title: Early onset of obsessive-compulsive disorder and associated comorbidity.
abstract: 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.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Greifswald, Greifswald, Germany. Deborah.Janowitz@well.ox.ac.uk
authors.forename: Deborah
authors.initials: D
authors.lastname: Janowitz
authors.forename: Hans Joergen
authors.initials: HJ
authors.lastname: Grabe
authors.forename: Stephan
authors.initials: S
authors.lastname: Ruhrmann
authors.forename: Susan
authors.initials: S
authors.lastname: Ettelt
authors.forename: Friederike
authors.initials: F
authors.lastname: Buhtz
authors.forename: Andrea
authors.initials: A
authors.lastname: Hochrein
authors.forename: Svenja
authors.initials: S
authors.lastname: Schulze-Rauschenbach
authors.forename: Klaus
authors.initials: K
authors.lastname: Meyer
authors.forename: Susanne
authors.initials: S
authors.lastname: Kraft
authors.forename: Claudia
authors.initials: C
authors.lastname: Ferber
authors.forename: Ralf
authors.initials: R
authors.lastname: Pukrop
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Freyberger
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
authors.forename: Peter
authors.initials: P
authors.lastname: Falkai
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
mesh_terms: 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