OCD The Difference Between Early and Late-Onset OCD By Owen Kelly, PhD Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. Learn about our editorial process Updated on September 17, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print MoMo Productions / Getty Images Table of Contents View All Table of Contents Gender Differences Symptoms and Treatment Development of Symptoms OCD and Comorbid Illnesses Brain Differences 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. 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. 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. 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-Onset OCD More males than females More severe symptoms Symptoms appear gradually Higher rates of tic disorders Late-Onset OCD Equal males and females Typical severity Symptoms develop suddenly, often tied to a trigger Higher rates of depression and anxiety disorders Gender Differences 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 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, a study 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, 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. Development of Symptoms 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, ADHD, anxiety disorder, and oppositional defiant disorders. 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 The brains of people with early-onset versus late-onset OCD may be different from one another as well. Studies have demonstrated that people with late-onset OCD have different patterns of neuropsychological deficits that those with early-onset OCD. It is not yet clear why this is the case and whether this has any impact on treatment. 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to 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:10.2174/1570159X16666180813155017 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 By Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for OCD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.