses give her a sense of autonomy.