The Difference Between Early and Late-Onset OCD

Table of ContentsView AllTable of ContentsEarly vs. Late OnsetGender DifferencesSymptoms and TreatmentSymptom DevelopmentOCD and Comorbid IllnessesBrain Differences

Table of ContentsView All

View All

Table of Contents

Early vs. Late Onset

Gender Differences

Symptoms and Treatment

Symptom Development

OCD and Comorbid Illnesses

Brain Differences

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Althoughsymptoms 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 whodevelop OCDearlier 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 thelate teensto early 20s.Interestingly, there may be distinct differences in the symptoms, responses totreatment, overlapping illnesses, brain structure, and thinking patterns of people with early- versus late-onset OCD.

At a Glance

Early vs. Late Onset OCD: Key Differences

Early-Onset OCDMore males than femalesMore severe symptomsSymptoms appear graduallyHigher rates of tic disordersLate-Onset OCDEqual males and femalesTypical severitySymptoms develop suddenly, often tied to a triggerHigher rates of depression and anxiety disorders

Early-Onset OCDMore males than femalesMore severe symptomsSymptoms appear graduallyHigher rates of tic disorders

More males than females

More severe symptoms

Symptoms appear gradually

Higher rates of tic disorders

Late-Onset OCDEqual males and femalesTypical severitySymptoms develop suddenly, often tied to a triggerHigher rates of depression and anxiety disorders

Equal males and females

Typical severity

Symptoms develop suddenly, often tied to a trigger

Higher rates of depression and anxiety disorders

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.

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.

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 bothpsychologicaland 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 300children 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.

Essentially, the age of the children in this particular study did not affect their response to cognitive-behavioral therapy that was tailored to their age, with or without medication.

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 ispediatric autoimmune neuropsychiatric disordersassociated with streptococcal infections (PANDAS), an autoimmune form of OCD that affects only children and in which symptoms appear very quickly.

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:

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.

Studies have demonstrated that people with late-onset OCD have different patterns of neuropsychological deficits than those with early-onset OCD. People with the early-onset subtype have worse visual recall. Those with the late-onset subtype have worse verbal fluency and executive function.

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 involvemedicationssuch asselective serotonin reuptake inhibitors(SSRIs), atricyclic antidepressant(TCA) called Anafranil, or antipsychotics.

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

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10 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Del Casale A, Sorice S, Padovano A, et al.Psychopharmacological treatment of obsessive-compulsive disorder (OCD).Curr Neuropharmacol. 2019;17(8):710–736. doi:10.2174/1570159X16666180813155017Burchi E, Pallanti S.Diagnostic issues in early-onset obsessive-compulsive disorder and their treatment implications.Curr Neuropharmacol. 2019;17(8):672–680. doi:10.2174/1570159X16666180426151746Mathes BM, Morabito DM, Schmidt NB.Epidemiological and clinical gender differences in OCD.Curr Psychiatry Rep. 2019;21(5):36. doi:10.1007/s11920-019-1015-2Nakatani 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;52(12):1261-1268.Neziroglu F, Fruchter Y.Manifestation and treatment of OCD and spectrum disorders within a pediatric population. In Kocabaşoğlu N, Çağlayan RHB, eds.Anxiety Disorders - From Childhood to Adulthood. IntechOpen; 2018:55-84. doi:10.5772/intechopen.79344Westwell-Roper C, Stewart SE.Challenges in the diagnosis and treatment of pediatric obsessive-compulsive disorder.Indian J Psychiatry. 2019;61(Suppl 1):S119–S130. doi:10.4103/psychiatry.IndianJPsychiatry_524_18Conelea CA, Walther MR, Freeman JB, et al.Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.J Am Acad Child Adolesc Psychiatry. 2014;53(12):1308–1316. doi:10.1016/j.jaac.2014.09.014Kim T, Kwak S, Hur JW, et al.Neural bases of the clinical and neurocognitive differences between earlyand late-onset obsessive–compulsive disorder.J Psychiatry Neurosci. 2020;45(4):234-242. doi:10.1503/jpn.190028Taylor S.Early versus late onset obsessive-compulsive disorder: evidence for distinct subtypes.Clin Psychol Rev. 2011;31(7):1083-1100. doi:10.1016/j.cpr.2011.06.007Burchi E, Hollander E, Pallanti S.From treatment response to recovery: a realistic goal in OCD.International Journal of Neuropsychopharmacology. 2018;21(11):1007-1013. doi:10.1093/ijnp/pyy079

10 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Del Casale A, Sorice S, Padovano A, et al.Psychopharmacological treatment of obsessive-compulsive disorder (OCD).Curr Neuropharmacol. 2019;17(8):710–736. doi:10.2174/1570159X16666180813155017Burchi E, Pallanti S.Diagnostic issues in early-onset obsessive-compulsive disorder and their treatment implications.Curr Neuropharmacol. 2019;17(8):672–680. doi:10.2174/1570159X16666180426151746Mathes BM, Morabito DM, Schmidt NB.Epidemiological and clinical gender differences in OCD.Curr Psychiatry Rep. 2019;21(5):36. doi:10.1007/s11920-019-1015-2Nakatani 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;52(12):1261-1268.Neziroglu F, Fruchter Y.Manifestation and treatment of OCD and spectrum disorders within a pediatric population. In Kocabaşoğlu N, Çağlayan RHB, eds.Anxiety Disorders - From Childhood to Adulthood. IntechOpen; 2018:55-84. doi:10.5772/intechopen.79344Westwell-Roper C, Stewart SE.Challenges in the diagnosis and treatment of pediatric obsessive-compulsive disorder.Indian J Psychiatry. 2019;61(Suppl 1):S119–S130. doi:10.4103/psychiatry.IndianJPsychiatry_524_18Conelea CA, Walther MR, Freeman JB, et al.Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.J Am Acad Child Adolesc Psychiatry. 2014;53(12):1308–1316. doi:10.1016/j.jaac.2014.09.014Kim T, Kwak S, Hur JW, et al.Neural bases of the clinical and neurocognitive differences between earlyand late-onset obsessive–compulsive disorder.J Psychiatry Neurosci. 2020;45(4):234-242. doi:10.1503/jpn.190028Taylor S.Early versus late onset obsessive-compulsive disorder: evidence for distinct subtypes.Clin Psychol Rev. 2011;31(7):1083-1100. doi:10.1016/j.cpr.2011.06.007Burchi E, Hollander E, Pallanti S.From treatment response to recovery: a realistic goal in OCD.International Journal of Neuropsychopharmacology. 2018;21(11):1007-1013. doi:10.1093/ijnp/pyy079

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Del Casale A, Sorice S, Padovano A, et al.Psychopharmacological treatment of obsessive-compulsive disorder (OCD).Curr Neuropharmacol. 2019;17(8):710–736. doi:10.2174/1570159X16666180813155017Burchi E, Pallanti S.Diagnostic issues in early-onset obsessive-compulsive disorder and their treatment implications.Curr Neuropharmacol. 2019;17(8):672–680. doi:10.2174/1570159X16666180426151746Mathes BM, Morabito DM, Schmidt NB.Epidemiological and clinical gender differences in OCD.Curr Psychiatry Rep. 2019;21(5):36. doi:10.1007/s11920-019-1015-2Nakatani 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;52(12):1261-1268.Neziroglu F, Fruchter Y.Manifestation and treatment of OCD and spectrum disorders within a pediatric population. In Kocabaşoğlu N, Çağlayan RHB, eds.Anxiety Disorders - From Childhood to Adulthood. IntechOpen; 2018:55-84. doi:10.5772/intechopen.79344Westwell-Roper C, Stewart SE.Challenges in the diagnosis and treatment of pediatric obsessive-compulsive disorder.Indian J Psychiatry. 2019;61(Suppl 1):S119–S130. doi:10.4103/psychiatry.IndianJPsychiatry_524_18Conelea CA, Walther MR, Freeman JB, et al.Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.J Am Acad Child Adolesc Psychiatry. 2014;53(12):1308–1316. doi:10.1016/j.jaac.2014.09.014Kim T, Kwak S, Hur JW, et al.Neural bases of the clinical and neurocognitive differences between earlyand late-onset obsessive–compulsive disorder.J Psychiatry Neurosci. 2020;45(4):234-242. doi:10.1503/jpn.190028Taylor S.Early versus late onset obsessive-compulsive disorder: evidence for distinct subtypes.Clin Psychol Rev. 2011;31(7):1083-1100. doi:10.1016/j.cpr.2011.06.007Burchi E, Hollander E, Pallanti S.From treatment response to recovery: a realistic goal in OCD.International Journal of Neuropsychopharmacology. 2018;21(11):1007-1013. doi:10.1093/ijnp/pyy079

Del Casale A, Sorice S, Padovano A, et al.Psychopharmacological treatment of obsessive-compulsive disorder (OCD).Curr Neuropharmacol. 2019;17(8):710–736. doi:10.2174/1570159X16666180813155017

Burchi E, Pallanti S.Diagnostic issues in early-onset obsessive-compulsive disorder and their treatment implications.Curr Neuropharmacol. 2019;17(8):672–680. doi:10.2174/1570159X16666180426151746

Mathes BM, Morabito DM, Schmidt NB.Epidemiological and clinical gender differences in OCD.Curr Psychiatry Rep. 2019;21(5):36. doi:10.1007/s11920-019-1015-2

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;52(12):1261-1268.

Neziroglu F, Fruchter Y.Manifestation and treatment of OCD and spectrum disorders within a pediatric population. In Kocabaşoğlu N, Çağlayan RHB, eds.Anxiety Disorders - From Childhood to Adulthood. IntechOpen; 2018:55-84. doi:10.5772/intechopen.79344

Westwell-Roper C, Stewart SE.Challenges in the diagnosis and treatment of pediatric obsessive-compulsive disorder.Indian J Psychiatry. 2019;61(Suppl 1):S119–S130. doi:10.4103/psychiatry.IndianJPsychiatry_524_18

Conelea CA, Walther MR, Freeman JB, et al.Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.J Am Acad Child Adolesc Psychiatry. 2014;53(12):1308–1316. doi:10.1016/j.jaac.2014.09.014

Kim T, Kwak S, Hur JW, et al.Neural bases of the clinical and neurocognitive differences between earlyand late-onset obsessive–compulsive disorder.J Psychiatry Neurosci. 2020;45(4):234-242. doi:10.1503/jpn.190028

Taylor S.Early versus late onset obsessive-compulsive disorder: evidence for distinct subtypes.Clin Psychol Rev. 2011;31(7):1083-1100. doi:10.1016/j.cpr.2011.06.007

Burchi E, Hollander E, Pallanti S.From treatment response to recovery: a realistic goal in OCD.International Journal of Neuropsychopharmacology. 2018;21(11):1007-1013. doi:10.1093/ijnp/pyy079

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