by Dr. Christine Conelea and Dr. Adrienne Manbeck
Tics, compulsions, and obsessions are part of many people’s everyday lives. 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 that can feel interconnected. There are some broad differences between 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. Still, disentangling symptoms in order to provide effective treatment can sometimes be challenging.
Tics and compulsions are similar in that they both involve movements that are repetitive and difficult for the person to control. Research has shown that overlapping genetic, neurological, and psychological factors contribute to both experiences. Because of this, researchers and clinicians consider both tics and compulsions to be on the “obsessive-compulsive spectrum.” However, there are important differences in treatment and in how loved ones can provide support.
Behaviors
Tics are sudden, repetitive, involuntary movements or sounds that are usually very brief. Common tics include rapid or hard eye blinking, facial scrunching, throat clearing or sniffing. In our studies, we have found that people with tics have an average of 8 tics per minute.
Many individuals with tics experience an urge right before they tic. This urge can feel like tension, an itch or pressure that typically goes away after the tic occurs. Tics tend to wax and wane over time. Compulsions are often more rule bound or rigid and are driven by a thought. Common compulsions include checking, counting, washing and reordering. They tend to be longer, smooth movements or sequences of movements. They’re linked to very specific situations, triggers, or thoughts to prevent something bad from happening or to relieve anxiety.
Why Treatments Differ
Although tic disorders and OCD sometimes look similar on the surface (repetitive movements can occur in both), they are different disorders. Subjectively speaking, tics can feel like a “body itch” while compulsions might feel like a “brain itch.” Though they may be very connected for some people, what works for one won’t necessarily work for the other.
In general, we often take a less interventionist approach to tic disorders because tics may not be inherently harmful. On the other hand, because compulsions work to reinforce obsessive thoughts and provide escape from non-harmful but unpleasant feelings, we often intervene with OCD as soon as possible. As clinicians working with children and teens, we want to help kids learn to be brave, learn that they can tolerate distress associated with anxiety, and learn that OCD doesn’t get to make their decisions for them.
Watchful Waiting
In general, OCD will not get better on its own. If a parent notices symptoms associated with distress or impairment, taking action of some kind is often the best approach. If tics aren’t causing problems for a child, it might be best to monitor. If tics become painful, start to bother your child, or in some other way cause harm, that might be the time to pursue treatment. The American Academy of Neurology refers to this as “watchful waiting” and sees it as an appropriate treatment, in some cases, for tics.
Tips for Providing Support
People with tic disorders face high stigma and discrimination compared to the general population. Tics are often hyper-visible and poorly understood. For OCD, stigma is more likely to emerge from public messaging rather than hypervisibility. The general public talks about OCD in a highly stereotyped way that misses a lot of people’s actual experiences with OCD and can trivialize symptoms.
For both OCD and tic disorders, parents can help support their child by collaboratively developing a reward structure for hard work in therapy.
For tic disorders, research has shown that situational factors have an important role in influencing tics, including what a person is doing, who is around them, and how they are feeling. Most people can identify situational factors that make their tics better or worse. Some factors frequently associated with tic exacerbation are fatigue, social events, and starting school in the fall. Stress, frustration, or anxiety-provoking events can make it harder for the brain to inhibit tics. Events frequently reported to coincide with tic reductions include social interactions with familiar people, situations in which the individual is a passive participant or deeply focused on a task, and leisure activities.
Because tics are so reactive to situational factors, one of the best ways to provide support is to create tic-neutral environments. This means eliminating intended or unintended consequences related to the tics, such as minimizing reactions to tics or changes to activities because of tics. We frame this as, “focusing on the person instead of the tics.” Tic neutrality can also help children feel better about tics since they can’t control them.
For OCD, minimizing parent accommodation, parents helping kids avoid anxiety-provoking things, can be helpful. Parents can help their kids by reducing accomodation and encouraging their children to be brave and face their fears in manageable, developmentally-appropriate ways.
About the Authors:
Christine Conelea, PhD is an Associate Professor in the Department of Psychiatry & Behavioral Sciences at the University of Minnesota, a licensed clinical psychologist, and the director of the MnTiC Lab. Dr. Conelea’s research interests include Tourette Syndrome/tic disorders, obsessive-compulsive disorder (OCD), and anxiety disorders. She is particularly interested in understanding how the brain, environment, and psychosocial factors interact to impact symptoms and treatment outcomes.
Adrienne Manbeck, PhD, is a postdoctoral fellow in the MnTiC Lab. Dr. Manbeck earned her doctorate in clinical psychology at the University of Minnesota and completed her pre-doctoral internship at Allegheny General Hospital in Pittsburgh, PA. Dr. Manbeck’s research aims to better understand the development, maintenance, and treatment of OCD and anxiety disorders across the lifespan, with a particular emphasis on the impact of societal stressors on these disorders, including the ways in which societal stressors impact symptom severity, access to high-quality treatment, and impact of treatment on symptoms.
More Reading:
Micali, N., Heyman, I., Perez, M., Hilton, K., Nakatani, E., Turner, C., & Mataix-Cols, D. (2010). Long-term outcomes of obsessive–compulsive disorder: Follow-up of 142 children and adolescents. British Journal of Psychiatry, 197(2), 128–134.
Conelea, C.A., Woods, D.W., Zinner, S.H. et al. The Impact of Tourette Syndrome in Adults: Results from the Tourette Syndrome Impact Survey. Community Ment Health J 49, 110–120 (2013).
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