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If you've ever wondered whether Tourette's Syndrome and Obsessive-Compulsive Disorder (OCD) are the same condition, you're not alone. Even some experts have wondered, and researchers have taken a closer look. These two disorders share some striking similarities that can make them appear nearly identical.
The science is clear. OCD and Tourette’s are not the same disorder. Research has found that OCD and Tourette’s can and do co-occur and share some common features. However, despite their similarities, OCD and Tourette’s are two distinct disorders, each with their own unique diagnostic criteria, underlying mechanisms, and treatment approaches. Understanding what makes them similar and what differentiates them from each other can help demystify these often-misunderstood disorders.
Why The Confusion?
The confusion between Tourette's and OCD stems from several characteristics that they share:
Repetitive Behaviors - Both conditions involve repetitive behaviors that can feel uncontrollable to the person experiencing them.
Age of Onset – Both OCD and Tourette’s typically emerge during childhood or adolescence.
Neurobiology – Both OCD and Tourette’s involve structural and neurological differences in similar brain regions, particularly the basal ganglia and frontal cortex.
Comorbidity – Perhaps the most confusing aspect, the two conditions frequently coexist. Research suggests that up to 60% of people with Tourette's syndrome also meet the criteria for OCD.
Genetics – Current research findings suggest a strong genetic overlap between Tourette’s and OCD. Twin and familial studies have found that people who have a first degree relative have higher rates of OCD.
Urges - People with both disorders experience "urges" or "premonitory sensations", uncomfortable feelings that seem to demand a response. For someone with OCD, they feel compelled to do a compulsion in order to reduce anxiety or feel “just right”. For someone with Tourette’s, these premonitory sensations are generally experienced as physical sensations, like the sensation of needing to clear your throat or the feeling you get before you sneeze. In both cases, performing a certain behavior (whether it's a tic or a compulsion) temporarily brings relief from the distress, creating a cycle that reinforces the pattern.
To complicate things, there is a disorder known as Tourettic OCD (TOCD). It is essentially an overlapping of OCD and Tourette’s symptoms. TOCD is not currently classified in the DSM 5 as an independent diagnosable disorder. However, it has been recognized in the literature as a unique intermediate neuropsychiatric disorder in which someone has symptoms of both OCD and Tourette’s and their tics, compulsions, and their preceding premonitory urges are overlapping and tightly intertwined.
The Key Differences
Despite their similarities, Tourette's and OCD are fundamentally different in important ways:
Tics vs. Compulsions
Tourette’s is a neurobehavioral disorder characterized by sudden, repetitive, and involuntary movements or sounds known as tics. Examples of tics include eye blinking, throat clearing, or vocal outbursts. These tics don't have a specific goal or intended purpose. It is thought that they result from internal neurological processes.
OCD compulsions, on the other hand, are purposeful, goal-directed behaviors that are performed to avoid or prevent a feared outcome. Examples of compulsions include repeated handwashing to prevent contamination or repeatedly checking that the stove is off to avoid a fire or gas leak.
The Role of Thoughts
OCD is characterized by unwanted, intrusive thoughts called obsessions. These unwanted thoughts create significant psychological distress and anxiety. Compulsions are performed to neutralize that anxiety. For example, someone with OCD might think, “If I don’t check the stove before I leave, a fire will start and burn the house down.” They may be compelled to check the stove multiple times before being able to leave home.
Tourette's tics, however, are not typically preceded by specific, anxious, intrusive thoughts or fears. While people with Tourette's do sometimes feel a physical urge before a tic (like the need to clear their throat), it's not usually linked to a cognitive obsession about a feared consequence.
Suppressing Tics and Compulsions
Research suggests that both tics and compulsions can be temporarily suppressed with appropriate strategies. And, how that happens is different for each disorder.
Although tics are involuntary, research has found that tics can be temporarily suppressed with behavioral approaches such as Comprehensive Behavioral Intervention for Tics (CBIT) and Habit Reversal Training (HRT). Behavioral approaches help to increase the person’s awareness of the tics and how to use a more appropriate behavior instead of the tic.
Research has found that OCD compulsions can respond to suppression as well. Exposure and Response Prevention (ERP) is a type of cognitive behavioral therapy specifically developed for treating OCD. The goal of ERP is to break the cycle of fear and avoidance and improve distress tolerance. By eliminating the behavior rituals and avoidance behaviors, people can learn how to tolerate distressing feelings without resorting to counterproductive behaviors. In short, instead of avoiding anxiety-provoking situations (exposure), people learn to not respond (response prevention) to the trigger.
It's important to note here that suppression does NOT include suppression of intrusive thoughts (obsessions). Thought suppression when applied to obsessions has been shown to be counterproductive to treating OCD and can make symptoms worse. Focused distraction and acceptance have been found to be effective for managing clinically significant intrusive thoughts.
Complexity
OCD compulsions tend to be more complex and follow specific rules or patterns, often involving elaborate rituals.
Tics are typically simpler, briefer, and don't follow logical sequences related to preventing harm or reducing anxiety about specific outcomes.
Why The Difference Matters
Being able to differentiate between whether someone has OCD or Tourette’s, or both, is crucial to effective treatment. While some therapeutic approaches can be helpful for both, like HRT and ERP, the specific techniques and focus will differ. And that difference is essential to positive treatment outcomes. Medications that may be highly effective for one may not be ideal for the other.
Accurate diagnosis ensures that the person receives the treatment that is appropriate for their needs. A qualified mental health clinician can provide an accurate diagnosis and help you develop an individualized treatment plan.
What’s Next?
If you’re wondering if you or someone you love may be struggling with OCD, you don’t have to figure it all out on your own. Therapy can be the next step on the journey to healing and recovery.
At StopOCD, we have expert therapists who are skilled in assessment and treatment of OCD. They can help you understand your symptoms and learn effective ways of managing them. And online therapy makes seeing a therapist easier than ever. Whether it’s your first time in therapy or you’ve been there before, there is hope and there is healing. When you’re ready, StopOCD therapists can show you the way forward.
References
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2. Mansueto, C. S. (n.d.). OCD and Tourette Syndrome: Re-examining the Relationship. Retrieved from https://iocdf.org/expert-opinions/ocd-and-tourette-syndrome/
3. Shitova, A. D., Zharikova, T. S., Kovaleva, O. N., Luchina, A. M., Aktemirov, A. S., Olsufieva, A. V., … Zharikov, Y. O. (2023). Tourette syndrome and obsessive-compulsive disorder: A comprehensive review of structural alterations and neurological mechanisms. Behavioural Brain Research, 453, 114606. https://www.sciencedirect.com/science/article/abs/pii/S0166432823003248?via%3Dihub
4. Huisman-van Dijk, H. M., Matthijssen, S. J. M. A., Stockmann, R. T. S., Fritz, A. V., & Cath, D. C. (2019). Effects of comorbidity on Tourette's tic severity and quality of life. Acta neurologica Scandinavica, 140(6), 390–398. https://pmc.ncbi.nlm.nih.gov/articles/PMC6899939/
5. Khoodoruth, M. A. S., Ahammad, F., Khan, Y. S., & Mohammad, F. (2023). The shared genetic risk factors between Tourette syndrome and obsessive-compulsive disorder. Frontiers in neurology, 14, 1283572. https://pmc.ncbi.nlm.nih.gov/articles/PMC10613519/
6. Katz, T. C., Bui, T. H., Worhach, J., Bogut, G., & Tomczak, K. K. (2022). Tourettic OCD: Current understanding and treatment challenges of a unique endophenotype. Frontiers in psychiatry, 13, 929526. https://pmc.ncbi.nlm.nih.gov/articles/PMC9363583/
7. Kim, S., Greene, D. J., Robichaux-Viehoever, A., Bihun, E. C., Koller, J. M., Acevedo, H., Schlaggar, B. L., & Black, K. J. (2019). Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome. Journal of child neurology, 34(12), 757–764. https://pmc.ncbi.nlm.nih.gov/articles/PMC6733613/
8. Liu, S., Li, Y., & Cui, Y. (2020). Review of habit reversal training for tic disorders. Pediatric investigation, 4(2), 127–132. https://pmc.ncbi.nlm.nih.gov/articles/PMC7331356/
9. Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian journal of psychiatry, 61(Suppl 1), S85–S92. https://pubmed.ncbi.nlm.nih.gov/30745681/
10. Najmi, S., Riemann, B. C., & Wegner, D. M. (2009). Managing unwanted intrusive thoughts in obsessive–compulsive disorder: Relative effectiveness of suppression, focused distraction, and acceptance. Behaviour Research and Therapy, 47(6), 494-503. https://www.sciencedirect.com/science/article/abs/pii/S000579670900059X
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