What Are OCD Tics? How Does OCD Relate To Tourette Syndrome?

Obsessive-compulsive disorder (OCD) is a mental health condition involving frequent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions).

OCD is related to anxiety in that intrusive thoughts often result in distress, and repetitive behaviors reflect an effort to manage the anxiety brought on by such thoughts. Obsessions and compulsions can interfere with everyday life.

What is a tic?

A tic is a fast, repetitive action that is hard to control. This might range from blinking or grimacing to coughing or repeating sounds or phrases (rarely swear words or obscenities). Tics can be described as a motor (action), verbal (words), and simple or complex.

For example, a simple motor tic might be jerking your head, while a complex one might be hopping or jumping.

Experiencing tics is not uncommon, particularly for children. Many children experience tics at a young age but grow out of them. Typically they are most severe from age 8  through the teenage years and start to improve after puberty.

Tics can be associated with stress, tiredness, anxiety, excitement, or happiness. They are preceded by an urge, which can sometimes be suppressed but doing so is often distressing.

When tics last for a long time or are severe enough to interfere with daily life, they can be treated with:

• exposure with response therapy (which is also used for OCD)

• habit reversal therapy (where you are trained to do something else when you feel a tic coming on)

• comprehensive behavioral intervention for tics.

Again, most children with tics grow out of them. However, when they do not, or when tics start as an adult, there is likely a more serious concern. Chronic tics can lead to a diagnosis of Tourette syndrome. Even this condition, however, may be resolved in adulthood.

What is Tourette syndrome?

Tourette syndrome is a disorder of the developing nervous system, which is named after the doctor who first described it in 1885, George Gille de la Tourette. It is typically diagnosed when the individual experiences tics that:

• Last more than a year

• Cause problems in daily life or result in self-harm (Some people might have tics that result in hitting themselves; others might experience coprolalia, where they produce uncontrolled swear words or obscenities)

• Cannot be explained by medications or another medical condition

In some cases, Tourette syndrome may last into adulthood and even worsen, but it does not affect lifespan. Tourette’s is at least in part an inherited condition. It is commonly comorbid with OCD and/or ADHD.

Can OCD cause tics?

There is a distinct similarity between compulsion and a tic, although tics are less likely to be triggered by obsessive thoughts and more likely by sounds, such as somebody coughing.

OCD does not appear to cause tics per se, but the comorbidity between Tourette syndrome and OCD is strong. About 50 %¹ of people with Tourette’s have some obsessive-compulsive symptoms, such as a strong desire to keep things neat and tidy. 

What is unclear is why OCD may be a risk factor for Tourette’s (and thus indirectly cause tics). Tourette syndrome may be a risk factor for OCD, or both conditions might be caused by common neural mechanisms.

Having OCD and Tourette’s is, of course, worse than having either disorder on its own.

Does OCD with tics require different treatment?

To a degree, each disorder requires different treatments. The go-to treatment for OCD is exposure with response therapy, which is also a useful therapy for tics.

One study² of teenagers with OCD and tics showed that the presence of tics did not make OCD outcomes worse. However, tic-related OCD had an earlier onset, and children with tic-related OCD were more likely to also have attention-deficit/hyperactivity disorder. 

It also appears to affect the kind of compulsions that develop. Specifically, tic-related OCD shows more compulsions related to washing/cleaning, hoarding, and ordering or counting.

It's unclear whether this changes response to treatment. However, there are indications that people with tics don't benefit from sertraline monotherapy. However, they may be more likely to respond to neuroleptic augmentation of SRIs. Therapists may also use slightly different techniques.

Other researchers argue that this should be classed as Tourettic OCD³ and handled differently. Specifically, they recommend making this a separate diagnosis, which often manifests despite a lack of any family history.

They recommend SSRI augmentation with low-dose neuroleptics or alpha 2 agonists, neuroleptic monotherapy, or alpha 2 monotherapy rather than the standard SSRI monotherapy. They also recommend a longer regimen of ERP and augmenting it with muscle relaxation techniques and substitution or habit replacement.

So yes, there may be different treatments needed to resolve both the OCD symptoms and the tics, although ERP is still the first line of treatment as it is effective for both.

When should you see a doctor?

It is fairly normal for a growing child to have mild tics. However, you should consult a doctor if:

1. You have a family history of Tourette syndrome

2. You have developed tics as an adult (after age 18)

3. Your child's tics are manifesting in ways that could cause physical harm to them or others

4. Your child is expressing coprolalia or other verbal tics, which could affect their ability to function in society

5. Your child is also showing compulsive behavior such as insisting on having everything in the right place, washing their hands ritualistically or excessively, or similar behaviors

Mild tics may not need treatment but can be seen as "growing pains." Therapy and medication are recommended for tics that are becoming a problem. If in doubt, talk to your doctor, who can refer you or your child to somebody who can help them deal with tics.

The lowdown

While OCD does not lead to tics per se, there is a fine line between a complex tic and a compulsion. OCD is often comorbid with Tourette syndrome, so some experts think it should be treated as its own condition. Tourette’s, which causes tics, is often a childhood problem, although it can persist into adulthood.

If you have OCD and tics, you may need a slightly different medication regimen and therapy than for "regular" OCD. You should talk to your doctor about tics that are harmful or interfering with your or your child's ability to function.