Early-Onset Versus Late-Onset OCD

When Your Symptoms Start Makes a Difference

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Although symptoms of obsessive-compulsive disorder (OCD) can begin at almost any age, research suggests that there are two distinct periods when OCD symptoms are most likely to appear.

The first occurs around the ages of 10 to 12 or just before puberty, and the second is between the ages of 18 to 23.

People who develop OCD before puberty are considered to have early-onset OCD, while those who develop OCD later in life are said to have late-onset OCD.

Interestingly, there may be distinct differences in the symptoms, response to treatment, overlapping illnesses, brain structure, and thinking patterns of people with early- versus late-onset OCD.

Early-Onset OCD Versus Late-Onset OCD

One of the biggest differences between early- and late-onset OCD seems to be between the ratio of males to females. Studies have consistently found that males are much more likely to develop early-onset OCD than females. This gender difference seems to balance out among people who develop OCD later in life, with males and females being equally as likely to develop the disorder.

It has been also been noted that the earlier symptoms appear, the more severe the symptoms are. Some research suggests too that the earlier the symptoms, the more difficult they can be to treat with both psychological and medical treatments. In other words, those with early-onset OCD may need to try more medications before finding relief from their symptoms and may need more trials of psychotherapy than people whose OCD begins later in life.

On the contrary, a study in the Journal of Child Psychology and Psychiatry that examined over 300 children with either early-onset OCD (before 10 years of age) and late-onset OCD (10 years of age or older) found that while there were differences in the symptoms between these two types of OCD, there was no difference in the children's response to treatment.

In other words, how young or old the child was did not affect their response to therapy (which was cognitive-behavioral therapy tailored to their age with or without medication.) This study emphasizes the importance of early diagnosis and treatment of OCD.

Another difference is that people with early-onset OCD often have a gradual appearance of symptoms, whereas people who develop OCD later in life tend to have symptoms that come on quickly and that are usually tied to some sort of trigger, like a stressful life event, such as the death of a loved one, loss of a job, or failing out of school.

An exception to this rule is pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), an autoimmune form of OCD that affects only children and in which symptoms appear very quickly.

OCD and Comorbid Illnesses

OCD often occurs with other illnesses (which are called comorbid illnesses). The types of comorbid illnesses that occur with OCD seem to be influenced by when the person's OCD symptoms started.

For example, while people with early-onset OCD tend to have high rates of tic disorders and Tourette’s syndrome, late-onset OCD is more commonly associated with depression and other anxiety disorders like generalized anxiety disorder or panic disorder.

More Differences Between Early-Onset OCD Versus Late-Onset OCD

The brains of people with early- versus late-onset OCD may be different from one another as well. Brain imaging studies suggest that people with early-onset OCD have a reduction in the size of certain brain regions that are not evident in people whose OCD started later in life.

Interestingly, however, studies have consistently demonstrated that people with late-onset OCD score poorer on measures of cognitive (thinking) function than do people with early-onset OCD. It is not yet clear why this is the case and whether this has any impact on treatment.

Sources:

Lomax CL, Oldfield VB, Salkovskis, PM. Clinical and treatment comparisons between adults with early- and late-onset obsessive-compulsive disorder. Behav Res and Ther.2009 Feb;47(2):99-104.

Nakatani E, Krebs G, Micali N, Turner C, Heyman I, Mataix-Cols D. Children with very early onset obsessive-compulsive disorder: clinical features and treatment outcome. J Child Psychol Psychiatry. 2011 Dec;52(12):1261-8.

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