OCD vs Tics – What’s the Difference?
Compulsion and tics can often look very similar and are often the subject of much confusion. While both disorders demonstrate some similar characteristics, in terms of repetition, they are very different disorders. The following article will describe the similarities and differences and when to seek professional help
What are ‘tics’?
Tics are sudden, sporadic, and uncontrollable behaviours that often occur in the neurological disorder, Tourette syndrome (TS). Tics are movements or vocalizations the individual expels as a response to relieve them from the intolerable urge they are experiencing in a particular muscle group – described as a ‘premonitory urge’ (similar to the irresistible urge to sneeze, or scratch an itch). Tics generally fall into two categories: simple and complex:
(a) Simple tics involve fewer muscle groups than complex, and include motor tics such as eye-blinking, twitching, and sniffing – or vocalizations such as coughing, grunting, or throat clearing.
(b) Complex tics typically develop from simple tics, and comprise of more disruptive behaviours, and organised movements, such as: jumping, smelling or touching rituals, Coprolalia (shouting offensive words), Echophenomena (repeating a sound), or Echolalia (repeating a word or phrase that was just spoken).
Examples of Tics
Simple and complex tics are also categorised as being either motor, or vocal. The characteristics of motor tics can appear as meaningless, or somewhat purposeful sudden jerks or movements (eg: movements that are done in the same way or appear to hold purpose, but are unrelated to actual situation) involving various parts of the body – most commonly the face, head, shoulders, and neck. Motor tics usually recur throughout the day or in bouts during periods of increased anxiety, tiredness or stress. Some typical examples of motor tics include:
- Forceful blinking or squinting
- Rolling the eyes, opening the eyes wide for brief periods, or making eye gestures
- Nose twitching, or flaring the nostrils
- Biting or rolling the tongue, teeth grinding or baring, chewing on the lip
- Rapid head jerking (to one side), or throwing the head back
- Shrugging the shoulders
- Arm flexing, nail biting,
- Running fingers through the hair,
- Touching the self, objects, or others
- Kicking, skipping, hopping, tapping, flexing or shaking the foot
- Abdominal/ trunk / pelvis movements (eg: tensing the abdomen or buttocks)
- Stimulus dependent tics (eg: tics that occur as the result of hearing, seeing, or smelling a particular stimulus)
- Making offensive or rude gestures
- Copying someone else’s actions (Echopraxia)
- Harmful tic-like behaviours that injure the self, or others
Phonic tics usually occur after the onset of motor tics, however they can also occur as the primary tic symptoms. Simple vocal tics resemble short utterances of meaningless sounds, while complex vocal tics are repeated utterances of words, phrases, or statements, usually inappropriate in context.
Examples of vocal (phonic) tics include:
- Coughing, or throat clearing
- Mimicking sounds (eg: such as animal or bird noises) or repeating phrases of others (Echolalia) or repeating something they have said themselves (Palilalia)
- Uttering particular words or syllables (including obscene words or phrases)
- Sudden changes in speech volume, tone or pitch
What causes TS?
A great deal of evidence suggests that Tourette syndrome is an inherited disorder passed through a family gene. However, other research suggests the causes of TS are the result of an irregularity in particular areas involved in the electrical activity of the brain, or the neurotransmitters involved in communicating and directing messages. Nevertheless, despite the body of research that has been conducted on the topic, a single and confirmable cause has yet to be concluded. Tourette syndrome is reported with a 75% higher prevalence rate in males over females, with symptoms typically developing during childhood – predominantly identified between the ages of 3 and 9 years, and before the age of 18.
How can Tourette syndrome be treated?
There are various treatment options for individuals experiencing Tourette syndrome, and a lot of this is dependent on the severity of the individuals’ tics (simple or complex) and how much disruption it causes them in their daily functioning. Many individuals with Tourette’s may benefit from taking the various medications on offer to help manage the symptoms of their tics. However, these medications do not completely remedy the symptoms, and most have side effects and possible withdrawal consequences if they are taken long-term. For many individuals with Tourette syndrome, the symptoms of their tics peak during early teens and reduce in their severity as they approach late teens, and continue to improve across adulthood.
Apart from medication, the other treatment that has been proven successful for helping manage tics is Cognitive Behavioural Therapy (CBT), in the two forms: Habit Reversal Therapy (HRT) and Cognitive Behavioural Intervention for Tics (CBIT). Both of these involve psychotherapeutically training the individual to increase their awareness of their urges and thought processes, and gradually replace their tics with other movement behaviours, eventually working to decrease and resolve their tic symptoms. Alongside CBT, talking therapy with a specialising psychologist is helpful to support the individual and help them cope with the emotional and social issues they may be experiencing as a result of their tics.
The success of psychotherapeutic treatment is based on the evidence that tics can be controlled to some extent by the individual, as many can supress their tics up to a point, or abstain entirely when deeply involved in a task requiring great concentration and attention. Moreover, there is a significant distinction between the urges associated with TS and other movement disorders such as Parkinson’s disease whose behaviours and movements occur entirely outside of their control.
OCD vs Tics: how are tics different to urges and compulsions associated with OCD?
While the symptoms of Tourette syndrome (tics) appear to have some similarities to the compulsions associated with OCD, the two disorders have distinct differences – mainly in the complexity of the behaviour/ compulsion. Some of the common differences between TS and OCD include:
- Individuals with OCD experience intrusive, unwanted, incessant mental thoughts or images, causing them great distress. Usually, their obsessive thoughts are associated with compulsive acts they feel the ‘urge’ to perform as a method of decreasing their anxiety and distress. Unlike tics, the compulsions individuals with OCD experience are ritualistic and routine like in nature, and are performed as a method to reduce the anxiety caused by their intrusive thoughts: Tics are not driven by the urge to relieve anxiety based on obsessive thoughts
- Tics are considered involuntary compulsions – OCD compulsions are habitually learnt behaviours that are repeated over time to achieve that ‘just right’ feeling
- Tics are thought to be driven by somatic discomfort, physical pain or tension, rather than the compulsions associated with OCD that are rooted in anxiety
- The symptoms of tics usually develop and can be detected during early to mid-childhood, whereas the symptoms of OCD can develop across individuals of any age
- Psychotherapeutic treatment options are different for OCD and TS: CBT treatment for OCD involves exposure therapy (ERT), whereas CBT treatment for tics involves Habit Reversal Therapy (HRT) and Cognitive Behaviour Intervention (CBIT).
- While complex tics resemble similar characteristics to compulsive acts associated with OCD, the symptoms of simple tics are usually detectable before complex tics develop.
Who can help?
If you can identify with any of the symptoms mentioned above, or if you feel unsure about whether you are experiencing the symptoms of OCD or TS, it is strongly advised to seek professional advice from a specialising psychologist, who can carry out a formal assessment of your symptoms for the appropriate treatment to be implemented.
Dr Daphne Bryan – Clinical Psychologist
What is your experience?
- Completed a doctorate in the treatment of anxiety in children
- Trained as an accredited Triple P Facilitator
- Completed skin picking and hair pulling program through the OCD LA Centre
- Delivered CBT and ACT group programs
- Written a number of programs on cyber bullying and improving self-esteem
- Worked in inpatient and outpatient settings
- Presented her research at the AACBT conference
What days do you work?
- Tuesday, Saturdays (late nights available on request)
What are your interest areas?
- Adolescents, adults and older adults
- Skin picking
- Hair pulling
- Stress and self-esteem management
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