Tourette’s Syndrome and Obsessive-Compulsive Disorder (OCD) often co-occur in children, teens, and young adults. While they have different characteristics and diagnostic criteria, they share some commonalities in terms of symptoms and underlying neurobiology.
Tourette’s Syndrome is a neurobehavioral disorder characterized by repetitive, involuntary movements and vocalizations known as tics. These tics can range from simple, like eye blinking or throat clearing, to complex, such as jumping or uttering words or phrases. The onset of Tourette’s typically occurs in childhood and its severity can wax and wane over time.
The Connection with OCD
Obsessive-Compulsive Disorder (OCD), on the other hand, is characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed in an attempt to alleviate anxiety or prevent a feared event from occurring. While OCD and Tourette’s are distinct diagnoses, they share a notable overlap. Research suggests that 30-60% of individuals with Tourette’s also experience symptoms of OCD.
The term “Tourettic OCD” captures the gray area that exists between Tourette’s and OCD. More specifically, this condition is characterized by actions that look like compulsive behaviors, such as repeating a certain movement over and over until it feels “just right”, evening up, or touching things a certain number of times. These compulsive behaviors are driven by an internal physiological sensation – a tension or urge – rather than a specific feared outcome, making their function similar to those of tics.
Tourette’s, OCD, and ADHD
Studies have also shown that there is a higher likelihood of individuals with Tourette’s and OCD having attention-deficit/hyperactivity disorder (ADHD) compared to the general population. ADHD not only adds complexity to the diagnostic picture, but it can also make symptom management more challenging. Stimulant medications, which are commonly used to treat ADHD, can exacerbate tics. Some individuals with comorbid ADHD and Tourette’s may be able to tolerate stimulants without a significant increase in tic severity. Additionally, there are some alternative non-stimulant medications that can be used to treat ADHD in individuals with Tourette’s.
Treatment and Management Strategies
While managing co-occurring Tourette’s and OCD can be complex, a comprehensive approach that addresses both conditions is essential. Below are treatments and strategies that can be effective in managing Tourette’s and OCD:
1. Exposure and Response Prevention (ERP): ERP is a specialized form of cognitive behavioral therapy (CBT) that is particularly effective in treating OCD. It involves exposing individuals to their feared situations or thoughts and then preventing them from engaging in their typical compulsive responses.
2. Habit Reversal Therapy (HRT): HRT is an effective treatment to reduce tics and other repetitive behaviors (such as skin picking and hair pulling). At its core, HRT helps people reduce unwanted repetitive behaviors by becoming aware of cues that indicate the behavior is about to happen and learning to replace them with incompatible behaviors.
3. Medication Management: In some cases, medication may be recommended to alleviate symptoms. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for OCD, and in severe cases, atypical antipsychotic medications may be considered for managing tics.
4. Distress Tolerance Stills: If compulsions or tics are driven by sensory or not-just-right feelings, including distress tolerance skills into treatment can be helpful.
How Parents Can Help
1. Reducing Accommodation: It is very common for parents to get inadvertently pulled into the OCD cycle. Children with OCD often have rituals that involve parents, such as having to say goodnight in the exact same way every night. We call these behaviors family accommodation – things that parents do (or refrain from doing) in order to reduce their child’s anxiety in the moment. Even though they may seem to give your child some relief in the moment, they actually make OCD worse in the long run.
2. Shifting Attention: Parental attention has a powerful influence on child behavior. Specifically, any behavior that gets attention from parents – positive or negative – is likely to happen again. Therefore, we encourage parents to avoid reacting to or drawing attention to tics as well as compulsions; rather, focus on your child’s strengths and accomplishments.
3. Validating the Emotion: We also recommend validating your child’s emotional experience, while not drawing attention to or accommodating the behavior. Letting them know that you get how they’re feeling can be powerful for a child. It is helpful to use language like, “It makes sense that this feels uncomfortable for you,” or “This feels really scary for you right now.”
Therapist Supervisor, Ph.D.
Courtney Villere is a therapist supervisor at InStride Health with a Ph.D. in Clinical Psychology from Boston University. Courtney has extensive training and expertise in treating OCD, anxiety, and related disorders. She has worked in inpatient, outpatient, and partial-day hospitalization settings with children, adolescents, and young adults. Courtney is passionate about supervising therapists and helping individuals with anxiety and OCD reclaim their lives. Courtney enjoys running, playing guitar, and going on road trips
with her husband and two children.
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