title: Age of onset in obsessive-compulsive disorder: admixture analysis with a large sample.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry and EMGO Institute, VU-University Medical Center and Academic Outpatient Clinic for Anxiety Disorders, GGZ InGeest, Amsterdam, The Netherlands.
authors.forename: G E
authors.initials: GE
authors.lastname: Anholt
authors.forename: I M
authors.initials: IM
authors.lastname: Aderka
authors.forename: A J L M
authors.initials: AJ
authors.lastname: van Balkom
authors.forename: J H
authors.initials: JH
authors.lastname: Smit
authors.forename: K
authors.initials: K
authors.lastname: Schruers
authors.forename: N J A
authors.initials: NJ
authors.lastname: van der Wee
authors.forename: M
authors.initials: M
authors.lastname: Eikelenboom
authors.forename: V
authors.initials: V
authors.lastname: De Luca
authors.forename: P
authors.initials: P
authors.lastname: van Oppen
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001007:Anxiety / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology; D001321:Autistic Disorder / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology*; D013981:Tic Disorders / Q000453:epidemiology; D055815:Young Adult