Obsessive-compulsive disorder (OCD) and Tourette’s syndrome are debilitating psychiatric conditions that share many common traits, from their symptoms to underlying causes. Despite these connections, there are several key differences that both patients and practitioners should bear in mind.
We spoke with Dr. Nicholas Farrell, a therapist at NOCD with extensive experience in Tourette’s syndrome and other tic disorders, to learn how these disorders are related, offer tools for assessing what condition you might have, and highlight treatment options.
What is OCD?
OCD is a mental health condition affecting around 1 in 40 adults. It is characterized by two primary symptoms: obsessions and compulsions.
Obsessions
Obsessions are intrusive and anxiety-inducing thoughts, images, feelings, or urges. They are often centered around particular topics or themes. Some common examples include:
- Contamination: Involves fears related to germs and illnesses
- Existential concerns: Involves unwanted or distressing thoughts related to philosophical matters such as the purpose of life or existence itself
- Relationships: Occurs when individuals with OCD are focused on worries about intimate relationships, romantic or otherwise
- False memories: People with OCD may experience intrusive thoughts regarding what they did or might have done in the past
Compulsions
Compulsions are mental or behavioral activities that an individual with OCD performs to alleviate the anxiety associated with their obsessions or prevent a negative outcome from occurring. Some common compulsions include:
- Frequent handwashing
- Seeking reassurance from friends and family
- Repetitive counting
- Reciting words or phrases
- Repetitive bodily movements
What are Tics and Tourette’s Syndrome?
Tics
Tics are sudden, involuntary (or extremely difficult to resist) movements or vocalizations that people perform repeatedly. As Dr. Farrell puts it, they are repetitive actions that, “from the sufferer’s point of view, are occurring beneath the level of conscious control.” Additionally, they most often occur in response to urges or an unpleasant inner tension.
Tics come in multiple different forms, which include:
Motor Tics
Motor Tics involve bodily movements. Common examples include blinking, facial grimacing, shoulder shrugging, and head jerking.
Vocal Tics
Tics can also take the form of sounds or vocalizations. As Dr. Farrell emphasizes, it’s important to note that this type of tic does not typically involve “uttering curse words or other vulgar, inappropriate things. That particular symptom is known as coprolalia.” Studies show that coprolalia only appears in 10 percent of individuals with Tourette’s syndrome (to be defined below). More common examples of vocal tics are throat clearing, snorting, and grunting.
Simple Tics
Tics differ in how simple or complex they are. “Simple tics,” as they are called, involve just a few parts of the body—examples include behaviors like blinking or sniffing.
Complex Tics
Tics can also be more elaborate, involving several different parts of the body or occurring alongside vocal tics. For example, a tic might involve bobbing one’s head while reciting a particular word or phrase.
Tourette’s Syndrome
A diagnosis of Tourette’s syndrome is made when an individual has been experiencing multiple motor tics and one or more vocal tics for at least one year. The condition must also have started before the age of 18.
Is Tourette’s Syndrome a Form of OCD?
At a superficial level, Tourette’s can appear very similar to OCD. Most importantly, individuals with both disorders repeatedly engage in unusual behaviors brought on by some sense of discomfort. This might lead many to wonder if Tourette’s syndrome is a form or type of OCD. To clarify, we can settle two further questions.
Does Tourette’s Disorder Involve Obsessions?
As Dr. Farrell notes, “one of the hallmark features of OCD is the presence of obsessions, which are disturbing mental intrusions, intrusive thoughts, images, or urges.” However, the feeling of discomfort that results in tics does not come from obsessions. “What nearly all people with tics describe is what’s known as the premonitory urge, which isn’t a thought or a mental event as much as it is experienced as a distressing, aversive physical state,” shares Dr. Farell. “Everybody kind of has their own experience with it, but more often than not, it’s described as just this inner tension or sense of unease that they feel compelled to get some relief from.”
Does Tourette’s Syndrome Involve Compulsions?
The tics that characterize Tourette’s syndrome are not compulsions. While compulsions are deliberate and effortful actions designed to neutralize anxiety caused by obsessions or to prevent some negative outcome from occurring, tics are largely involuntary and lack any real goal other than the intention to relieve inner tension or discomfort. As Dr. Farrell describes it, “Tics are not done with the express intent to prevent something bad from happening. On a more physiological level, they’re done with the intent to escape an uncomfortable sensation.”
What is Tourettic OCD?
Tourettic OCD sits in a gray area between OCD and Tourette’s syndrome, displaying some of the traits of each condition, but not others.
Tourettic OCD is like Tourette’s syndrome in the sense that, as Dr. Farrell describes, “the behaviors are still best described as tics and still experienced as largely involuntary from the sufferer’s point of view.”
The condition is like OCD in the sense that repetitive behaviors seem to occur in response to obsessions or intrusive thoughts. However, though the tics are caused by obsessions, they are still not performed with the goal of preventing any bad consequences. Take, for example, common intrusive thoughts about contamination. In the case of OCD, they might lead someone to perform actions that reduce the chances of becoming contaminated or getting sick. In the case of Tourettic OCD, while this same obsession might lead the individual to perform repetitive actions, they wouldn’t be performed with the same goal or intention. Instead, the tics are done simply to alleviate inner tension or discomfort. And as opposed to the premonitory urge in Tourette’s syndrome, this unease is caused by obsessions.
How Can I Tell If I Have OCD or Tourette’s?
There are several simple questions you can answer to determine whether or not you have either OCD, Tourette’s syndrome, or another condition based on your symptomatology.
#1: Do You Experience Obsessions?
In the case of “pure” Tourette’s syndrome (not Tourettic OCD), there are no obsessions. So if you are experiencing obsessions, that’s a sign that you have OCD, not Tourette’s. However, it is possible to have both conditions (more on this below)
#2: Are the Repetitive Actions You Perform Reflexive or Involuntary?
As was noted above, tics are primarily involuntary and reflex-like, though they may be suppressed with enough effort. As Dr. Farrell shares, having the urge to do a tic is similar to “what it’s like to have an itch that you can’t scratch. It comes with a sense of “I have to get rid of this feeling.’” Though compulsions can be preceded by strong urges or intense anxiety that may be difficult to ignore, they have more of a voluntary and deliberate character.
#3: Are the Repetitive Actions You Perform Done to Prevent Some Negative Outcome?
Often, the actions performed by individuals with OCD are done to prevent some adverse outcomes associated with their obsessions from occurring. For example, their compulsions may be designed to prevent others from contracting an illness or feel certain that their plane lands safely. This is not the case in either Tourette’s syndrome or Tourettic OCD.
#4: Are You 18 or Older?
As Dr. Farrell emphasizes, tic disorders and Tourette’s syndrome are “almost exclusively disorders developed during childhood and adolescents. […] it’s very rare for the onset to be anything after age 18.” Of course, symptoms can persist into adulthood, so if what you’re experiencing now started as a child or adolescent, it might still be a sign of a tic disorder. However, if your potentially tic-like symptoms appear for the first time during adulthood, odds are they aren’t genuine tics, and you have another condition, such as OCD.
Are OCD and Tourette’s Often Misdiagnosed?
Dr. Farrell argues that while misdiagnosis is possible, it’s unlikely if you work with an experienced professional. Though both conditions involve repetitive behaviors, OCD and Tourette’s syndrome have clear distinguishing factors. Things might become a bit more challenging when separating Tourette’s from Tourettic OCD, but even then, there are categorical differences.
Can you have both OCD and Tourette’s?
Yes, it is possible to have OCD and Tourette’s syndrome. In fact, it’s relatively common. According to the International OCD Foundation (IOCD), Up to 60% of individuals with Tourette’s syndrome also report OCD symptoms.
This overlap between symptoms suggests that the disorders may share some underlying causes. Researchers have found that both conditions are highly heritable and argue that they are likely to be due to the same or similar underlying genetic factors.
Can Tourette’s Syndrome Be Treated?
Several therapeutic techniques are effective in treating Tourette’s Syndrome.
One of the more common treatments is habit reversal training (HRT), designed to assist individuals with unwanted repetitive behaviors or habits. The treatment helps patients spot the buildup of tension that can lead to a tic and learn to replace tics with healthier responses.
Tourette’s syndrome can also be treated with exposure and response therapy (ERP), which is a form of cognitive behavioral therapy where individuals are exposed to a fear or uncomfortable circumstance while they resist engaging in their typical response. In the case of Tourette’s syndrome, patients are asked to attempt to suppress tics after being exposed to situations known to give rise to them. One experiment found ERP to be equally effective in treating Tourette’s as HRT.
Tourette’s syndrome is occasionally treated with medication, though there is a lot of variation regarding the medicines that practitioners prescribe.
It’s worth noting that Tourette’s syndrome tends to improve on its own over time. Studies have found that more than 80 percent of patients have significant improvement in tics by adulthood. Of course, this is not to say that individuals with Tourette’s syndrome should not be treated, but to provide reassurance to those with the condition that their symptoms are likely to improve.
How is OCD treated?
OCD is treated with either therapy, medication, or both. ERP therapy is the most popular and effective option. Here, patients work with their therapist to trigger a fear or obsession (e.g., by touching something dirty) without engaging in their usual compulsion or avoidance response (e.g., repeatedly washing their hands). Over time, preventing compulsions in response to obsessions and anxiety allows people with OCD to habituate to uncertainty and distress, decreasing their anxiety when exposed to triggers and increasing their tolerance for uncertainty.
In addition to ERP, OCD treatment can be complemented with selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and sertraline. These medications block the reuptake of serotonin, a chemical messenger in the brain associated with the symptoms of OCD. For more severe cases of OCD, medication can allow therapy members to be more receptive to ERP treatment.