Understanding Tourettic Obsessive-Compulsive Disorder (TOCD)

In this article, we will take a close look at Tourettic Obsessive-Compulsive Disorder, a unique neuropsychiatric condition that presents a blend of symptoms from both Chronic Tic Disorders, including Tourette Syndrome, and Obsessive-Compulsive Disorder. We will explore the symptoms, causes, and treatment options for this complex disorder.
Frederika Malichová

Frederika Malichová

Neuroscientist at the University Of Cambridge.

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What Is Tourettic OCD?

Tourettic Obsessive - Compulsive Disoroder (TOCD) is a rare neuropsychiatric condition. 

It refers to the mix of symptoms from Tourette Syndrome (TS) and Obsessive-Compulsive Disorder (OCD). The combination of these two results in a unique set of symptoms including tic-like behaviour that carries a compulsive and partially anxious nature similar to OCD [1].

TOCD is usually characterised by an early age of onset and interestingly the prevalence of TOCD is higher in males. 

Intriguingly OCD in TOCD is manifested more in compulsions such as rubbing, tapping and touching as well as observing symmetry concerns and thoughts of exactness [1]. On the contrary, symptoms of OCD like obsessive checking, cleaning and seeking reassurance are not that commonly observed in TOCD [1].

What Are The Symptoms of Tourettic OCD?

The primary symptom of Tourettic OCD is the presence of tics. Tics refer to sudden and repetitive movements or sounds that people do over and over. These tics are the primary symptom of TS as well [2].

From the line of TS symptoms, patients with Tourettic OCD may experience coprolalia (the use of obscene or socially inappropriate words or phrases) [3].

Further, individuals with Tourettic OCD express obsessive-compulsive symptoms such as excessive touching, rubbing and observing symmetry [4].

Patients with Tourettic OCD can also experience sensory symptoms including bodily sensations, mental urges and a sense of inner tension [5]. These are more commonly found in patients having TS and OCD than patients having OCD alone [5].

In addition to these sensory symptoms, patients with Tourettic OCD often experience "just right" phenomena. They need things to be "just right" or a feeling of incompleteness until certain actions are performed [5]

What Causes Tourettic OCD?

The exact cause of Tourettic OCD is not understood, however, there are several factors contributing to the development of the condition. 

According to the studies, Tourettic OCD is more commonly observed in patients who have a family member also having this condition [6, 7, 8]. Therefore this suggests the involvement of genetics in Tourettic OCD.

In addition, impaired function in certain parts of the brain or problems with the transmission of certain brain chemicals, such as serotonin and norepinephrine contribute to the development of OCD and therefore development of Tourettic OCD [6, 7, 9]

Environmental factors, such as trauma, abuse, or other stressful events, can also play a part in the development of OCD and other mental health conditions [6, 7]

Occasionally, OCD symptoms can develop or worsen after a strep infection in children [10, 11, 6, 7].

Can we treat TOCD?

In terms of the treatment of TOCD, a combination of medication and cognitive-behavioural therapy is recommended. 

Medication for TOCD includes clomipramine and all selective serotonin reuptake inhibitors [12]. In case the patient is unresponsive to monotherapy with serotonin reuptake inhibitors, augmentation of serotonin reuptake inhibitors with atypical antipsychotics may be beneficial [13].

How Does Tourettic OCD Differ From Normal OCD?

Tourettic OCD (TOCD) is a unique subtype of Obsessive-Compulsive Disorder (OCD) that presents with symptoms akin to both Tourette's Disorder (TD) and OCD. Unlike standard OCD, TOCD is characterized by complex tic-like behaviours with a compulsive and partially anxious nature. These behaviours often include compulsions such as rubbing, tapping, or touching associated with symmetry concerns or thoughts of exactness [1].

TOCD is distinct from classic OCD in its onset, prevalence, and symptom clusters. It typically has an earlier age of onset, a male predominance, and a lower tendency toward compulsions related to checking, cleaning, and reassurance seeking. Instead, TOCD patients show a higher tendency toward compulsions associated with symmetry concerns or thoughts of exactness [1].

In terms of treatment, TOCD is often more complex and resistant to treatment than standard OCD. It typically requires a combination of pharmacology and behavioural therapy in multiple modalities [1].

Frederika Malichová

Frederika Malichová

Frederika is a postgraduate researcher at the University of Cambridge, where she investigates new biomarkers for Frontotemporal Dementia and other tauopathies. Her research has been published at prestigious conferences such as the Alzheimer’s Association International Conference 2023. She obtained her BSc in Biomedical Sciences from UCL, where she worked closely with the UK Dementia Research Institute.