The Relationship Between Types and Severity of Repetitive Behaviors in Gilles de la Tourette's Disorder and Obsessive-Compulsive Disorder
J Clin Psychiatry 2000;61(7):505-513
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Background: This study investigated which
categories of obsessive-compulsive and Tourette-related behaviors
in Gilles de la Tourette's disorder and obsessive-compulsive
disorder (OCD) without tics are experienced as most severe across
the study groups and what the differences are in symptom
distribution between the study groups.
Method: Fourteen subjects with both Tourette's
disorder and OCD, 18 subjects with Tourette's only, 21 subjects
with OCD (no tics), and 29 control subjects were studied using a
semistructured interview designed to equally assess Tourette- and
OCD-related behaviors according to DSM-III-R criteria. Each
reported repetitive behavior was evaluated on the presence of
anxiety and on goal-directedness. Anxiety-related items were
categorized as obsessions or compulsions and non-anxiety-related
items as impulsions. Severity of each reported item was assessed
with respect to time per day consumed and amount of distress and
interference induced by the item. Following these criteria, each
reported item was classified as a symptom, a subthreshold
symptom, or just as being present.
Results: Across the study groups, obsessions
were experienced as more severe than (Tourette-related)
impulsions and compulsions. Within the study groups, patients
with both Tourette's disorder and OCD reported more symptomatic
Tourette-related impulsions, such as mental play, echophenomena,
and impulsive or self-injurious behaviors; less overall
symptomatic obsessions; and less symptomatic washing than
patients with OCD (no tics). The differences among individuals
with Tourette's with or without OCD reflected differences in
symptom severity rather than differences in symptom distribution.
Conclusion: Obsessions are more time consuming,
distressing, and interfering than compulsions and impulsions.
Furthermore, the symptomatic repetitive behaviors were
distributed differently among patients with both Tourette's
disorder and OCD and patients with OCD (no tics). Patients with
Tourette's and OCD are phenomenologically more similar to
Tourette's than to OCD. These differences possibly represent
differences in underlying pathophysiology between Tourette's and