Cross-sectional comparison of the clinical characteristics of adults with early-onset and late-onset obsessive compulsive disorder

Background: Age at onset (AAO) in obsessive compulsive disorder (OCD) may differentiate genetically and clinically heterogeneous subtypes. The current cross-sectional study compared the characteristics of early-onset OCD (onset age≤18 years) and late-onset OCD (onset age>18 years). The AAO cut-off was based on the onset distribution observed in our systematically recruited patients with OCD.

Methods: Six hundred and two (including 339 men and 263 women) outpatients meeting DSM-IV criteria of OCD were recruited from the Shanghai Mental Health Center and were screened by a battery of instruments: Yale-Brown Obsessive Compulsive Scale (YBOCS) attached Y-BOCS Symptom Checklist, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and State-Trait Anxiety Inventory (STAI). The demographic and clinical characteristics of the 275 early-onset patients were compared to those of the 327 late-onset patients.

Results: Compared to patients with late-onset OCD, early-onset patients with OCD were significantly more likely to be male (66.9% vs. 47.4%, X2=23.1, p<0.001), to have a positive family history of mental illnesses (26.5% vs. 19.0%, X2=4.9, p=0.026), and to have a longer duration of illness [80.0 (SD=80.7) vs. 65.5 (SD=78.3) months, t600=3.17, p=0.002]. Early-onset patients also had significantly higher scores on the HAMA, HAMD, STAI2, and obsessive in Y-BOCS. The sexual and symmetry/exactness obsessions and the washing/cleaning compulsions were significantly more prevalent in the early-onset group.

Conclusions: The study of a large sample from mainland China confirms the findings from previous studies and supports the hypothesis that early-onset OCD is a demographically and clinically distinct subtype of OCD.