It can be hard to distinguish one condition from the next, especially if they both share similar characteristics. Tourette’s and OCD both consist of urges, compulsions and seemingly irrational behavior.
So what is the difference between Tourette’s and OCD? As someone with both conditions, I felt it would be valuable to put this down in writing.
Tourette’s is more action based. It starts with an urge, like a mental itch, that you need to ‘scratch’ either with a body movement or a vocal sound or phrase. OCD focuses more on thoughts, often uncomfortable, scary or disgusting, and followed by a process to try and eradicate or reverse those thoughts.
There is a third term- known as ‘Tourettic OCD‘- that is an overlap of the two.
Table of information showing difference between Tourette’s and OCD
|Tourette’s Syndrome (TS)||Obsessive Compulsive Disorder (OCD)|
|Disorder type||Neurodevelopmental/Motor/Tic Disorder||Mental/Anxiety Disorder|
|How common?||1% of population||2.3% of population|
|Who is affected?||Anyone, however 3-4 times more likely in males||Anyone, males and females affected equally|
|Classic symptoms||Head nodding, shoulder shrugging, blinking, grunts, coughs, shouting words/phrases||Intrusive thoughts, ruminating, excessive checking, cleaning, ordering, hoarding|
|Symptom development||Often in childhood||Usually before 35 years of age|
|Is there a cure?||Not currently||Not currently|
|Therapies||Exposure and Response Prevention (ERP), Habit Reversal Therapy (HBT)||Exposure and Response Prevention (ERP)|
How I tell the difference
As a child I recall both conditions taking control of my life. I would have the urge to touch things a lot, especially the floor or my knee numerous times a day. I would also need to read a book in a specific style, making a mistake would mean I would have to start all over again. The same with video games. I would have a routine I had to stick to and if I messed up, back to the start.
Touching things was a classic Tourette’s tic. The urge was simply an itch that wouldn’t go away until I scratched it. No uncomfortable thoughts or a need to reverse anything, just an movement that I needed to do to relieve the pressure in my mind. This is a motor tic, more on these can be read in my post Understanding Motor and Vocal Tics.
When reading, OCD came into play. If I didn’t read the title out loud, followed by the sub-title, followed by the blurb on the back cover, I couldn’t open the book. If I made a mistake in either the introduction or first chapter, I would have to start the process again.
This is the ‘contamination‘ type of OCD. I couldn’t carry on because I would constantly think about having an imperfect start to the book, and this would ruin the whole book. It would be contaminated by negative thoughts of imperfection, anxiety and stress. I would recommend more reading on types of OCD in my post What is OCD? if you are new to the condition.
Don’t worry if this may seem a little confusing. These conditions are rare, vary a lot and can share many similarities. Despite having them for over twenty years I still find myself questioning a lot of it!
Can they overlap?
At times I do feel these conditions overlap, or at least work together very closely.
One example of this is a blinking tic I do from time to time. Sometimes, the urge to blink comes up and I do it. Another pops up almost immediately, and another. I do them and I can finally rest. There is no special number of times I have to do a tic, again like an itch. They just come and go as they please.
Then, my OCD kicks in and registers that I only did it three times. I feel the urge to do a fourth one so it ends on a nice even number. The Tourette’s was the first three, the last one was an OCD compulsion. Different feelings manifested before the compulsions, despite the compulsion being exactly the same. An itch for the first ones, and more anxiety and the need for order for the fourth one.
This is when Tourettic OCD comes into play.
Do treatments work for both?
I attended Cognitive Behavioral Therapy (CBT) sessions, adopting some similar techniques for both. I needed it mainly for intrusive thoughts that were bringing on major anxiety, although I felt it would be a waste if I didn’t focus some time on my tics.
Exposure and Response Prevention (ERP) is an example of such therapy. This focuses on bringing on the urge and sitting with the feeling, often the urge starts to fade if it isn’t rewarded by a compulsion. This can work for both TS and OCD as it is often possible to sit with a feeling before reacting to it.
Depending on how both TS and OCD manifest in the person, certain techniques may work for both, or each condition may need it’s own dedicated treatment. This is also affected by other associated conditions being present.
In short, Tourette’s starts with an urge to carry out a movement or noise. It isn’t usually a thought or a voice inside your head telling you to, more of an itch or a pressure build. It is just there and needs addressing before any relief.
OCD is often driven by unpleasant thoughts and anxiety. These can be thoughts of harm coming to family if certain rituals aren’t carried out, or house fires starting if a certain amount of checking isn’t done.
There is more thought in OCD, more imagining of hypothetical scenarios and more guilt.
Despite differing, similar treatments work to help ease the symptoms and possibly to rid them almost entirely. You may have one, you may have both or Tourettic OCD.
It would be wise to speak with a specialist in your area about the exact compulsions to get a better diagnosis.
More on Tourettic OCD