Obsessive-Compulsive Disorder in Late Life John E. Calamari, Noelle K. Pontarelli, and Kerrie M. Armstrong, Rosalind Franklin University of Medicine and Science Seoka A. Salstrom, Anxiety and Agoraphobia Treatment Center, Northbrook, Illinois Although obsessive-compulsive disorder (OCD) has received increasing attention, the study and treatment of OCD in late life has been neglected. The obsessions and compulsions seen with older adults do not appear to differ from the symptoms experienced by other age groups, although developmental issues might influence symptom focus (e.g., memory functioning-related obsessions). Hoarding difficulties might be prevalent in late life, although additional studies are needed. Seniors with OCD can present with comorbid psychiatric disorders, multiple general medical problems, and impaired cognitive functioning, complicating evaluation. There have not been controlled clinical trials of cognitive-behavioral therapy (CBT) for late-life OCD, although initial reports suggest older adults respond to CBT that includes age-related treatment modifications. We illustrate the challenges to assessing and treating older adults with OCD with case examples involving memory-related obsessions and clinical hoarding. The successful strategies used for adapting CBT for the treatment of late-life generalized anxiety disorder might serve as a model for advancing the study and treatment of late-life OCD. T HE etiology and treatment of obsessive-compulsive disorder (OCD) has received increasing attention during the last several decades (e.g., Salkovskis, 1985). While the disorder has been a growing focus of study for psychopathologists evaluating etiologic processes, disor- der heterogeneity, treatment response, and the mecha- nisms mediating treatment outcome, OCD in older adults has been largely neglected. Several factors might explain the limited study of late-life OCD. Epidemiologic studies suggest that OCD in late life occurs infrequently (Grant Mancebo, Pinto, Williams, Eisen & Rasmusasen, 2007; Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). Age at onset of OCD was understood to be young adulthood (e.g., Rasmussen & Tsuang, 1986). Congruent with past reports, Pinto, Mancebo, Eisen, Pagano, and Rasmussen (2006) found that patients reported average disorder onset before age 20, although substantial variability was found (mean = 18.5, SD = 9.9, range 4–62). With the understanding that OCD began in the early adult years, most research on the etiology of the disorder was conducted with young adult samples (Calamari, Janeck, & Deer, 2002). Additionally, OCD has been broadly underidentified or misdiagnosed, often resulting in long delays between illness onset, proper diagnosis, and the initiation of treatment (e.g., Rasmussen & Tsuag). Evaluation of the large clinical sample participating in the Brown University OCD longitudinal study revealed a mean interval of 11 years between meeting diagnostic criteria and receiving treatment (Pinto et al., 2006). The diagnosis of OCD in older adults, who often present with several comorbid mood or anxiety disorders (for a review, see Bryant, Jackson, & Ames, 2008), is particularly challenging, with some clinicians attributing symptoms to psychiatric conditions better understood as mental health problems for seniors (e.g., major depression; cf. Calamari, Faber, Hitsman, & Poppe, 1994). Based on our critical review of the limited research on late-life OCD and our clinical experience, we believe that OCD occurs in older adults with regularity and that when OCD does affect people over age 65, it is often debilitating and significantly diminishes quality of life. We believe that late-life OCD is an appropriate topic for this special issue of Cognitive and Behavioral Practice focused on adapting behavioral and cognitive therapies for important clinical problems experienced by older adults, a rapidly growing segment of the population. Below, we briefly discuss several important challenges to the diagnosis and treatment of late-life OCD (for reviews see Calamari et al., 2002; Carmin, Calamari, & Ownby, in press). Older adults with OCD often present with co-occurring psychiatric disorders and general health problems (Gurian & Miner, 1991; Lenze et al., 2000) making diagnosis particularly challenging. Addi- tionally, we critically review estimates of the prevalence of late-life OCD. We suggest that the condition might occur 1077-7229/11/136–150$1.00/0 © 2011 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved. www.elsevier.com/locate/cabp Available online at www.sciencedirect.com Cognitive and Behavioral Practice 19 (2012) 136–150