Can OCD develop later in life?

Reading about obsessive-compulsive disorder (OCD), people may learn that it’s most commonly developed earlier in life, and many popular depictions of the condition confirm this, showing children or young adults developing OCD. 

But if you’re experiencing OCD symptoms at a different stage in life, you may be left wondering: Is this really OCD? If so, wouldn’t I have gotten it sooner? These questions can be highly confusing and distressing—let’s shed some light on the topic.

When does OCD usually develop?

According to the current edition of the Diagnostic and Statistical Manual for Mental Disorders, the onset of OCD is usually in the teen or adolescent years. It says the mean onset is age 19 and about 25% of cases start by the age of 14 years old. It does state that males will typically see onset earlier than females with about 25% male cases starting before the age of 10 years.  It is less common to see onset of OCD after the age of 35 years old, but it is certainly possible. Symptoms of OCD typically tend to occur gradually over time, however cases of acute onset are also reported.

Clinicians who diagnose OCD use specific criteria. They not only look for the presence of intrusive thoughts, urges, images, or unrealistic fears, but also compulsions done in response to distress or anxiety. No matter how or when these symptoms arise, if they cause significant distress, take up a lot of time in an average day, or interrupt one’s ability to function in daily life, they are an indication of OCD.

Can OCD develop at any time?

Yes! OCD can develop at any time, though in the general population, people are more likely to develop OCD during certain periods of life than others. OCD’s symptoms, possible causes, and experiences are widely varied, and the age at which it may be developed is no different. Symptoms start gradually, or can be acute, becoming severe all at once.  

Let’s consider an example of adult acute onset of OCD:

Jim is a 34 year old male. He works as a contractor for the family construction company, and has been married for nearly 5 years. Jim has always struggled with worry, from his health and grades as a child to his finances and relationships as an adult. Years ago, he started seeing a counselor and was diagnosed with Generalized Anxiety Disorder (GAD), but his symptoms have remained relatively constant and he simply considers them a part of who he is. 

Recently, however, he was at his younger sister’s house and was spending time with his 3 year old niece. While he was holding his niece he had the thought “What if you are attracted to her?” Immediately, he was filled with anxiety. He instantly put his niece down on the ground and walked into the other room. Later that night, he couldn’t stop thinking about having that thought earlier in the day. He told himself over and over that he would never harm his niece. He also told his fiance about the thought and asked her if he should be worried. His fiance told him not to worry about it, but he just couldn’t let it go. 

For the next several days, Jim was highly anxious about that one thought, even losing sleep. Jim starts to research online about intrusive thoughts about harming children and decides to avoid his younger sister and his niece until he is completely sure there is nothing to worry about. 

As he spends more and more time trying to feel certain that he could never harm his niece, Jim starts to notice other intrusive thoughts coming into his head of a more graphic and sexual nature. He feels triggered if he sees random children in the grocery store. Jim continues to confess every scary thought or image to his fiancee. She starts to become concerned and discovers through her own research that even though he has only been struggling with this new fear for about a week, Jim might be experiencing POCD or Pedophilia-themed OCD. She encourages Jim to make an appointment with a therapist to begin addressing his fears. 

If OCD develops later in life, is treatment less effective?

OCD can be debilitating and interfere greatly with one’s ability to feel comfortable in their life, but it is treatable at any age. By doing exposure and response prevention (ERP) therapy with a trained ERP therapist, you can find relief from the cycle of OCD. ERP is the gold standard of treatment for OCD and is backed by decades of clinical research. Most people who do ERP with a trained OCD therapist experience a decrease in OCD symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears. 

People who struggle with OCD will work with a therapist to build an exposure hierarchy and begin confronting one trigger at a time. Usually an ERP therapist will start with exposures that bring about a low level of anxiety, then work up to harder exposures as confidence is built. When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions. Over time, this allows you to tolerate anxiety and uncertainty, even at an age when you may doubt your ability to adapt and change.

Is OCD treated differently at different ages?

Treating OCD in children and adolescence can look a bit different than treatment of an adult, as children sometimes have less insight into their disorder or motivation to change. Parents of minors may also be involved in treatment of their child and will learn how to reduce and eliminate any accommodations they are making for their child’s OCD. 

Other than simple explanations and modifications to treatment, the underlying concept and principles of ERP remain the same for anyone with OCD, whether they are 9, 29, or 59. No matter what theme of OCD one experiences, how long they’ve had the condition, what caused it, or at what age it began, OCD is highly treatable. You can learn to manage your OCD symptoms in the long term and gain freedom from the vicious cycle of obsessions and compulsions.