Hostname: page-component-7f64f4797f-m2b9p Total loading time: 0 Render date: 2025-11-04T07:48:30.321Z Has data issue: false hasContentIssue false
  • English
  • Français

Symptoms in Obsessive-Compulsive Disorder and Tourette Syndrome: A Spectrum?

Published online by Cambridge University Press:  07 November 2014

Neal R. Swerdlow ,
Sam Zinner ,
Robert H. Farber ,
Cassie Seacrist  and
Heidi Hartston
Get access Rights & Permissions [Opens in a new window]

Abstract

There is clear overlap in the clinical symptoms of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). As a result, OCD (with or without tics) and TS (with or without obsessive-compulsive symptoms [OCS]) have been conceptualized to form a disorder spectrum—an overlapping set of phenotypes reflecting presumed commonality at the level of the underlying genetics and neuropathology. We identified the characteristics of a research sample of patients with OCD or TS, based on information obtained in semistructured clinical interviews, to examine the similarities and differences in the clinical symptoms across this spectrum. This sample conformed to known age-of-onset and sex distribution patterns for OCD and TS. Previously reported patterns of predominant aggressive and sexual obsessions and touching compulsions were observed in subjects with tic-related OCD, compared with non—tic-related OCD (ie, OCD alone). The majority of patients with tic-related OCD experienced horrifically violent obsessions that were less common in OCD alone and much less common in TS. Nonetheless, symptomatic and functional impairment in TS subjects was clearly related to the intensity of their OCS. The specific obsessions and compulsions associated with clinical impairment in TS differed from those associated with impairment in OCD. These results suggest that, despite the many overlapping dimensions of these disorders, the symptoms and associated impairment in “pure” OCD, tic-related OCD, and TS do not form a simple continuous spectrum.

Information

Type
Feature Articles
Information
CNS Spectrums , Volume 4 , Issue 3: Tourette Syndrome: Part Two , March 1999 , pp. 21 - 33
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1.Pauls, DL, Towbin, KE, Leckman, JF, et al. Gilles de la Tourette's syndrome and obsessive-compulsive disorder. Evidence supporting a genetic relationship. Arch Gen Psychiatry. 1986;43:1180–1182.CrossRefGoogle ScholarPubMed
2.Pauls, DL. The genetics of obsessive compulsive disorder and Gilles de la Tourette's syndrome. Psychiatr Clin North Am. 1992;15:759–766.CrossRefGoogle ScholarPubMed
3.Karno, M, Golding, JM, Sorenson, SB, et al. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988;45:1094–1099.CrossRefGoogle ScholarPubMed
4.Steingard, R, Dillon-Stout, D. Tourette's syndrome and obsessive-compulsive disorder: clinical aspects. Psychiatr Clin North Am. 1992;15:849–860.CrossRefGoogle ScholarPubMed
5.Apter, A, Pauls, DL, Bleich, A, et al. An epidemiological study of Gilles de la Tourette's syndrome in Israel. Arch Gen Psychiatry. 1993;50:734–738.CrossRefGoogle ScholarPubMed
6.Mason, A, Banerjee, S, Eapen, V, et al. The prevalence of Tourette syndrome in a mainstream school population. Dev Med Child Neurol. 1998;40:292–296.Google Scholar
7.Cohen, DJ, Leckman, JF, Pauls, D. Neuropsychiatric disorders of childhood: Tourette's syndrome as a model. Acta Paediatr. 1997;422(suppl):106–111.CrossRefGoogle ScholarPubMed
8.McElroy, SL, Phillips, KA, Keck, PE Jr., Obsessive compulsive spectrum disorder. J Clin Psychiatry. 1994;55(suppl):33–51.Google ScholarPubMed
9.Coffey, BJ, Miguel, EC, Biederman, J, et al. Tourette's disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis. 1998;186:201–206.CrossRefGoogle ScholarPubMed
10.Hebebrand, J, Klug, B, Fimmers, R, et al. Rates for tic disorders and obsessive compulsive symptomatology in families of children and adolescents with Gilles de la Tourette syndrome. J Psychiatr Res. 1997;31:519–530.CrossRefGoogle ScholarPubMed
11.McDougle, CJ, Goodman, WK, Price, LH. Dopamine antagonists in tic-related and psychotic spectrum obsessive-compulsive disorder. J Clin Psychiatry. 1994;55(suppl):24–31.Google ScholarPubMed
12.Leonard, HL, Lenane, MC, Swedo, SE, et al. Tics and Tourette's disorder: a 2- to 7-year follow-up of 54 obsessive-compulsive children. Am J Psychiatry. 1992;149:1244–1250.Google ScholarPubMed
13.Holzer, JC, Goodman, WK, McDougle, CJ, et al. Obsessive-compulsive disorder with and without a chronic tic disorder: a comparison of symptoms in 70 patients. Br J Psychiatry. 1994;164:469–473.CrossRefGoogle ScholarPubMed
14.de Groot, CM, Bornstein, RA, Janus, MD, Mavissakalian MR. Patterns of obsessive compulsive symptoms in Tourette subjects are independent of severity. Anxiety. 1994–1995;1:268–274.CrossRefGoogle ScholarPubMed
15.Leckman, JF, Grice, DE, Barr, LC, et al. Tic-related vs.non—tic-related obsessive compulsive disorder. Anxiety. 1994–1995;1:208–215.CrossRefGoogle ScholarPubMed
16.George, MS, Trimble, MR, Ring, HA, et al. Obsessions in obsessive-compulsive disorder with and without Gilles de la Tourette's syndrome. Am J Psychiatry. 1993;150:93–97.Google ScholarPubMed
17.Spitzer, RL, Williams, TB, Gibbon, M. Instruction Manual for the Structured Clinical Interview for DSM-IIIR. New York, NY: New York State Psychiatric Institute; 1986.Google Scholar
18.Goodman, WK, Price, LH, Rasmuissen, SA, et al. The Yale-Brown obsessive compulsive scale: II. development, use and reliability. Arch Gen Psychiatry. 1989;46:1006–1011.CrossRefGoogle Scholar
19.Leckman, JF, Riddle, MA, Hardin, MT, et al. The Yale Global Tic Severity Scale: initial testing of a clinician rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989;28:566–573.CrossRefGoogle ScholarPubMed
20.Achenbach, TM. Manual for the Behavior Checklist Profile. Burlington, VT: University of Vermont Press; 1991.Google Scholar
21.Farber, RH, Clementz, BA, Swerdlow, NR. Characteristics of open- and closed-loop smooth pursuit responses among obsessive-compulsive disorder, schizophrenia and nonpsychiatric subjects. Psychophysiology. 1997;34:157–162.CrossRefGoogle Scholar
22.Swerdlow, NR, Magulac, M, Filion, D, Zinner, S. Visuospatial priming and latent inhibition in children and adults with Tourette's disorder. Neuropsychology. 1996;10:485–494.CrossRefGoogle Scholar
23.Farber, RH, Swerdlow, NR, Clementz, BA. Saccadic performance characteristics and the behavioral neurology of Tourette syndrome. J Neurol Neurosurg Psychiatry. In press.Google Scholar
24.Clementz, BA, Farber, RH, Lam, MN, et al. Ocular motor responses to unpredictable and predictable smooth pursuit stimuli among patients with obsessive-compulsive disorder. J Psychiatry Neurosci. 1996;21:21–28.Google ScholarPubMed
25.Swerdlow, NR, Benbow, CH, Zisookm, S, et al. A preliminary assessment of sensorimotor gating in patients with obsessive compulsive disorder (OCD). Biol Psychiatry. 1993;33:298–301.CrossRefGoogle Scholar
26.Miguel, EC, Rauch, SL, Jenike, MA. Obsessive-compulsive disorder. Psychiatr Clin North Am. 1997;20:863–883.CrossRefGoogle ScholarPubMed
27.Burd, L, Kerbeshian, L, Wikenheiser, M, et al. Prevalence of Gilles de la Tourette's syndrome in North Dakota adults. Am J Psychiatry. 1986;143:787–788.Google ScholarPubMed
28.Burd, L, Kerbeshian, L, Wikenheiser, M, Fisher, W. A prevalence study of Gilles de la Tourette syndrome in North Dakota school-age children. J Am Acad Child Psychiatry. 1986;25:552–553.CrossRefGoogle ScholarPubMed
29.Rasmussen, SA, Eisen, JL. The epidemiology and differential diagnosis of obsessive compulsive disorder. J Clin Psychiatry. 1992;53(suppl):4–10.Google ScholarPubMed
30.Leckman, JF, Peterson, BS, Pauls, DL, Cohen, DJ. Tic disorders. Psychiatr Clin North Am. 1997;20:839–861.CrossRefGoogle ScholarPubMed
31.Seeman, P, Bzowej, NH, Guan, HC, et al. Human brain dopamine receptors in children and aging adults. Synapse. 1987;1:399–404.CrossRefGoogle ScholarPubMed
32.Leckman, JF, Zhang, H, Vitale, A, et al. Course of tic severity in Tourette syndrome: the first two decades. Pediatrics. 1998;102:14–19.CrossRefGoogle ScholarPubMed
33.Baxter, LR, Phelps, ME, Mazziotta, JC, et al. Local cerebral glucose metabolic rates in obsessive-compulsive disorder. Arch Gen Psychiatry. 1987;44:211–218.CrossRefGoogle ScholarPubMed
34.Benkelfat, C, Nordahl, TE, Semple, WE, et al. Local cerebral glucose metabolic rates in obsessive-compulsive disorder. Arch Gen Psychiatry. 1990;47:840–848.CrossRefGoogle ScholarPubMed
35.McGuire, PK, Bench, CJ, Frith, CD, et al. Functional anatomy of obsessive-compulsive phenomena. Br J Psychiatry. 1994;164:459–468.CrossRefGoogle ScholarPubMed
36.Braun, AR, Stoetter, B, Randolph, C, et al. The functional neuroanatomy of Tourette's syndrome: an FDG-PET study. II: regional changes in cerebral glucose metabolism differentiating patients and controls. Neuropsychopharmacology. 1995;9:277–291.CrossRefGoogle Scholar
37.Eidelberg, D, Moeller, JR, Antonini, A, et al. The metabolic anatomy of Tourette's syndrome. Neurology. 1997;48:927–934.CrossRefGoogle ScholarPubMed
38.Moriarty, J, Costa, DC, Schmitz, B. Brain perfusion abnormalities in Gilles de la Tourette's syndrome. Br J Psychiatry. 1995;167:249–254.CrossRefGoogle ScholarPubMed
39.Sieg, KG, Buckingham, D, Gaffney, GR, et al. Tc-99m HMPAO SPECT brain imaging of Gilles de la Tourette's syndrome. Clin Nucl Med. 1993;18:255–257.CrossRefGoogle ScholarPubMed
40.Riddle, MA, Rasmusson, AM, Woods, SW, et al. SPECT imaging of cerebral bloodflow in Tourette syndrome. Adv Neurol. 1992;58:207–211.Google Scholar
41.Moriarty, J, Eapen, V, Costa, DC, et al. HMPAO SPECT does not distinguish obsessive-compulsive and tic syndromes in families multiply affected with Gilles de la Tourette's syndrome. Psychol Med. 1997;27:737–740.CrossRefGoogle Scholar
42.Lipinski, JF, Sallee, FR, Jackson, C, et al. Dopamine agonist treatment of Tourette disorder in children: results of an open-label trial of pergolide. Mov Disord. 1997;12:402–407.CrossRefGoogle ScholarPubMed
43.Hollander, E, Kwon, JH, Stein, DJ, et al. Obsessive-compulsive and spectrum disorders: overview and quality of life issues. J Clin Psychiatry. 1996;57(suppl):3–6.Google ScholarPubMed
44.Stein, DJ, Roberts, M, Hollander, E, et al. Quality of life and pharmaco-economic aspects of obsessive-compulsive disorder. A South African survey. S Afr Med J. 1996;86(suppl):1582–1585.Google ScholarPubMed
45.Swerdlow, NR. Reflections on research on the still expanding obsessive-compulsive disorder spectrum. ADAA Reporter. 1998;9:1.Google Scholar