Late vs. Early Onset OCD – What’s The Difference?

Most people think that obsessive-compulsive disorder (OCD) presents during the teenage years or in early adulthood, and while this is true for many people with OCD, the truth is it can arise at almost any age. In fact, researchers categorize the manifestation of OCD into two distinct age brackets: early-onset or late-onset. Understand, however, that there are some variances in the exact age of onset.

However, the general consensus is that early-onset involves developing or being diagnosed with OCD during late childhood or early teenage years, while late-onset involves developing or being diagnosed with OCD during late teenage years or early adulthood (the early 20s). Surprisingly, however, there are noticeable differences in the signs and symptoms, treatment responses, comorbidities, brain structure abnormalities, and thought processes of OCD sufferers who have an early-onset and those who have a late-onset.

If you or a loved one was recently diagnosed with early-onset OCD or late-onset OCD, and you want to learn more about OCD and the differences between the two manifestations, you have come to the right place. In this article, you will learn what OCD is, the differences between early-onset and late-onset OCD, what it is like to have early-onset or late-onset OCD, and ways that both types can be successfully treated.

What is OCD?

Because obsessive-compulsive disorder (OCD) involves severe anxiety, it is considered an anxiety condition by most researchers and practitioners. Essentially, OCD is a common mental health condition that involves non-stop, unwanted, and intrusive thoughts, urges, fears, emotions, images (obsessions), and/or repetitive ritualistic behaviors (compulsions).

There are many “types” of OCD, such as meta OCD or reading OCD to relationship OCD or harm OCD – and that is only a small fraction of the different “types” of OCD. OCD is a lonely condition because it is often linked to shame and guilt. In other words, people with OCD tend to hide their symptoms from others for fear of being judged, labeled, or criticized. Nowadays, OCD is linked to jokes or quirky characters in movies and sitcoms. The term “OCD” is also used as a verbal weapon against people who are too “neat,” or “orderly,” or a person who is a perfectionist.

While some people with OCD want things to be “perfect” or “just right,” or want things orderly or a certain way, that does not always mean that they have OCD. Yet, the term is frivolously tossed around to hurt or label others. OCD is so debilitating that it can cause a person with this condition to lose their job, friends, romantic interests or partner, self-confidence, and so much more.

OCD tends to present early in life, but that is not always the case. Sometimes, people with OCD do not develop it or be diagnosed with it until their 30s or later. The good news is there are a variety of readily available treatments designed to ease OCD symptoms. OCD is usually addressed through a multi-treatment approach involving cognitive-behavioral therapy (CBT) or exposure-response and prevention (ERP) therapy. However, other treatments may be added to an OCD sufferer’s treatment plan. These treatments may include “trauma therapies,” addiction therapy, individual therapy, art therapy, or hypnotherapy.

Sometimes, when OCD therapies alone are not garnering the desired results, one or more medications may be prescribed. The most common medication used to treat OCD is SSRI antidepressants. Natural remedies, like CBD, crystal therapy, or mindfulness meditation are also sometimes used in conjunction with standard OCD treatments. OCD podcasts, forums, books, and support groups are also good resources for people struggling with OCD and their loved ones.

What is Early-Onset OCD?

Early-onset OCD typically manifests in people who are between the ages of 8 and 12 years old. More males than females tend to develop early-onset OCD. Although early-onset OCD symptoms tend to gradually appear over time, they also tend to be more severe. Moreover, people who develop early-onset OCD have a higher risk of developing a tic disorder than those who develop it later in life. Early-onset OCD sufferers may initially experience mild OCD symptoms that do not cause much distress, however, these symptoms usually increase in severity over time and are usually linked to a specific trigger, trauma, or an upsetting life event like the death of a loved one.

What is Late-Onset OCD?

Late-onset OCD usually occurs during one’s late teen years or early adulthood (i.e., ages 13 to 23). However, unlike early-onset OCD, the same percentage of males and females can develop late-onset OCD. Also, late-onset OCD symptoms tend to develop quickly (or at least quicker than early-onset OCD symptoms) and be more moderate in severity. Researchers suggest that the most common time for a person to develop OCD is during young adulthood, however, people can develop this condition during all stages of life. In fact, people in their 30s, 40s, 50s, and even 60s can develop OCD. Keep in mind, however, that people who develop OCD later in life have an elevated risk of developing an anxiety or depression condition.

What Are Some Differences Between Early-Onset OCD and Late-Onset OCD?

Although early-onset and late-onset OCD are both parts of the same whole – OCD, there are some noticeable differences between the different presentations of this condition. While the time when you develop OCD may seem insignificant, in actuality it plays a large part in the severity, cause, and treatment of your OCD symptoms.

Listed below are the differences between early-onset OCD and late-onset OCD:

Gender

One of the biggest differences between early-onset and late-onset OCD is the percentages of males and females who develop it. Researchers overwhelmingly agree that males are more prone to develop early-onset OCD than females. However, studies suggest that these percentages appear to “even out” when it comes to males and females with both males and females developing late-onset OCD at an equal rate.

Brain Structure Abnormalities

Researchers have found that people who develop early-onset OCD have different brain structure abnormalities than those who develop it later in life. More specifically, studies suggest that people who develop early-onset OCD have different neuropsychological deficits than people who develop late-onset OCD. However, the cause of this difference and its impact on OCD treatment success is currently unknown.

Symptomatology

Another difference is that early-onset OCD symptoms tend to gradually appear, whereas late-onset OCD symptoms tend to arise quickly and without warning. According to researchers, late-onset OCD symptoms are usually tied to a trigger of some sort or a highly stressful or traumatic experience, such as the loss of a loved one, an assault, getting kicked out of school, losing a job, being gravely injured, etc.

Note: The only time that OCD symptoms arise early is when a child develops pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), an autoimmune form of OCD that only occurs in children.

Comorbidities

Researchers suggest that OCD can co-occur with other mental health conditions like attention-deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), oppositional defiant disorder (ODD), etc. Studies also suggest that people who develop early-onset OCD have a higher risk of also developing a tic disorder or tic-related OCD. This risk does not appear to be elevated in people who develop OCD later in life. Still, both early-onset OCD sufferers and late-onset OCD sufferers are at risk of OCD comorbidity.

Treatment Success

Researchers have found that the earlier a person develops OCD, the more severe it is. Moreover, some studies suggest that the earlier you develop OCD the harder it is to treat – pharmaceutically and psychologically. More specifically, when a person has early-onset OCD, they often have to go through more medications to find the one or two that will “quiet” the noise in their mind and reduce or stop urges to perform rituals or routines to ease their stress and anxiety – often the culprits fueling their OCD symptoms.

Early-onset OCD sufferers may also need more intensive and longer psychotherapy (CBT or ERP therapy) to manage their OCD symptoms than people who develop late-onset OCD. According to a 2011 study, while there were noticeable differences in OCD symptoms between children with early-onset OCD (over the age of 9 years of age) and those with late-onset OCD (over the age of 9 years old) both groups experience the same response to treatments.

Still, the jury is still out as to if there are differences in treatment success between OCD sufferers who develop OCD early and those who develop it later in life. More research is needed to determine if these two presentations of OCD should be treated differently or the same.

Real-Life Examples of Early-Onset OCD

Listed below are real-life examples of early-onset OCD from people who live with it: 

• “I’m not sure when mine started, but probably like 9 or 10? The first obsession that I remember vividly is that I was worried I was attracted to everyone. I remember being in an airport with my family and getting really upset because I was attracted to everyone in the airport. Was probably like 10 or 11 then, I guess.”

• “I didn’t get diagnosed until I was 16, but I’m pretty sure it kicked in between 6-8 for me. I remember at that age being acutely aware of the fact that I “wasn’t like other kids”, and being ashamed of it and also terrified of the idea that there might be something wrong with me.”

• “I was diagnosed somewhere from 8-10 after my grandfather died, which I think was around the time I developed full-blown obvious OCD, but I definitely had the tendencies as long as I can remember. Maybe subclinical in early childhood and grief tipped the balance to clinical.”

Real-Life Examples of Late-Onset OCD

Listed below are real-life examples of late-onset OCD from people who live with it:

• “Mine didn’t start until I was maybe 19 or 20. And I’ve thought about it long and hard to see if I had anything in my past like it. I think there’s actually some research talking about why changes in mental health can happen at this time, but I don’t have any names off the top of my head.”

• “So I’m 22 and developed OCD in January of this year. At first, it was simple things like repeating myself under my breath involuntarily or having minor hand contortions. In the past few months, it has escalated to my whole body ritualistically contorting while my bones pop and crack. And now I have to cut my left arm until it feels right. I can’t go into my own bathroom anymore without feeling the overwhelming urge to slice my arm. And even if I stave off the compulsions for a few hours, I cannot sleep until I give in. This is ridiculous and so sudden. I have found that most of my triggers focus on my relationship with my SO and my friends.

I’m seeing a therapist and after the first visit, I know I made the right choice. To those of you who have been dealing with this vial, misunderstood, life-altering illness, I’m so incredibly sorry. I was one of the “oh that makes my OCD crazy” people. I don’t believe in karma, but I bet those of you who do are getting a kick out of this one. The hell I’ve been through the past 6 months is nothing compared to living with this for a lifetime.”

Is Early-Onset OCD Treated Differently Than Late-Onset OCD?

No, early-onset OCD and late-onset OCD are treated the same.

The most common way to treat both forms of OCD is with CBT or ERP therapy. If OCD therapy alone does not work, then medication (i.e., SSRIs, SNRIs, antipsychotics, etc.) are prescribed in conjunction with therapy. Although self-help tools and natural remedies are not often prescribed by a doctor to help OCD, many OCD sufferers turn to them due to their lack of side effects.

It is important to understand that self-help tools like Impulse Therapy, and natural remedies like acupuncture and St. John’s Wort take time to work (approximately 4-6 weeks), so sometimes it is necessary to combine them with your prescribed treatments until they start working.

Always discuss your desire to add self-help tools and natural remedies to your treatment plan with your doctor. The best way to treat OCD successfully is to research it. In other words, learn everything you can about it so you can recognize your triggers and take steps to thwart the obsessions and compulsions. With the right treatments, you can conquer OCD, regardless of when you developed it.

What Are Ways That You Can Combat Early-Onset OR Late-Onset OCD?

Listed below are ways that you can combat early-onset OCD or late-onset OCD:

• Spend time with friends and family
• Identify your triggers
• Write about each day in a journal
• Express yourself with art
• Talk to someone you trust about what you have been experiencing
• Adopt a healthy diet
• Practice stress-management techniques (i.e., deep breathing exercises, yoga, meditation, etc.)
• Get plenty of sleep
• Develop an exercise routine
• Practice self-care
• Go on dates
• Try to develop new habits to replace your rituals or routines
• Question the negative and intrusive thoughts, feelings, visions, urges, fears, etc.
• Be kind to yourself
• Seek OCD treatment
• Attend your therapy sessions
• Take your medications
• Join an OCD support group
• Learn as much as you can about OCD – symptoms, causes, and treatments
• Busy yourself

Final Thoughts

Although OCD is life-altering regardless of when a person develops it, the timing can make a significant impact on the severity of your symptoms (obsessions and/or compulsions), the cause, and the treatment used. Males are more likely to develop early-onset OCD while both males and females are likely to develop late-onset OCD. The treatment for both forms of OCD is typically CBT or ERP therapy and medication (i.e., SSRI antidepressants), although early-onset OCD may take longer to treat. On the flip side, late-onset OCD tends to appear more quickly than early-onset OCD.

With early-onset, the presentation is usually gradual so there is more time to adjust to having the condition, while with late-onset OCD the symptoms can hit you like whiplash, causing you to have less time to process your new reality. The good news is that regardless of when you develop OCD it can be successfully treated with a variety of methods, such as natural remedies like CBD, art therapy, journaling, learning healthy coping mechanisms, eating healthy, exercising and hypnosis, and self-help tools like Impulse Therapy, an online OCD recovery treatment program designed to help people get a grip on their OCD symptoms, regardless of when they present.

References

• Pittenger, C., & Bloch, M. H. (2014). Pharmacological treatment of obsessive-compulsive disorder. The Psychiatric Clinics of North America, 37(3), 375–391. Retrieved from https://doi.org/10.1016/j.psc.2014.05.006
• Nakatani, E., Krebs, G., Micali, N., Turner, C., Heyman, I., & Mataix-Cols, D. (2011). Children with very early onset obsessive-compulsive disorder: Clinical features and treatment outcome. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 52(12), 1261–1268. Retrieved from https://doi.org/10.1111/j.1469-7610.2011.02434.x
• Taylor S. (2011). Early versus late onset obsessive-compulsive disorder: evidence for distinct subtypes. Clinical psychology review, 31(7), 1083–1100. https://doi.org/10.1016/j.cpr.2011.06.007
• Westwell-Roper, C., & Stewart, S. E. (2019). Challenges in the diagnosis and treatment of pediatric obsessive-compulsive disorder. Indian Journal of Psychiatry, 61(1), S119–S130. Retrieved from https://doi.org/10.4103/psychiatry.IndianJPsychiatry_524_18
• Conelea, C. A., Walther, M. R., Freeman, J. B., Garcia, A. M., Sapyta, J., Khanna, M., & Franklin, M. (2014). Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the pediatric OCD treatment study II. Journal of the American Academy of Child and Adolescent Psychiatry, 53(12), 1308–1316. Retrieved from https://doi.org/10.1016/j.jaac.2014.09.014
• Neziroglu, F., & Fruchter, Y. (2018). Manifestation and treatment of OCD and spectrum disorders within a pediatric population. Anxiety Disorders – From Childhood to Adulthood. Retrieved from https://www.researchgate.net/publication/330939681_Manifestation_and_Treatment_of_OCD_and_Spectrum_Disorders_within_a_Pediatric_Population
• Anholt, G. E., Aderka, I. M., van Balkom, A. J., Smit, J. H., Schruers, K., van der Wee, N. J., Eikelenboom, M., De Luca, V., & van Oppen, P. (2014). Age of onset in obsessive-compulsive disorder: admixture analysis with a large sample. Psychological Medicine, 44(1), 185–194. Retrieved from https://doi.org/10.1017/S0033291713000470
• Kim, T., Kwak, S., Hur, J. W., Lee, J., Shin, W. G., Lee, T. Y., Kim, M., & Kwon, J. S. (2020). Neural bases of the clinical and neurocognitive differences between early-and late-onset obsessive–compulsive disorder. Journal of Psychiatry & Neuroscience, 45(4), 234–242. Retrieved from https://doi.org/10.1503/jpn.190028
• Grant, J. E., Mancebo, M. C., Pinto, A., Williams, K. A., Eisen, J. L., & Rasmussen, S. A. (2007). Late-onset obsessive compulsive disorder: Clinical characteristics and psychiatric comorbidity. Psychiatry Research, 152(1), 21–27. Retrieved from https://doi.org/10.1016/j.psychres.2006.09.015