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Obsessive Compulsive Disorder (OCD) is a mental health condition in which people carry out repetitive and ritualistic behaviours. As with dementia and depression, OCD and dementia share some symptoms which can make diagnosis more difficult. OCD usually develops by early adulthood, so if an older person starts exhibiting symptoms, this may in fact be an early sign of dementia.
Symptoms you may notice include:
- Repetitive behaviour
- Rituals and routines
- Becoming excessively worried about potential threats and dangers, such as germs, disease, accidents or being attacked
- Keeping things in a specific order or neurotically neat and tidy
- Hoarding
- Muttering to themselves and counting under their breath
- Becoming more superstitious
Why do people with dementia have OCD-like symptoms?
In OCD, people have obsessive thoughts that they can only ease by carrying out certain behaviours. For example, they are consumed by the compulsion to boil the kettle twelve times before they can pour water from it and cannot relax until they have done so. They may believe that something bad will happen if they don’t, or just be unable to shake off the nagging thought without carrying out the compulsive behaviour.
Many symptoms of dementia can cause a person to act in a similar manner, sometimes unintentionally and sometimes as a way of coping. Some reasons include:
- Poor memory can result in the person repeating actions or checking that they have done it multiple times.
- Poor memory can also cause them to become fixated on subjects they are anxious about, as they cannot remember the answers to their questions or concerns. They can become obsessed with particular topics, sometimes for the aforementioned reason and sometimes because this subject or activity is familiar and they feel confident that they can still do or talk about it.
- Difficulty with understanding what time of day it is and where they are can lead to a fixation on knowing what the time is or carrying out exact routines at certain times.
- Challenges with reasoning, as well as a drop in confidence and feelings of powerlessness, can result in increased anxiety and an obsession with things being lucky or unlucky.
- Lack of confidence due to losing certain abilities can push them to repeat tasks to ease this anxiety and to feel useful, such as obsessive cleaning.
- Delusions and hallucinations can increase their anxiety and need to carry out compulsive behaviours in order to feel better.
How can I help someone with obsessive behaviour in dementia?
Supporting somebody with dementia and obsessive behaviours can be a daily challenge.
Remember that getting visibly angry or frustrated with them will likely make their behaviours worse as their anxiety and cognitive function will get worse with additional stress and damage to their confidence.
- Be patient when answering the same questions again and again, or write down answers to frequently asked questions somewhere they can easily check as many times as they need to.
- Get them to talk about some of the obsessive behaviours. They may need time to open up but doing so without being judged can help both of you.
- Learn more about how dementia and OCD/obsessive behaviours affect people through research. It’s really important to understand what it feels like for them to live with these challenges.
- Gently ask them why they need to complete certain rituals and reassure them that nothing bad will happen if they don’t, but do not forcibly stop them from doing them.
- A change of scenery can limit routines and rituals. For example, if they have an extensive routine they must perform before they eat their dinner, taking them out to eat or to a friend’s for dinner often means they don’t feel obliged to perform that ritual that evening, which is a welcome break for you both.
- Try to minimise their worries or need to perform certain rituals without enabling them. In other words, try to do small things that will reduce their worrying without encouraging their behaviour or letting it negatively affect your life too much. For example, letting them know each night that you’ve locked the doors and check the windows could mean that they don’t have to spend a long time re-locking and checking the doors and windows themselves.
- Look after yourself. Living with someone with OCD behaviours or dementia can be very stressful, especially if you are their primary carer. You may benefit from some therapy yourself or from calling one of the below helplines for further advice and support.
Is there treatment for obsessive behaviour in dementia?
Medical intervention can help with obsessive behaviour in people with dementia.
One option is Cognitive Behavioural Therapy (CBT). This is a type of talking therapy that is often used to treat people with OCD and has also shown to be very effective in helping people with dementia to manage symptoms related to mental health, including anxiety and depression.
Your GP may refer you for CBT or another kind of therapy that they think would be helpful, or they may prescribe medication to ease anxiety.
If you live in England, you can refer yourself for talking therapy here. This is paid for by the NHS and you must be assessed as needing it. The assessment and therapy are done over the phone, online or in person. You may also be posted or emailed a workbook or online course to complete as part of your treatment.
Helplines
The Alzheimer’s Society’s Dementia Connect support
Telephone: 0333 150 3456
Online: Dementia Connect
Mind Infoline
Telephone: 0300 123 3393
Email: info@mind.org.uk
Post: Mind Infoline, PO Box 75225, London, E15 9FS
Admiral Nurse Dementia Helpline
Telephone: 0800 888 6678
The Silver Line helpline for older people
Telephone: 0800 4 70 80 90
