Clinical Features Distinguishing Patients With Tourette's Syndrome and Obsessive-Compulsive Disorder From Patients With Obsessive-Compulsive Disorder Without Tics

Objective: It is not clear whether obsessive-compulsive disorder (OCD) inthe context of Tourette’s syndrome (TS) is the same as that disorder found in patientswith OCD alone. This study evaluated the severity and characteristics of theobsessive-compulsive symptoms in adult patients with OCD and TS compared to adult patientswith OCD alone.

Method: Thirteen subjects with both DSM-III-R TS and OCD and 13 subjectswith OCD alone were recruited. Obsessive-compulsive severity was determined by using theYale-Brown Obsessive Compulsive Scale. The Tourette Syndrome Association Unified TicRating Scale was administered to determine tic severity, and the adult version of theAttention Deficit and Hyperactivity Checklist was used to detect a history of childhoodattention-deficit hyperactivity disorder (ADHD).

Results: Subjects with OCD alone had very few obsessions and compulsionsthat were not also experienced by subjects with both TS and OCD. In contrast, subjectswith TS and OCD were significantly more likely to report obsessions involving nonviolentimages, excessive concern with appearance, and need for symmetry. Touching, blinking orstaring, and counting compulsions were also significantly more common in this group. Eightsubjects with OCD and TS had a childhood history of ADHD, compared to none of the pure OCDsubjects.

Conclusion: There are subtle but definite differences in symptomatologyof subjects with pure OCD compared to those with OCD and TS consistent with putativedifferences in pathophysiology between the 2 groups, i.e., abnormalities in theserotonergic system in OCD patients and serotonergic and dopaminergic abnormalities inthose with OCD and TS. These observations may be consistent with genetic heterogeneitywithin both OCD and TS.