Early onset of obsessive-compulsive disorder and associated comorbidity.
BACKGROUND
Previous studies have aimed to identify subtypes of obsessive-compulsive disorder (OCD) based on their age of onset (AOO). Obsessive-compulsive spectrum disorders (OCS disorders) such as tic disorders have been particularly associated with an early onset in some studies. However, subtypes of early- and late-onset OCD are unevenly determined, and the biological and the clinical validity of these subtypes are unknown. This study was undertaken to discriminate the subtypes of OCD in different AOO levels and to test the hypothesis that different AOO bands are associated with a differential pattern of comorbidity.


METHODS
Two hundred fifty-two patients with OCD were interviewed directly with the German version of the Schedule for Affective Disorders and Schizophrenia-Lifetime Anxiety Version, which provides DSM-IV diagnosis. Subgroups with different ages of onset were investigated (cut-off levels of 10, 15, and 18 years).


RESULTS
Subjects with an early AOO (onset < or =10 years) were significantly more likely to have OCS disorders (odds ratio [OR]=3.46; P=.001; 95% confidence interval [CI]: 1.72-6.96), in particular tic/Tourette's disorders (OR=4.63; P=.002; 95% CI: 1.78-12.05), than were late-onset subjects.


CONCLUSIONS
For most mental disorders (e.g., anxiety and mood disorders), no associations with AOO of OCD were identified. However, subjects in the early-onset group (< or =10 years) had a significant increase in comorbid tic and Tourette's disorders. Future research should examine potential neurobiological features associated with early-onset presentations of OCD. Early detection and management of comorbidities may offset impairments later in life.
Janowitz
Deborah
D
Department of Psychiatry and Psychotherapy, University of Greifswald, Greifswald, Germany. Deborah.Janowitz@well.ox.ac.uk
Grabe
Hans Joergen
HJ
Ruhrmann
Stephan
S
Ettelt
Susan
S
Buhtz
Friederike
F
Hochrein
Andrea
A
Schulze-Rauschenbach
Svenja
S
Meyer
Klaus
K
Kraft
Susanne
S
Ferber
Claudia
C
Pukrop
Ralf
R
Freyberger
Harald J
HJ
Klosterkötter
Joachim
J
Falkai
Peter
P
John
Ulrich
U
Maier
Wolfgang
W
Wagner
Michael
M
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D005260:Female; D005858:Germany; D006801:Humans; D006998:Hypochondriasis / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D015994:Incidence; D007406:Interview, Psychological; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology; D010552:Personality Assessment; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D020323:Tics / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D005879:Tourette Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology; D055815:Young Adult