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Age of onset in obsessive–compulsive disorder: admixture analysis with a large sample

Published online by Cambridge University Press:  20 March 2013

G. E. Anholt*
Department of Psychiatry and EMGO Institute, VU-University Medical Center and Academic Outpatient Clinic for Anxiety Disorders, GGZ InGeest, Amsterdam, The Netherlands Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
I. M. Aderka
Department of Psychology, Boston University, Boston, MA, USA Department of Psychology, University of Haifa, Mount Carmel, Haifa, Israel
A. J. L. M. van Balkom
Department of Psychiatry and EMGO Institute, VU-University Medical Center and Academic Outpatient Clinic for Anxiety Disorders, GGZ InGeest, Amsterdam, The Netherlands
J. H. Smit
Department of Psychiatry and EMGO Institute, VU-University Medical Center and Academic Outpatient Clinic for Anxiety Disorders, GGZ InGeest, Amsterdam, The Netherlands
K. Schruers
Academic Anxiety Center, PsyQ Maastricht and Research Institute for Mental Health and Neuroscience, Maastricht University, The Netherlands
N. J. A. van der Wee
Department of Psychiatry and Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
M. Eikelenboom
Department of Psychiatry and EMGO Institute, VU-University Medical Center and Academic Outpatient Clinic for Anxiety Disorders, GGZ InGeest, Amsterdam, The Netherlands
V. De Luca
Neurogenetics Section, Centre for Addiction and Mental Health, University of Toronto, ON, Canada
P. van Oppen
Department of Psychiatry and EMGO Institute, VU-University Medical Center and Academic Outpatient Clinic for Anxiety Disorders, GGZ InGeest, Amsterdam, The Netherlands
*Address for correspondence: Dr. G. E. Anholt, Department of Psychiatry and Institute for Research in Extramural Medicine, VU-University Medical Center and Academic Outpatient Clinic for Anxiety Disorders, GGZ InGeest, A. J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands. (Email:



Research into age of onset in obsessive–compulsive disorder (OCD) has indicated significant differences between patients with early and late onset of the disorder. However, multiple criteria have been used arbitrarily for differentiating between early- and late-onset OCD, rendering inconsistent results that are difficult to interpret.


In the current study, admixture analysis was conducted in a sample of 377 OC patients to determine the number of underlying populations of age of onset and associated demographic and clinical characteristics. Various measures of anxiety, depression, co-morbidity, autism, OCD, tics and attention deficit hyperactivity disorder (ADHD) symptoms were administered.


A bimodal age of onset was established and the best-fitting cut-off score between early and late age of onset was 20 years (early age of onset ⩽19 years). Patients with early age of onset were more likely to be single. Early age of onset patients demonstrated higher levels of OCD severity and increased symptoms on all OCD dimensions along with increased ADHD symptoms and higher rates of bipolar disorder.


It is suggested that 20 years is the recommended cut-off age for the determination of early versus late age of onset in OCD. Early age of onset is associated with a generally graver OCD clinical picture and increased ADHD symptoms and bipolar disorder rates, which may be related to greater functional implications of the disorder. We propose that age of onset could be an important marker for the subtyping of OCD.

Original Articles
Copyright © Cambridge University Press 2013 

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