OCD, Tics, and Tourette Syndrome
When my son Dan’s obsessive-compulsive disorder was at its worst, he developed facial contortions, twitching throughout his body, and some noticeable tics. As if having severe OCD wasn’t frightening enough!
As it turns out, tics and Tourette syndrome are not uncommon in those with OCD. Statistics vary, but approximately 50% of children with OCD have, or have had, tics and 15% of them have been diagnosed with Tourette syndrome. So what’s the connection?
According to Dr. Barbara Coffey, Professor in the Department of Psychiatry and Chief of the Tics and Tourette’s Clinical and Research Program at the Icahn School of Medicine, there is indeed a genetic relationship between OCD and tic disorders. In fact, if a child presents with tics or Tourette syndrome, there is a good chance he or she will have some family members who have OCD, with or without tics or Tourette syndrome.
Tourette syndrome is often diagnosed alongside obsessive-compulsive disorder. Dr. Coffey talks about how treating OCD effectively can actually have a profound effect on the tic symptoms of Tourette’s. The tics typically are diminished to the extent that no additional treatment is necessary.
This is good news, though not particularly surprising. Because OCD is typically anxiety driven, and anxiety appears to exacerbate tics, we would expect that treating OCD would greatly reduce tics. What is interesting to note, however, is that the recommended treatment for OCD (exposure and response prevention therapy, SSRIs) differs from the accepted treatment for tics and Tourette syndrome (relaxation training, habit-reversal training, and standard neuroleptics as well as other meds). For those who are interested in an in-depth discussion of these two disorders and their relationship, I highly recommend checking out this article by Dr. Charles Mansueto on the IOCDF website.
As with most issues related to obsessive-compulsive disorder, it can get complicated. Dan’s twitching intensified when he was taking atypical antipsychotic medication, and he developed jerky movements as well. Combine this with tremors and a non-stop bouncing leg, and it was tough to see him in this condition. I can’t even imagine what it must have felt like for him.
Thankfully, I’m happy to report that in Dan’s case, his twitching, tics, and all movement issues resolved once his OCD was treated and he was taken off all his medications. But it certainly didn’t happen overnight; it was gradual. His diagnoses of depression and GAD (Generalized Anxiety Disorder) also fell by the wayside once his obsessive-compulsive disorder was under control. So while he had multiple diagnoses and issues when things were really bad, each one of them appears to have stemmed from his obsessive-compulsive disorder. What an insidious disorder!
As is often the case, it always comes back to the same thing — the importance of getting proper treatment for obsessive-compulsive disorder. If other concerns such as tics, depression, or anxiety remain after the OCD is under control, they can be addressed appropriately. But you just might be pleasantly surprised to see these issues resolve once OCD isn’t calling the shots anymore.