What is Tourettic OCD?

Medically Reviewed By – Juliet Gustafson, LMSW

Tourettic OCD is a hybrid phenomenon between two mental disorders, Tourette syndrome and OCD. The term Tourettic OCD was formed due to the overlapping symptoms of both OCD and TS. Moreover, TOCD is considered a subtype of OCD, which impacts everyday life and overall quality of life.

Over the last couple of decades, as studies began to advance, the general public began to misuse and often fail to differentiate between classic OCD and tourettic OCD(tic related ocd). So the question remains, What is Tourettic OCD? And how is it different from classic OCD?

This post is all about What is Tourettic OCD.

What is OCD

Obsessive compulsive disorder is a mental health disorder that impacts millions of people throughout the globe. OCD consists of two fundamental parts, obsessions/intrusive thoughts and compulsions.

Obsessions are the undesirable and unwanted thoughts, urges and/or mental images that recur frequently over a period of time. These obsessions are very time consuming and cause a great deal of anxiety and stress.

Compulsions on the other hand are the physical and/or mental actions performed frequently over a period of time in order to relieve anxiety and stress caused by obsessions.

What is Tourette Syndrome

Tourette syndrome (also known as TS) is a neurological disorder revolving around intrusive and uncontrollable actions such as movements, urges and/or vocalizations. These repetitive behaviors are called “Tics” and they play a huge role in tourettic OCD. Tic severity fluctuates from minor/moderate to severe. This is due to several factors discussed further in this article.

Furthermore, Tics negatively impact people with Tourette syndrome as they are associated with feelings of social awkwardness, embarrassment, anxiety, shame, and guilt. Individuals with tourettic OCD often experience anxiety and distress due to their tics. 

Moreover, there are two types of tic disorders, either Motor (motor responses) or vocal. It is important to note that both types of Tics recur frequently over a period of time, interfering with all aspects of daily life.

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Motor Tics Vs Vocal Tics 

This disorder is longer-lasting and continues for at least a year. The tics in Chronic Tic Disorder are either vocal or motor but they don’t fall under both categories. Motor Tics – Intrusive thoughts and unwanted physical movements performed in sequences over and over again. 

Examples of Motor Tics 

• blinking, wrinkling the nose or grimacing
• jerking or banging the head
• clicking the fingers
• touching other people or things

Vocal Tics – intrusive thoughts and unwanted production of sounds and/or phrases frequently over a period of time. 

Examples of Vocal Tics 

• Throat clearing
• Coughing
• Sniffing or snorting
• Whistling or hissing
• Grunting or gurgling
• Squealing or screeching
• Animal or bird noises
• Phrases (often profanities)
• Sudden changes in volume or pitch
• Repeating sounds or phrases

Types of Tics

Tics are categorized in two ways, either simple or complex. 

Related Article(s) – What Are The 4 Types Of OCD?

Simple Tics – sudden, brief, repetitive movements that involve a few muscle groups.

Examples of Simple Tics

• Eye blinking and other eye movements
• Facial grimacing
• Shoulder shrugging
• Head or shoulder jerking

Complex Tics – distinct, coordinated patterns of movement involving several muscle groups in different parts of the body. 

Examples of Complex Tics

• Sniffing or touching an object
• Hopping
• Jumping
• Bending
• Twisting

What is Tourettic OCD? 

TOCD is not a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but rather an unofficial term that refers to the overlap of Tourette Syndrome and OCD . OCD is a subtype of OCD in which individuals experience OCD like behaviors without experiencing obsessions and/or intrusive thoughts.

In other words, Tourettic OCD (TOCD)  is influenced by features of both OCD and TS and differs from either disorder alone. Patients with TOCD experience thoughts, sensations, anxiety and behavioral urges much like compulsions in OCD. 

Both OCD and TS (mental disorders) are characterized with an unpleasant feeling that precedes the activity. In OCD, the discomfort is mental (feelings of anxiety and stress) but in TS, the discomfort is a physical or sensory need. TOCD characteristic symptoms can appear alone or can exist in combination with classic OCD symptoms

The urge to engage in repetitive behavior is present in both disorders, however compulsions ask for an increased level of  mental control (voluntary) and awareness whereas tics are traditionally thought of as involuntary. 

Contrary to OCD, TOCD patients typically report significant physical discomfort that motivates compulsive activities rather than obsessional thoughts, which are more common in OCD.

How Are Tourette’s and OCD related?

OCD and Tourette’s syndrome are comorbidly linked with each other. In other words, if you have OCD, there is a slight chance you may have and/or experience symptoms of Tourettes.Among the more common co-morbid conditions are depression, other anxiety disorders, eating disorders, and TS.

In fact, according to The Japanese Society of Child Neurology, 30% of children diagnosed with TS, meet the diagnostic criteria for (OCD). Furthermore, the proportion of individuals with TS who also have OCD is much higher, ranging from 28 to 63%.

In addition, a twin study conducted in 1985 found that of 43 pairs of twins in which one twin had TS, OCD symptoms were apparent in 83% of individuals. It is safe to say that OCD and Tourette syndrome are highly linked together as symptoms from both diseases tend to overlap. 

Similarities between Tourette’s and OCD 

There are many similarities between OCD and Tic disorders. Both disorders follow a recovery and relapse period throughout their lifetime. Childhood or teenage onset is common in both, and although OCD may manifest later, an association is apparent such that a large proportion of children diagnosed with OCD also present with tics. Moreover, genetic links such as personal or family history have also been identified between OCD and Tic disorders.

In both, repetitive behaviors including repeated thoughts and/or acts are widespread and common. The patient believes these behaviors to be, at least in part, involuntary. These RB are frequently associated with risky or forbidden topics such violence, sex, or scrupulosity.

Both OCD and TS symptoms can be aggravated by stress or worry. Moreover, Tics and compulsions have the same function, which is to relieve anxiety, distress or uncertainty in the case of OCD.

Furthermore, according to a 2010 study, there is also evidence that dysfunction of the basal ganglia and related structures could be involved in both conditions. 

Differences between Tourette’s and OCD 

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Despite the many similarities between the symptoms of TS and OCD, there are of course some clear differences. For a start, because tics typically begin earlier in life than classic OCD, the course of the condition might vary.

Moreover, Tic symptoms also appear overall more likely to improve with age, whereas in OCD, they often worsen over time. Furthermore, It is interesting as OCD is said to be an anxiety disorder, but in Tourettic OCD the rituals have nothing to do with anxiety, worries or fears

How to Stop OCD Tics in Adults

Unfortunately there is no definitive cure for Tourettic OCD. However, much like classic OCD, TOCD symptoms can decrease in both frequency and severity due to a couple of evidence based treatment options.

Cognitive Behavioral Therapy (CBT) and Exposure-Response Prevention Therapy (ERPT) are widely accepted as first-line behavioral interventions for OCD related symptoms, while Comprehensive Behavioral Intervention for Tics (CBIT) is a widely accepted behavioral treatment for tics.

Cognitive Behavioural Therapy 

The core concept of cognitive behavior therapy (CBT) is the idea that your thoughts, feelings, bodily sensations, and behaviors are linked together and that having negative ideas and feelings may keep you stuck in a negative loop.

Cognitive behavior therapy aims to help individuals understand the connection between their thoughts, feelings, and behaviors. For TS, stress and anxiety is a common trigger for tics. Cognitive behavior therapy will help an individual identify ways to decrease overall stress, thus impacting their thoughts and behaviors. 

Exposure and Response Prevention Therapy 

Exposure and response prevention (ERP) is a type of CBT that has been proven to be especially helpful for people with OCD.

ERP teaches a patient coping skills to utilize when a triggering scenario arises, allowing them to use the skills to avoid their obsession from taking control.

s ERP involves gradually exposing yourself to your fears and learning to resist the urge to perform compulsive behaviors.

Related Article(s) – What Will Happen if OCD is Left Untreated?

Habit Reversal Therapy 

Habit reversal training (HRT) is an evidence-based therapy designed to help patients overcome habits and change their behaviors.

HRT can assist clients in changing their established reactions to stressors. HRT, whether automated or concentrated, aims to help individuals become more self-aware of their behaviors.

These courses teach participants how to recognize the early signs of negative behavior. Having this understanding gives you the power to change out unhealthy emotions for better ones.

Medication 

When psychotherapy does not work or is not acceptable, pharmacological treatment is recommended. Antidepressants that affect the balance of chemicals in the brain are typically used in conjunction with psychotherapy.

To be more specific, SSRIs (selective serotonin reuptake inhibitors) are used to balance serotonin levels in the brain.

Combination Therapy

A mix of two types of therapies together. This is the most common and effective way to deal with TOCD. A combination of ERP/CBT and medication in the form of SSRI is the recommended way to deal with OCD, Tics and TOCD. 

Antipsychotic Medications

These medications are effective in treating tics and TS due to their ability to modify the dopamine levels in the brain. These type of medications are a considered great treatment options

Related Article(s) – Can Art Therapy Help OCD?

Final Thoughts on Tourettic OCD

All in all, OCD and Tourette’s are highly linked together and are believed to be comorbid with each other. However, since symptoms of Tourettes and OCD overlap, the term Tourettic OCD was born. Tourettic OCD is a combination of features mixed into one from both OCD and Tourette syndrome. 

This post was all about What is Tourettic OCD.

References 

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• Franklin ME, Harrison JP, Benavides KL. Obsessive-compulsive and tic-related disorders. Child Adolesc Psychiatr Clin N Am. 2012 Jul;21(3):555-71. doi: 10.1016/j.chc.2012.05.008. Epub 2012 Jun 16. PMID: 22800994; PMCID: PMC3401067.

• Mansueto CS, Keuler DJ. Tic or compulsion?: it’s Tourettic OCD. Behav Modif. 2005 Sep;29(5):784-99. doi: 10.1177/0145445505279261. PMID: 16046664.

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• Hanna GL, Piacentini J, Cantwell DP, Fischer DJ, Himle JA, Van Etten M. Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents. Depress Anxiety. 2002;16(2):59-63. doi: 10.1002/da.10058. PMID: 12219336.

• Clare M. Eddy, Andrea E. Cavanna,Tourette syndrome and obsessive compulsive disorder: Compulsivity along the continuum,Journal of Obsessive-Compulsive and Related Disorders,Volume 3, Issue 4, 2014,

• Tourette syndrome and obsessive–compulsive disorderLombroso, Paul J. et al.Brain and Development, Volume 30, Issue 4, 231 – 237