Tics vs Compulsions

[Retired]

I need some help in finding a way to verbalize and describe the difference between the involuntary neurologically based motor or vocal tics of Tourette Syndrome and the compulsive behaviour which is often a co-morbid condition associated with Tourette in some people.

Compulsions and tics might appear to be the same, because there might be repetitive actions in both.

On some level I think I can distinguish between the two, and though I understand the origin of tics are neurological and the origin of compulsions is psychological, how can they be distinguished when helping a person with Tourette gain insight into their disorder.

Some examples of motor tics: twitching one's shoulder, eye blinking, abdominal muscle contractions.

Some examples of reported compulsions:licking the mouthpiece of a public telephone, (in Toronto I heard the following placing one's foot on the track of an approaching streetcar and removing it as the streetcar approached.

Both the tics and compulsions described are repetitive...but it seems the compulsions are triggered by situations whereas the tics occur under most conditions.

Any further insights into this would be really appreciated.

 

[David Baxter PhD]

Interesting question and I'm not surfe how to answer it (or at least not in 25 words or less)...

I think tics are more automatic, less voluntary, more motoric. Compulsions are at least potentially more under voluntary control, more of a "choice" potentially, although it may not seem that way to sufferers. Compulsions are to a degree more about anxiety reduction or prevention, whereas tics are more independent of emotional state or psychological triggers (although they can of course be exacerbated by stress).

I'm really thinking out loud here - not sure how helpful this is.

 

[Daniel E.]

Compulsions are at least potentially more under voluntary control, more of a "choice" potentially, although it may not seem that way to sufferers.

Yeah, for example, if you paid someone with OCD $1,000,000 to simply postpone a compulsion for a few minutes or hours (or even days or weeks), he would almost certainly postpone the compulsion and take the money.

 

[Retired]

I appreciate the brainstorming, because to be able to define the distinction will be helpful in assisting people with Tourette seeking support.

if you paid someone with OCD $1,000,000 to simply postpone a compulsion for a few minutes or hours

An interesting proposition..and perhaps true to some extent, though some people with Tourette are capable of suppressing their tics for a finite period of time. The amoount of time varies on the person, and because it's like trying to withold a sneeze, it has to be expressed eventually.

It is thought the baseline anxiety level of people with Tourette is generally higher than that of the general population, so external stressors as well as dealing with the involuntary tics may increase one's anxiety level.

Compulsions are to a degree more about anxiety reduction or prevention

Would you elaborate on the role of prevention

To what degree can compulsions be controlled with behavioural modification, such as finding strategies to redirect one's thoughts when the desire for a compulsion arises? <-- this is a brainstorming question :brainstorm:

 

[David Baxter PhD]

My approach in treating compulsive and obssessive-compulsive behaviors is mutlifaceted and based somewhat on the approach described in the book Brain Lock.

In the case of compulsive behaviors, one of the things I emphasize is that it's essential to identify not only what the person is going TO (i.e., the specific compulsive behavior) but what the person is going away FROM - i.e., what feelings or tasks or worries is the person avoiding or postponing or distracting from or pushing away?

In OCD, as an example, certain rituals occur in response to anxiety or a specific worry and operate (albeit incompletely) to reduce the anxiety; other rituals occur to prevent something bad happening, i.e., to prevent the anxiety that would otherwise be experienced if the "something bad" were to happen or if the thought about the "something bad" potentially happening were allowed to enter consciousness.

 

[Cat Dancer]

One of my OCD obsessive thoughts is "I've ruined everyone's life." The way I was dealing with this (the compulsion) was self harm, pretty severely. Today I had this thought over and over and over and I just had to practically sit on my hands to stop myself from giving into the compulsion which I thought would make things ok and prevent something bad from happening anymore.

I don't know much about Tourette's, but I had always thought it was more involuntary. I am learning a lot here on the forum about so many different things.

Some of my other compulsions have been counting the baby's blocks. I had to make sure she had all of her blocks or something bad might happen. I had to give up on that.

Also, straightening curtains is a big issue for me. Straightening things, lining them up. Pillowcases have to be a certain way. I'm able to let go of these things more, there are so many though and it is hard.

 

[Retired]

I don't know much about Tourette's, but I had always thought it was more involuntary

You are absolutely right, Janet, that Tourette tics are completely involuntary, as the disorder is neurological in nature.

However, many people with Tourette have accompanying conditions (co-morbid) such as OCD and/or ADHD.

This is when Tourette is referred to as Tourette Plus.

Though I do not have data on hand, I believe the incidence of OCD among people with Tourette may he higher than that of the general population.

When people with Tourette are first diagnosed, the line between tics and compulsions may be blurred, and I was hoping to gain a better understanding of compulsive behaviour, its dynamics and causes to help us differentiate between the two when providing info and support.

 

[Daniel E.]

Here's an excerpt from a journal article in 2005 about tics vs. compulsions and behavior therapy for both disorders:

In clinical practice, the boundary between symptoms arising from OCD and TD is not easily determined. Simple motor or phonic tics like eye blinking or throat clearing can usually be distinguished from compulsions by their relative brevity, lack of purpose, and typically
involuntary nature. Complex motor tics, on the other hand, such as repeating actions a specific number of times, or until it feels right may be indistinguishable from compulsions (Castellanos, 1998; Towbin, 1988). For the clinician, however, this distinction has been a critical component of clinical decision making. If a pattern of repetitive, intrusive behaviors were construed as a compulsion, pharmacological and cognitive-behavioral treatment would appropriately be provided in accordance with current practice guidelines for OCD (March, Frances, Carpenter, & Kahn, 1997). The guidelines emphasize exposure based cognitive-behavior therapy and serotonin reuptake-inhibiting medication (SSRI’s) as treatments of choice for OCD. If the behaviors were characterized as tics, behavioral strategies such as contingency management, relaxation training, self-monitoring and habit reversal would be appropriate choices (Azrin & Peterson, 1988). In these cases, neuroleptics and alpha 2 agonists have been likely choices for pharmacological treatment.

Tic or Compulsion?: It’s Tourettic OCD
Behavior Modification, Vol. 29, No. 5, 784-799 (2005)
(online article requires library access or paid subscription)

 

[David Baxter PhD]

Interesting. Thank you again, Daniel. Great research there, as always.

 

[Retired]

Thank you Daniel! The information is greatly appreciated..

Using the link you provided, I was able to find these related articles:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Link&db=PubMed&dbFrom=PubMed&from_uid=16046664

It will take a few days to digest all this, and will be most helpful.

 

[cailean]

The word "involuntary", although accurate, often leaves the impression that tics are always like shivers or hiccups. In many cases they're actually easier to repress. In addition to being involuntary, though, tics are unmotivated.

Anyways, there's also a line within tics themselves, between simple and complex tics. The simple tics include basic movements or noises ("beep-beep" or jerking of the neck) while complex tics may involve other people or longer phrases (I need to touch your arm, for example). Complex tics sit on the border of tics and compulsions.

I still think there is a line there. The complex tic is more likely unmotivated as well - more of a general, local "urge" while an actual compulsion would have some kind of 'reasioning' or obsession attached to it. But I would definitely suspect that people with OCD have more complex tics than those without... but that's a theory.

In my own case, I've had tics turn to compulsions when an existing obsession latches onto a tic. Many of my tics need to be repeated eight times. That's originally a number obsession, but the tics themselves are not a part of the OCD. Most of the tics existed first as simple movements, but eventually had to be repeated to satisfy the obsession. The obsession, though, is seperate from the tics and also latches onto other actions, such as pushing an elevator button.

 

[Retired]

Welcome Cailean, and thank you for sharing your insights.

Also welcome to Psychlinks. Hope you look around the Forum and find it interesting.

Glad you found us. :welcome:

Regards,

Steve

 

[Retired]

Tic or Compulsion? It's Tourettic OCD
2007

Abstract
A subgroup of individuals suffering from obsessive-compulsive disorder (OCD) frequently present to treatment with an atypical yet distinguishable array of symptoms akin to both Tourette's disorder (TD) and OCD. These individuals often receive standard treatments for OCD (or less likely, TD) that fail to address the blended features of their presentation. It is argued that these individuals would be better served, both psychotherapeutically and pharmacologically, by the adoption of a Tourettic OCD (TOCD) conceptual framework.

(from Behavioral Modification 2005; 29(5):784—799)
Summer 2007, Vol. V, No. 3 FOCUS THE JOURNAL OF LIFELONG LEARNING IN PSYCHIATRY

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Complete article on the topic of Tics vs Compulsions with a copy attached for your download/printing convenience.