Clinical Features Distinguishing Patients With Tourette's Syndrome and Obsessive-Compulsive Disorder From Patients With Obsessive-Compulsive Disorder Without Tics
J Clin Psychiatry 1998;59(9):456-459
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Objective: It is not clear whether obsessive-compulsive disorder (OCD) in
the context of Tourette's syndrome (TS) is the same as that disorder found in patients
with OCD alone. This study evaluated the severity and characteristics of the
obsessive-compulsive symptoms in adult patients with OCD and TS compared to adult patients
with OCD alone.
Method: Thirteen subjects with both DSM-III-R TS and OCD and 13 subjects
with OCD alone were recruited. Obsessive-compulsive severity was determined by using the
Yale-Brown Obsessive Compulsive Scale. The Tourette Syndrome Association Unified Tic
Rating Scale was administered to determine tic severity, and the adult version of the
Attention Deficit and Hyperactivity Checklist was used to detect a history of childhood
attention-deficit hyperactivity disorder (ADHD).
Results: Subjects with OCD alone had very few obsessions and compulsions
that were not also experienced by subjects with both TS and OCD. In contrast, subjects
with TS and OCD were significantly more likely to report obsessions involving nonviolent
images, excessive concern with appearance, and need for symmetry. Touching, blinking or
staring, and counting compulsions were also significantly more common in this group. Eight
subjects with OCD and TS had a childhood history of ADHD, compared to none of the pure OCD
Conclusion: There are subtle but definite differences in symptomatology
of subjects with pure OCD compared to those with OCD and TS consistent with putative
differences in pathophysiology between the 2 groups, i.e., abnormalities in the
serotonergic system in OCD patients and serotonergic and dopaminergic abnormalities in
those with OCD and TS. These observations may be consistent with genetic heterogeneity
within both OCD and TS.