Obsessive-compulsive disorder (OCD) is characterized by symptoms such as intrusive thoughts and repetitive behaviors. A common question among individuals with OCD is whether OCD can worsen with age.
Research on this is mixed and shows no universal progression. However, untreated OCD, life stressors, and cognitive decline in individuals 65+ can exacerbate symptoms like negative thought loops and compulsions.
Read on to learn more about OCD and how age, stress, and other factors can affect symptoms.
What is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition marked by persistent, unwanted thoughts called obsessions, and repetitive behaviors or mental acts known as compulsions, such as excessive handwashing or checking locks. These cycles consume significant time, often more than an hour daily, and impact work, school, relationships, and daily routines.
OCD affects roughly 2-3 million adults in the U.S. annually, with symptoms typically emerging in childhood, adolescence, or early adulthood [1].
No single cause exists for OCD, instead, it arises from a mix of genetic vulnerability (e.g., family history increases risk 4-7 times), environmental triggers like trauma or infections (such as pediatric streptococcus), and brain differences, including overactivity in the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia [2].
Common Obsessions and Compulsions
| Obsession Theme | Obsession | Compulsion |
| Contamination | Fear of germs, dirt, illness | Excessive handwashing and cleaning, or taking antibiotics for fear of germs |
| Harm | Intrusive thoughts of hurting oneself/others or losing control | Checking locks/weapons, avoiding triggers |
| Symmetry/Order | Need for items or numbers to align perfectly | Organizes files, books, and items in an exact order |
| Forbidden/Taboo | Doubts about morality, religion, or sexual impulses | Mental reviewing, excessive praying |
| Doubt/Checking | Worry about appliances being on or doors being unlocked | Repeatedly checking locks or appliances |
Can OCD Get Worse With Age?
OCD does not universally worsen with age, but research shows symptoms often peak in late adolescence or early adulthood before stabilizing or improving through middle age for many individuals (if they have been or are being treated).
In adults over 65, some evidence points to worsened symptoms such as checking compulsions, although this is thought to be tied to cognitive decline or overlapping conditions like dementia rather than inherent OCD [3].
Factors like untreated compulsions or life stressors can trigger flares at any stage, but chronological age alone rarely drives progression without other influences [4].
OCD and Accelerated Brain Aging
A recent study published in 2022 looked at brain aging in people with obsessive-compulsive disorder (OCD) using MRI scans and computer models to predict “brain age” based on gray matter volume.
Researchers compared 100 OCD patients to healthy controls and found that those with OCD had brains that appeared about 0.8 years older than their actual age. The findings suggest that OCD could alter brain development over time, contributing to how the disorder evolves [5].
What Makes OCD Symptoms Worse?
Several factors contribute to the worsening of OCD symptoms with age. This can be due to natural developmental changes in brain structure and functioning that happen in older age in regions involved in emotional regulation and decision-making. Life stressors, trauma, and drug or alcohol abuse can also cause it [1] [4].
- Untreated Symptoms: Untreated compulsions reinforce the OCD cycle, making obsessions harder to resist.
- Life Stressors: Grief, trauma, loss of a job, or transitions can heighten anxiety and trigger OCD flare-ups.
- Co-occurring Conditions: 90% of adults with OCD experience another co-occurring condition, such as depression, anxiety, or trauma, which can reduce motivation for therapy and increase obsessive thinking.
- Sleep Problems: Lack of sleep can weaken prefrontal cortex function, reducing impulse control and increasing intrusive thoughts.
- Brain Changes: Age-related declines in neuroplasticity, hormone shifts, and overall cognitive decline can exacerbate symptoms.
- Isolation: Lack of support systems in older populations can worsen anxiety, increasing negative feedback loops and worsening symptoms.
Does Age Complicate Treatment?
Older age does not inherently make OCD treatment impossible or ineffective, but it can complicate treatment with specific challenges, including:
- Diagnostic overlap: OCD symptoms can mimic dementia, depression, or anxiety in seniors, delaying accurate identification.
- Comorbidities: Co-existing conditions like cognitive decline, chronic illness, or substance use reduce treatment response and motivation.
- Stigma and access: Ageism, social isolation, and limited geriatric mental health services reduce help-seeking and awareness of specialized providers.
- Physical/cognitive limits: Slower processing, mobility issues, or medication interactions may require adapted CBT/ERP protocols
Evidence-Based OCD Treatment at Maple Mountain
At Maple Mountain Mental Health and Wellness, our compassionate team of clinical psychiatrists and experienced therapists provides evidence-based treatments for OCD, including specialized CBT and advanced FDA-approved TMS Therapy. Our licensed mental health team prioritizes your well-being and safety throughout the therapeutic process.
Through a holistic, blended approach, we address each aspect of your health and recovery needs to support long-term healing. Reach out today for an evaluation.
Sources
[1] National Institute of Mental Health. 2007. Obsessive-Compulsive Disorder (OCD).
[2] do Rosário, M. (2023). The genetic epidemiology of obsessive-compulsive disorder: a systematic review and meta-analysis. Translational psychiatry, 13(1), 230.
[3] Şair, A. et al. (2022). Obsessive-Compulsive Disorder in Patients with Mild Cognitive Impairment: A Comparative Study with Healthy Older Adults. Psychiatry and clinical psychopharmacology, 32(3), 222–228.
[4] Morgado, P. et al. (2021). Stress Influences the Effect of Obsessive-Compulsive Symptoms on Emotion Regulation. Frontiers in psychiatry, 11, 594541.
[5] Cheng, J. et al. (2022). Accelerated Brain Aging in Patients With Obsessive-Compulsive Disorder. Frontiers in psychiatry, 13, 852479.