Tics, OCD, and Tourettic OCD: Making Sense of Your Experience

By Christine Conelea, PhD

Tics, compulsions, and obsessions are part of many people’s everyday internal and external lives. Some people experience a unique overlap, known as Tourettic OCD (TOCD), in which tics, compulsions, and urges are tightly intertwined. As clinicians and researchers at the University of Minnesota Tic and Compulsivity Lab (MnTiC), we see people living with different, unique combinations of these symptoms. Disentangling these symptoms can sometimes be confusing. How can you tell the difference in your own experience so that you can better describe how you feel and communicate effectively with your friends, family, and providers?

Tics and compulsions are similar in that they both involve movements that are repetitive and difficult for the person to control. Research has also shown that overlapping genetic, neurological, and psychological factors contribute to both behaviors. Because of this, researchers and clinicians consider tics and compulsions to both be on the “obsessive-compulsive spectrum.” However, there are some differences that we look for as clinicians when trying to figure out which kind of behavior it is. 

Internal Experience

First, the experience someone has internally before the behavior differs. In a tic, someone usually experiences what's called a premonitory urge, a vague urge or physical sensation that they need to do the movement or sound. People often describe urges with words like pressure, tickling, tension, and itching. Urges can be different for each tic a person has. For many tics, the urge sensation is in the same physical location as the tic, such as an itch in the throat prior to a throat clearing tic. However, for some tics, urges can be a more general sense of “needing to move.” Sometimes the person might not have an urge at all, they simply tic. Most people with tics don’t experience or notice urges until they are about 9 years old.

Before a compulsion, people usually experience an obsession. This is a specific thought or cognition that usually has an anxiety component to it. This can be experienced as a fear that something bad might happen if the compulsion isn't done. In some cases, it can also be a thought involving disgust or something being gross. 

Differences in Behaviors

Second, the behaviors can look different from each other while they're occurring. Tics are sudden, rapid movements or sounds that are usually very brief. Most tics last about 1-2 seconds. Tics can be temporarily suppressed with effort, but they otherwise tend to occur very frequently. In our studies, we have found that people have an average of 8 tics per minute. Tics are not very specific to a certain trigger or situation. Instead, they occur across lots of situations and settings. We also see the intensity and the severity go up and down or wax and wane over time. 

Compulsions are often more rule-bound or rigid. They tend to be longer, smooth movements or sequences of movements. They're linked to very specific situations, triggers, or thoughts. 

Post-Behavior Experience

Finally, the experience someone has internally after they do the behavior is also different. After a tic, most people experience a momentary relief in that urge sensation, kind of like when you feel an urge to sneeze, then you sneeze, and that urge is immediately gone. Tics tend to happen in bouts, such that the urge might quickly return after a tic happens and take a few tics to fully go away. 

In OCD, compulsions neutralize the obsession. In other words, the person has the sense that the bad thing that they anticipated could happen now won't happen. The ritual brings some sort of relief from anxiety once it is complete.

These are some broad differences between the tics, obsessions, and compulsions, but it’s important to note that they do overlap and that a person can have all of these things at the same time.

Tourettic OCD

The term Tourettic OCD was first coined by Dr. Charlie Mansueto in his 2007 publication entitled Tic or Compulsion? It’s Tourettic OCD. This term came about because of the high co-occurrence of OCD and tics for many people. For example, about 30% of people who have a tic disorder also have OCD (Freeman et al 2000) and about 50% of people with OCD have had a tic at some point (Conelea et al. 2014).

Common Symptoms

Common symptoms of Tourettic OCD tend to involve repetitive behaviors that are done because of a vague sense of incompleteness or what we call that not just right feeling–meaning the need to do a behavior over and over in a certain way until there's a sense of completeness achieved. This is different from how we think about harm-avoidant OCD, where people do compulsions in order to prevent a feared outcome. 

Importantly, the term Tourettic OCD happened in an era when we tried to describe neuropsychiatric disorders as separate categories. For example, we would describe them based on the behaviors or the symptoms that clinicians could see. 

Brain Organization: Neurocircuits

However, we now know a lot more about the brain and how it's organized. And this has led to newer models where we try to understand how these symptoms emerge based on the organization of the brain. Based on neuroscience, we have a better understanding of OCD and tics that's built around our knowledge of neurocircuits, or how different regions of the brain work together to drive our behavior. 

Sensory Motor Circuit

In terms of this idea of Tourettic OCD, a key circuit is the sensory-motor circuit. It's responsible for all of the pre-movement sensations we feel, like an urge to move. Its job is to send a movement message to the motor cortex that actually lets the body express the movement.

In both tics and OCD, research has shown that the sensory-motor circuit is overactive and over-connected. So, we think that Tourettic OCD likely reflects one shared process that's happening in the brain, this overactive sensory-motor circuit, and not necessarily two separate diagnoses. 

We also know that people with Tourettic OCD may not respond as well to our first-line treatments, like medication for OCD and Cognitive Behavioral Intervention for Tics (CBIT). Lots of exciting research is happening now to learn how specific circuits contribute to specific symptoms people with tics and OCD experience. By better understanding the biology that drives the symptoms, we're hoping to move toward a future where we have more targeted, focused treatments.

As we celebrate the resilience and creativity of tic communities during Tourette Awareness Month, as well as advances in research and treatment, remember that whatever your experience of tics and compulsions, your brain is wonderful and unique and you are amazing just as you are!

Check out MnTic Lab's research.

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