The Difference Between Early and Late-Onset OCD

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

Studies differ on the exact age of onset, but generally speaking, the first period occurs during late childhood or early adolescence, and the second occurs in the late teens to early 20s. Interestingly, there may be distinct differences in the symptoms, responses to treatment, overlapping illnesses, brain structure, and thinking patterns of people with early- versus late-onset OCD.

Early vs. Late Onset OCD: Key Differences

Gender Differences in Early vs. Late Onset OCD

One of the biggest differences between early-onset and late-onset OCD is the ratio of males to females. Studies have consistently found that males are much more likely to develop early-onset OCD than females.

Severity of Symptoms and Response to Treatment

It has also been noted that the earlier OCD symptoms appear, the more severe they are. Some research suggests too that the earlier you develop OCD 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. However, not all of the research supports this.

For example, a study that examined over 300 children with either early-onset OCD (before 10 years of age) or 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.

It looks like the jury is still out when it comes to treatment response and symptom severity in early-onset versus late-onset obsessive-compulsive disorder. More research is needed on the topic.

How Symptoms Develop in Early vs. Late 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 since they 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

Obsessive-compulsive disorder often occurs with other illnesses, which are called comorbid illnesses. Some of the most common types of disorders that occur with OCD are:

• Major depressive disorder (MDD)
• Attention-deficit hyperactivity disorder (ADHD)
• Anxiety disorders
• Oppositional defiant disorder (ODD)

There is also a subtype of OCD called tic-related OCD which is more common in males and has an earlier age of onset.

Brain Differences in Early vs. Late OCD

The brains of people with early-onset versus late-onset OCD may be different from one another as well. However, more research is needed to determine how these differences affect symptom and treatment patterns.

Research also suggests that having early onset OCD is associated with a greater likelihood of having more close family members who also have OCD. This may suggest a stronger genetic component for early-onset OCD.

One study found that people with early-onset OCD have larger volumes in the precentral, orbitofrontal, middle frontal, and middle temporal gyri of the brain. The researchers suggest that these differences offer evidence of distinct differences between the early and late subtypes. Because of these differences, they recommend considering different treatment options based on whether a person has early-onset OCD or late-onset OCD.

Keep in Mind

If you have symptoms of OCD, talk to your doctor about when these symptoms first appeared. Understanding whether you have early vs. late OCD may help mental health professionals better determine the approach to treatment that might be most helpful for you. With treatment, approximately 32% to 70% of people experience remission of their OCD symptoms. 

Treatments for OCD may involve medications such as selective serotonin reuptake inhibitors (SSRIs), a tricyclic antidepressant (TCA) called Anafranil, or antipsychotics.

Psychotherapy can also be helpful. Types of therapy that can help with OCD include cognitive behavioral therapy (CBT), exposure and response prevention (ERP) therapy, and acceptance and commitment therapy (ACT).