Anxiety

Susan, who is seventy, agrees that she is a very "clean" person. She spends much of each day cleaning and ordering her house. She describes having this behavior ever since childhood, when she avoided getting muddy and dirty. She says that her husband doesn't mind: "He says I'm a good housekeeper." Susan seems happy, too; proud of her clean house. However, more probing with questions reveals the extent of her problem: she explains that, all her life, she has felt very anxious about dirt, germs, and disorder. Earlier in her life she spent essentially all of each day cleaning, sometimes confining herself to one small square of a room, "so I could really get it clean." This behavior led to the loss of her only job (ironically, as a cleaning woman) and, for a time, estrangement from her husband and children. Her anxiety disorder was complicated by depression in her thirties and forties.

For the last several years, Susan has been taking a medication similar to Prozac (fluoxetine). She is doing much better: "Now I only spend three hours per day cleaning, and I can eat in a restaurant without bringing my disinfectant." But she still acknowledges significant distress at times, and while her relationship with her family is improved, there is still significant strain when her children bring their children over. "I just have to clench my teeth and bear it when they spill something."

Obsessive-compulsive disorder (OCD) is a combination of obsessions—repetitive, intrusive, unwanted thoughts, images, or impulses—and compulsions—repetitive acts done to ward off obsessions and/or to reduce anxiety. OCD occurs in about 1 percent of the elderly population and, since it is chronic, it will probably increase as individuals with this disorder enter the ranks of the aged. Susan's case exemplifies the chronic nature of OCD: she has suffered with it for sixty-plus years! Her case also illustrates an unfortunate complication of anxiety disorders: depression. The disability, in terms of job difficulties and strained relationships, is also typical of chronic anxiety disorders at any age. Susan's response to medications known as serotonin reuptake inhibitors is typical: helpful but incomplete. In younger adults, a type of psychotherapy known as behavior therapy can be effective; however its efficacy is unknown in elderly persons.