Obsessive-compulsive behaviour (OCB)

A large proportion of people with Tourette Syndrome have obsessive and compulsive behaviours (OCB). Indeed, obsessive behaviours were considered, in the earliest descriptions of the disorder, to be an integral part of TS. Evidence from clinical research suggests a wide variance in the prevalence of OCB in cohorts of individuals studied. Although there has been a recent tendency to give a diagnosis of OCD alongside a separate diagnosis of TS, it is becoming clear that specific differences characterise Tourettic-OCD and classic OCD [<R>] and that OCB in TS has a very intrinsic involvement in many other symptoms of TS and is frequently very resistant to the drugs that are used to treat OCD (such as SSRIs). 


In TS, obssessive and compulsive behaviours tend more to focus on 'evening things up', symmetry, counting, numerical balance, perfectionism and 'getting to the root of things'. Obsessive thought patterns may be a significant difficulty and be a source of distraction and anxiety. Enshrinement of fragments of sensory input (words, sounds, music, incidents etc.), thoughts and memories, may result in endless reiteration. In classic OCD, concerns about contamination and 'germs' often predominate and may give rise to obssessive behaviours relating to cleaning, ordering their living environment meticulously and washing or protecting the body from dirt and infection. They may develop elaborate rituals to ensure they or their family are not exposed to potential contamination. People with TS frequently have strong 'intentions' to impose organisational order and neatness on their 'environment but in actuality may tend towards a state of seeming disorder. There are however many similarities but distinction must be acknowledged as it implies differring origins for behaviours and the consideration of different approaches to diagnosis and subsequent management.


In OCB and OCD there is always an awareness that behaviour or thoughts may be irrational but often require 'expression' in order to a feeling of things being 'just right'. Obsessions and compulsions appear to have an intricate relationship with complex tic behaviours. Tics (simple and complex), in Tourette Syndrome, may often include a compulsive (conscious) aspect or premonitory 'urge'.