Obsessive behaviour and dementia

Obsessive Compulsive Disorder (OCD) is a mental health condition in which people carry out repetitive and ritualistic behaviours. Some people with dementia may develop repetitive, ritualistic or fixated behaviours that can look similar to symptoms of obsessive compulsive disorder (OCD). However, these behaviours can have different causes and do not necessarily mean the person has OCD.

At a glance

• Why behaviours develop: Repetitive or ritualistic behaviour in dementia may be linked to memory problems, anxiety, confusion or other changes
• Common signs to notice: Repetitive behaviours, strict routines, excessive worry, hoarding, keeping things in a particular order, counting, muttering, or increased superstition may occur in someone with dementia.
• Ways to provide support: Stay patient, offer reassurance, encourage discussion without judgement, avoid forcing the person to stop rituals, and reduce anxiety without reinforcing obsessive behaviours.
• Getting professional support: If the behaviour is causing distress or affecting daily life, a GP can consider possible causes and whether further assessment, psychological support or treatment may be appropriate.

What can repetitive or obsessive behaviour look like in dementia?

• Rituals and routines
• Becoming excessively worried about potential threats and dangers, such as germs, disease, accidents or being attacked
• Keeping things in a particular order
• Hoarding
• Muttering to themselves and counting under their breath
• Becoming more superstitious

Can dementia cause obsessive behaviour?

OCD involves unwanted thoughts, urges or images (obsessions) and repetitive behaviours or mental acts (compulsions). A person may feel driven to carry out a particular action to reduce the anxiety or distress caused by an obsession.

Repetitive behaviour in dementia can look similar, but it may have different causes, such as memory problems, anxiety or confusion.

• Poor memory may result in the person repeating actions or checking that they have done it multiple times. 
• Poor memory might also cause them to become fixated on subjects they are anxious about, as they cannot remember the answers to their questions or concerns. They might 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, may result in increased anxiety and an obsession with things being lucky or unlucky.
• Lack of confidence due to losing certain abilities might push them to repeat tasks to ease this anxiety and to feel useful, such as obsessive cleaning.
• Delusions and hallucinations might increase their anxiety and the 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.

Repeated questions or behaviours can be difficult to respond to, particularly if you are tired or worried yourself. Where possible, try to respond calmly and offer reassurance, as stress or confrontation may increase the person’s distress.

• 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.
• Try to notice whether certain situations, changes in routine, anxiety or confusion seem to trigger the behaviour. Understanding what may be causing distress can help you find ways to reassure the person.
• 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.

Is there treatment for obsessive or OCD-like 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.

If repetitive or obsessive behaviour is causing distress or affecting daily life, speak to the person’s GP. They can consider possible causes and whether further assessment, psychological support or treatment may be appropriate.

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. 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

Next steps

• Consider possible causes: Repetitive or ritualistic behaviour can have different causes, including memory problems, anxiety or confusion. Avoid assuming that the behaviour is OCD.
• Respond with patience: Stay calm, avoid visible frustration, and offer gentle reassurance without forcing the person to stop their routines.
• Seek professional advice: Speak to a GP if the behaviour is new, causing distress or becoming difficult to manage. They can help consider possible causes and what support may be appropriate.

FAQs