However, other evidence involving course (Leonard et al., 1992) and pharmacological treatment response (Delgado, Goodman, Price, Heninger, & Charney, 1992), suggests distinctive etiologies. In addition, research findings support a genetic linkage between OCD and TD (Pauls, 1992 Pauls, Alsobrook, Goodman, Rasmussen, & Leckman, 1995), attest to possible shared neurobiological underpinnings (Baxter & Guze, 1992 Leckman, Goodman, Anderson, Riddle, Chappell, & Swiggan-Hardin, 1995), and describe similar clinical phenomenology (Como, 1995 Leckman, 1993). Researchers have reported that 20 percent to 60 percent of TD sufferers display OCD symptoms, and studies of OCD patients have found tics in over 50 percent of cases and TD in 15 percent of cases (Leonard, Lenane, Swedo, Rettew, Gershon, & Rapoport, 1992 Pitman, Green, Jenike, & Mesulam, 1987). Tourette’s Disorder is diagnosed when multiple motor tics and one or more phonic tics have been present during the course of the illness (American They may also be ‘complex’ such as facial gestures, smelling objects, touching, or repeating words or phrases out of context. They may be ‘simple’ such as eye blinking, neck jerking, shoulder shrugging, or throat clearing. Tics typically occur in bouts, vary in intensity, and wax and wane in severity. Tics are sudden, repetitive, stereotyped motor movements or phonic productions that are often perceived as involuntary but which are sometimes accompanied by premonitory sensory urges. One area of emerging interest has been the substantial overlap between OCD and tic disorders including Tourette’s disorder (TD). Increasingly, these distinctions have become important components of a phenomenological analysis of OCD that can enhance diagnostic formulations and guide treatment planning (O’Sullivan, Mansueto, Lerner & Miguel, 2000).

In particular, certain distinctions involving the content of obsessions, the nature of compulsions, the functional relationship between obsessions and compulsions, and the response to treatment are potentially useful discriminators in the identification of valid OCD subtypes. However, the phenomenology of OCD is complex and varied, with important differences underscoring the likely heterogeneity of the disorder. Obsessive-compulsive disorder (OCD) typically manifests as an array of thematically elaborated intrusive thoughts or images (obsessions) accompanied by ritualized, overt or covert behaviors (compulsions) that individuals feel compelled to perform (American Psychiatric Association, 1994). Tic or a Compulsion? It’s “Tourettic OCD” It is argued that these individuals would be better served, both psychotherapeutically and pharmacologically, by the adoption of a “Tourettic OCD” (TOCD) conceptual framework. These individuals often receive standard treatments for OCD (or less like, TD) that fail to address the blended features of their presentation. Keuler, Ph.D., The Behavior Therapy Center of Greater Washington AbstractĪ subgroup of individuals suffering from obsessive-compulsive disorder (OCD) frequently present to treatment with an atypical yet distinguishable array of symptoms akin to both Tourette’s Disorder (TD) and OCD. , The Behavior Therapy Center of Greater Washington, Bowie State Universityĭavid J. Tic or Compulsion? It’s “Tourettic OCD” Pre-publication Version, Published in Behavior Modification, Fall 2006.Ĭharles S.

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