OCD, Tics, and Tourette Syndrome

by ambro freedigitalphotos.net

by ambro freedigitalphotos.net

When my son Dan’s obsessive-compulsive disorder was at its worst, he developed facial contortions, or twitching, as well as 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?

In this two-minute video, Dr. Barbara Coffey confirms that 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.

The good news is that, in those with both conditions, treating OCD usually results in a reduction, or even disappearance, of tics. Because OCD is typically anxiety driven, and anxiety appears to exacerbate tics, this result is really not surprising. What is interesting to note, however, is that the recommended treatment for OCD (ERP 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 OCD, 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.

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 off all his medications. But it took a while. His diagnoses of depression and GAD (Generalized Anxiety Disorder) also fell by the wayside once his OCD 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.

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 remain after the OCD is under control, they can be addressed appropriately. But you just might be pleasantly surprised to see multiple issues resolve once OCD isn’t calling the shots anymore.

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16 Responses to OCD, Tics, and Tourette Syndrome

  1. Ruby Tuesday says:

    Janet, as always you have shared some very valuable information. That’s one of the many things I like about your work; there is so much that is new (to me) and very intriguing indeed.

    A random bit of information you may or may not know, but that might interest you:

    You mentioned that “Dan’s twitching intensified when he was taking atypical antipsychotic medication, and he developed jerky movements as well.” This jumped out at me and I was just curious if the doctor prescribing spoke to you or Dan about dystonic reactions and drug-induced Parkinsonism? I’ve been through both with antipsychotics. The drug-induced Parkinsonism I chose to bear until it came to the point where I had such intense shaking and tremor that I could no longer pick up a drink, because the medication helped me immensely. I have always had an “essential tremor”, so even though it was exacerbated, I had much more tolerance and experience than one who has never dealt with a tremor. After I did discontinue, my symptoms resolved completely.

    However, I actually ended up in the ED one night due to a severe dystonic reaction that had me nearly paralyzed. And while the literature says that dystonic reactions are very rarely fatal, that of course tells us that they can in fact kill you. Based on the treatment I received and observations of others on scene, I firmly believe had I not been treated then and there, I would have died, become one of the “rarelys”.

    I’ve wandered off, I’m sorry. But dystonia can cause things like twitching of facial muscles and nerves (among other things), and that can become a permanent effect, lasting well after the offending drug has been withdrawn. Lucky for Dan that he got off it. As for me, my charts are explicitly clear that I cannot tolerate antipsychotics under any circumstance.

    Sorry that this comment went all over the place. I won’t say I’m not prone to that anyway, but it’s worse at the moment because of a (literally) fevered brain. I should probably just quit while I’m behind here. 😉

    • Oh Ruby, I can’t even begin to imagine how frightening those experiences must have been, and am so thankful that you did not become one of the “rarelys,” and that you now know you need to stay away from antipsychotics.
      While we brought up all the concerns you mentioned to Dan’s psychiatrist at the time, he downplayed all Dan’s symptoms and even made me feel as if I was overreacting. Of course I did my own research and knew about these side effects. As you say, it’s a good thing Dan got off those drugs before they resulted in permanent damage……..or worse.
      I appreciate your thoughtful comment (which, by the way, is NOT all over the place :)), though I’m sad to hear of your horrible experiences, Sorry to hear about your fevered brain as well, and hope you are back to the right temperature soon!

  2. I find the connection between Tourette and OCD interesting. I wonder sometimes if I don’t have some tics or movements tied to OCD. My OCD is so much better now than it was. It doesn’t bother me very much, and if it does show up, I recognize it and deal with it. But I do wish I was one whose depression when by the wayside. I think my depression came as a child before the OCD manifested itself.

    Sorry I’ve been missing. I hope to be around more.

  3. Thanks for sharing, Tina. I’m guessing depression that results from having OCD is more likely to wane once the OCD is treated than depression that is completely separate from OCD, as appears to be the case in your situation. I hope things get better for you soon; I know you are dealing with lots of change.

  4. This post really spoke to me Janet. My son has Tourettes but not OCD. He has Aspergers though. Your gentle explanations and good treatment for your son shine through.

  5. 71 & Sunny says:

    I definitely had/still sometimes have a shoulder tic. In talking with a neurologist about it he confirmed it was a legitimate tic, and I’m just sure it was all anxiety driven. It’s mostly gone now, but if I really spend time thinking about it, it can come back. Getting the OCD under control is what I’m sure got the tic mostly under control too.

    • I’ve never heard of a shoulder tic Sunny, but I never heard of coughing as a tic either, so there are always new things to learn! Isn’t it amazing that if you think about it, the tic comes back……we humans are such interesting creatures :)!

  6. I have a pretty severe case of OCD. (Celebrating 25 years in treatment this year!) I was blessed to find CORRECT treatment right away in 1990. My father had very bad depression, so when my OCD became unmanageable I reached out to my Dad’s doctors and they recognized the symptoms immediately and sent me straight to the right doctors…boy was that a blessing! I started meds and ERP at the same time right away.

    Anyway…I have tics that go away when my stress level is down, but return when I’m stressed (like trying to fight off a compulsion.) I have tics where I need to rotate (stretch out) my wrists and crack my knuckles if I’m struggling to shut off a faucet (one of my most challenging obsessions and compulsions is fear of flooding the house…totally irrational of course since sinks and bathtubs have overflow drains LOL…but OCD doesn’t care…it just fires up the fear center of my brain when I’m shutting off those darn faucets. Sometimes shutting off a faucet is no problem (when I’m not stressed). When I’m stressed, I can “loop”… sometimes turning a faucet on/off for as long as 30-40 minutes. VERY annoying/frustrating/hard on self esteem…and during those times the wrist and knuckle cracking tics come back to the surface right away.

    My treatment started when I was 27 years old, but I can trace my first tic back to 4th grade (10 years old.) That year I couldn’t stop myself from repeatedly blinking. I think the trigger was stress from trying very hard to get good grades. It did go away that same year (I fought it, but I’m not sure I succeeded…it may have gone away on its own.)

    A bit of history: Not surprisingly, I was a very high strung type A overachieving kid. That was a blessing while I lived at home and I could “control” my environment…all I had to really worry about was getting good grades (which I did.) My OCD REALLY kicked in when I left home and bought my first house. I was a control freak and a perfectionist. I didn’t know I craved “control”, but I sure knew I was a perfectionist in everything I decided to take on (academics/hobbies/sports, etc.) The stress of owning a house (first time I couldn’t keep everything in “perfect” condition and under “control”…as houses are a never ending maintenance issue by definition) was when my OCD got VERY bad. I bought that house in 1985, and as I said I started treatment in 1990.

    Also I’m a sporadic tennis player. The stress of competition triggers the “wrist” tics (as well as some facial tics I get when under stress). These tics return right away every time I get on a tennis court…even if I’m practicing against a ball machine…and even if I’ve been away from tennis for several years. Fascinating.

    The wrist stretching and facial tics also got worse and worse as I progressed in my career (more responsibilities and more stress was no doubt the trigger.) The facial tics in particular were embarrassing. Now I’m retired (had to get away from the stress.) Facial tics: gone.
    Once again: Fascinating.

    Anyone else have trouble with repetitive proofreading (checking) of something they write? I just read the previous paragraph about 8 times before I could stop myself!

    I think my brain needs a 60,000 mile service!! Maybe an “engine rebuild” is in order. Maybe one day, that “engine rebuild” (cure) will be there. I sure hope so!

    Thanks for “listening” 🙂

    PS: Writing this has reminded me of something very important: None of us are fighting this nasty disease alone. Somehow that brings at least a little peace during the struggle.

    Be Well everyone!
    Never stop making the most of the life you have been given!

    Peace,

    -Paul

    PPS: I hope I’ve made a ton of mistakes writing this…makes for a good ERP!!

    • Thanks so much for sharing, Paul, and I know there are others with OCD who have trouble with repetitive reading and proofreading. I love that you have such a great sense of humor. I’m guessing that has helped you through some tough times!

      • I’ve been meaning to comment about the “humor” you noted in my writing Janet. I was told almost from day one of treatment that humor is a good tool to have in your OCD toolbox. What’s interesting (at least to me) is that I spend a LOT of time thinking and talking about serious issues. I don’t (with rare exceptions) enjoy humorous movies or TV shows. I don’t consider myself to be a “funny guy” (though a few people have told me I have a good sense of humor, so maybe I just don’t see it.) The only person I “goof around with” is my Mom, who is simply a sweetheart and just had her 90th birthday yesterday! I think I’m actually MUCH too serious about life, and I almost never use humor as a “weapon” against OCD. I think I’ll start working on that! 😉
        Happy Easter/Passover everyone!
        -Paul

      • Happy Birthday to your mom, Paul! That is quite a milestone. And I agree that humor can help us through the tough times..we can never laugh enough :)!

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