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

  • G. E. Anholt (a1) (a2), I. M. Aderka (a3) (a4), A. J. L. M. van Balkom (a1), J. H. Smit (a1), K. Schruers (a5), N. J. A. van der Wee (a6), M. Eikelenboom (a1), V. De Luca (a7) and P. van Oppen (a1)...



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.


Corresponding author

* 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:


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Aderka, IM, Nickerson, A, Hofmann, SG (2012). Admixture analysis of the diagnostic subtypes of social anxiety disorder: implications for the DSM-V. Journal of Behavior Therapy and Experimental Psychiatry 43, 752757.
Anholt, GE, Cath, DC, Emmelkamp, PM, van Oppen, P, Smit, JH, van Balkom, AJ (2006). Do obsessional beliefs discriminate OCD without tic patients from OCD with tic and Tourette's syndrome patients? Behaviour Research and Therapy 44, 15371543.
Anholt, GE, Cath, DC, van Oppen, P, Eikelenboom, M, Smit, JH, van Megen, H, van Balkom, AJ (2010). Autism and ADHD symptoms in patients with OCD: are they associated with specific OC symptom dimensions or OC symptom severity? Journal of Autism and Developmental Disorders 40, 580589.
Baron-Cohen, S, Wheelwright, S, Skinner, R, Martin, J, Clubley, E (2001). The Autism-Spectrum Quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders 31, 517.
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988 a). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.
Beck, AT, Steer, RA, Garbin, MG (1988 b). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 42, 861865.
Bellivier, F, Golmard, JL, Rietschel, M, Schulze, TG, Malafosee, A, Preisig, M, Leboyer, M (2003). Age at onset in bipolar I affective disorder: further evidence for three subgroups. American Journal of Psychiatry 160, 9991001.
Bellodi, L, Sciuto, G, Diaferia, G, Ronchi, P, Smeraldi, E (1992). Psychiatric disorders in the families of patients with obsessive-compulsive disorder. Psychiatry Research 42, 111120.
Bolton, D, Rijsdijk, F, O'Connor, TG, Perrin, S, Eley, TC (2007). Obsessive-compulsive disorder, tics, and anxiety in 6-year-old twins. Psychological Medicine 37, 3948.
Busatto, GF, Buchpiguel, CA, Zamignani, DR, Garrido, GE, Glabus, MF, Rosario-Campos, MC, Castro, CC, Maia, A, Rocha, ET, McGuire, PK, Miguel, EC (2001). Regional cerebral blood flow abnormalities in early-onset obsessive compulsive disorder: an exploratory SPECT study. Journal of the American Academy of Child and Adolescent Psychiatry 40, 347354.
Butwicka, A, Gmitrowicz, A (2010). Symptom clusters in obsessive-compulsive disorder (OCD): influence of age and age of onset. European Child and Adolescent Psychiatry 19, 365370.
Chabane, N, Delorme, R, Millet, B, Mouren, MC, Leboyer, M, Pauls, D (2005). Early-onset obsessive compulsive disorder: a subgroup with a specific clinical and familial pattern? Journal of Child Psychology and Psychiatry 46, 881887.
Delorme, R, Golmard, JL, Chabane, N, Millet, B, Krebs, MO, Mouren-Simeoni, MC, Leboyer, M (2005). Admixture analysis of age at onset in obsessive-compulsive disorder. Psychological Medicine 35, 237243.
de Mathis, MA, Diniz, JB, Shavitt, RG, Torres, AR, Ferrão, YA, Fossaluza, V, Pereira, C, Miguel, E, do Rosario, MC (2009). Early onset obsessive-compulsive disorder with and without tics. CNS Spectrums 14, 362370.
Douglass, HM, Moffitt, TE, Dar, R, McGeer, R, Silva, P (1995). Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors. Journal of the American Academy of Child and Adolescent Psychiatry 34, 14241431.
DuPaul, GJ, Power, TJ, Anastopoulos, AD, Reid, R (1998). ADHD Rating Scale-IV. Checklists, Norms and Clinical Interpretation. Guilford Press: New York.
Eakin, L, Minde, K, Hechtman, L, Ochs, E, Krane, E, Bouffard, R, Greenfield, B, Looper, K (2004). The marital and family functioning of adults with ADHD and their spouses. Journal of Autism and Developmental Disorders 8, 110.
Ferrao, YA, Shavitt, RG, Bedin, NR, de Mathis, ME, Carlos, Lopes A, Fontenelle, LF, Torres, AR, Miguel, EC (2006). Clinical features associated to refractory obsessive compulsive disorder. Journal of Affective Disorders 94, 199209.
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1995). Structured Clinical Interview for DSM-IV (SCID). Biometrics Research, New York State Psychiatric Institute: New York.
Fisher, PL, Wells, A (2005). How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis. Behaviour Research and Therapy 43, 15431558.
Goes, FS, McCusker, MG, Bienvenu, OJ, MacKinnon, DF, Mondimore, FM, Schweizer, B, DePaulo, JR, Potash, JB (2012). Comorbid anxiety disorders in bipolar disorder and major depression: familial aggregation and clinical characteristics of comorbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder. Psychological Medicine 42, 14491559.
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, R, Hill, CL, Heninger, GR, Charney, DS (1989). The Yale-Brown Obsessive-Compulsive Scale I: Development, use, and reliability. Archives of General Psychiatry 46, 10061011.
Grant, GE, Mancebo, MC, Pinto, A, Williams, KA, Eisen, JL, Rasmussen, SA (2007). Late-onset obsessive compulsive disorder: clinical characteristics and psychiatric comorbidity. Psychiatry Research 152, 2127.
Hollander, E, Kwon, JH, Stein, DJ, Broatch, J, Rowland, CT, Himelein, CA (1996). Obsessive-compulsive and spectrum disorders: overview and quality of life issues. Journal of Clinical Psychiatry 57 (Suppl. 8), 36.
Janowitz, D, Grabe, HJ, Ruhrmann, S, Ettelt, S, Buhtz, F, Hochrein, A, Schulze-Rauschenbach, S, Meyer, K, Kraft, S, Ferber, C, Pukrop, R, Freyberger, HJ, Klosterkotter, J, Falkai, P, John, U, Maier, W, Wagner, M (2009). Early onset of obsessive-compulsive disorder and associated comorbidity. Depression and Anxiety 26, 10121017.
Kolenikov, S (2001). Denormix: Stata module to perform decomposition of normal mixture ( Accessed 24 July 2012.
Labad, J, Menchon, JM, Alonso, P, Segalas, C, Jimenez, S, Jaurrieta, N, Leckman, JF, Vallejo, J (2008). Gender differences in obsessive-compulsive symptom dimensions. Depression and Anxiety 25, 832838.
Leckman, JF, Bloch, MH, King, RA (2009). Symptom dimensions and subtypes of obsessive-compulsive disorder: a developmental perspective. Dialogues in Clinical Neuroscience 11, 2133.
Leckman, JF, Denys, D, Simpson, HB, Mataix-Cols, D, Hollander, E, Saxena, S, Miguel, EC, Rauch, SL, Goodman, WK, Phillips, KA, Stein, DJ (2010). Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V. Depression and Anxiety 27, 507527.
Leckman, JF, Grice, DE, Boardman, J, Zhang, H, Vitale, A, Bondi, C, Alsobrook, J, Peterson, BS, Cohen, DJ, Rasmussen, SA, Goodman, WK, McDougle, CJ, Pauls, DL (1997). Symptoms of obsessive-compulsive disorder. Archives of General Psychiatry 154, 911917.
Leckman, JF, Riddle, MA, Hardin, M, Ort, SI, Swartz, KL, Stevenson, J, Cohen, D (1989). The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry 28, 566573.
Lomax, CL, Oldfield, VB, Salkovskis, PM (2009). Clinical and treatment comparisons between adults with early- and late-onset obsessive-compulsive disorder. Behaviour Research and Therapy 47, 99104.
Maina, G, Albert, U, Salvi, V, Pessina, E, Bogetto, F (2008). Early-onset obsessive-compulsive disorder and personality disorders in adulthood. Psychiatry Research 158, 217225.
Mancebo, MC, Greenberg, B, Grant, JE, Pinto, A, Eisen, JL, Dyck, I, Rasmussen, SA (2008). Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder. Comprehensive Psychiatry 49, 4350.
Masia, CL, Storch, EA, Dent, HC, Adams, P, Verdeli, H, Davies, M, Weissman, MM (2003). Recall of childhood psychopathology more than 10 years later. Journal of the American Academy of Child and Adolescent Psychiatry 42, 612.
Moritz, S, Niemeyer, H, Hottenrott, B, Schilling, L, Spitzer, C (2012). Interpersonal ambivalence in obsessive-compulsive disorder. Behavioural and Cognitive Psychotherapy 13, 116.
Murray, CJ, Lopez, AD, Wibulpolprasert, S (2004). Monitoring global health: time for new solutions. British Medical Journal 329, 10961100.
Noshirvani, HF, Kasvikis, Y, Marks, IM, Tsakiris, F, Monteiro, WO (1991). Gender-divergent aetiological factors in obsessive-compulsive disorder. British Journal of Psychiatry 158, 260263.
Palumbo, D, Maughan, A, Kurlan, R (1997). Hypothesis III. Tourette syndrome is only one of several causes to a development basal ganglia syndromes. Archives of Neurology 54, 475481.
Pauls, DL, Alsobrook, JP 2nd, Goodman, W, Rasmussen, S, Leckman, JF (1995). A family study of obsessive-compulsive disorder. American Journal of Psychiatry 152, 7684.
Rosa-Alcázar, AI, Sánchez-Meca, J, Gómez-Conesa, A, Marín-Martínez, F (2008). Psychological treatment of obsessive-compulsive disorder: a meta-analysis. Clinical Psychology Review 28, 13101325.
Rosario-Campos, MC, Leckman, JF, Mercadante, MT, Shavitt, RG, Prado, HS, Sada, P, Zamignani, D, Miguel, EC (2001). Adults with early-onset obsessive-compulsive disorder. American Journal of Psychiatry 158, 18991903.
Schuurmans, J, van Balkom, AJ, van Megen, HJ, Smit, JH, Eikelenboom, M, Cath, DC, Kaarsemaker, M, Oosterbaan, D, Hendriks, GJ, Schruers, KR, van der Wee, NJ, Glas, G, van Oppen, P (2012). The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study: design and rationale of a longitudinal naturalistic study on the course of OCD and clinical characteristics of the sample at baseline. International Journal of Methods in Psychiatric Research 21, 273285.
Sobin, C, Blundell, ML, Karayiorgou, M (2000). Phenotypic differences in early- and late-onset obsessive-compulsive disorder. Comprehensive Psychiatry 41, 373379.
Swedo, SE, Rapoport, JL, Leonard, H, Lenane, M, Cheslow, D (1989). Obsessive-compulsive disorder in children and adolescents. Clinical phenomenology of 70 consecutive cases. Archives of General Psychiatry 46, 335341.
Taylor, S (2011). Early versus late onset obsessive-compulsive disorder: evidence for distinct subtypes. Clinical Psychology Review 31, 10831100.
Tozzi, F, Manchia, M, Galway, NW, Severino, G, Del, Zompo M, Day, R, Matthews, K, Struass, J, Kennedy, JL, McGuffin, P, Vincent, JB, Farmer, A, Muglia, P (2011). Admixture analysis of age at onset in bipolar disorder. Psychiatry Research 185, 2732.
Tükel, R, Ertekin, E, Batmaz, S, Alyanak, F, Sozen, A, Aslantas, B, Atli, H, Ozyildirim, I (2005). Influence of age of onset on clinical features in obsessive-compulsive disorder. Depression and Anxiety 21, 112117.


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

  • G. E. Anholt (a1) (a2), I. M. Aderka (a3) (a4), A. J. L. M. van Balkom (a1), J. H. Smit (a1), K. Schruers (a5), N. J. A. van der Wee (a6), M. Eikelenboom (a1), V. De Luca (a7) and P. van Oppen (a1)...


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