Prior research has been mixed on whether tic-related OCD is a clinically distinct subtype, with some studies showing differences in symptoms, treatment response, and comorbidities and others showing no differences.
It is also unclear if tic-related OCD responds differently to treatments like SSRIs and CBT.
This study aimed to clarify the clinical utility of a broad definition of tic-related OCD in a large sample of youth who were partial medication responders.
Key Points
Rationale
Prior research examining whether tic-related OCD is aclinically distinct subtypehas been mixed.
For example, some research has found that those with tic-related OCD are more likely to be male (Leckman et al., 1994), have an earlier age of OCD onset (Diniz et al., 2006), exhibit higher rates of aggressive obsessions and ordering/hoarding compulsions (Zohar et al., 1997; Hanna et al., 2002), and have increased levels of externalizing symptoms compared to those with OCD alone (Ivarsson, Melin, & Wallin, 2008).
However, other studies have found no significant differences in clinical characteristics like OCD symptom dimensions and severity, comorbidity rates, or overall functioning when comparing youth with tic disorders+OCD to those with OCD alone (Lewin et al., 2010).
Data on treatment response has also been inconsistent. One study found that the presence of tic disorders moderated outcomes, with no response to sertraline monotherapy but equal response to CBT alone or combined treatment (March et al., 2007).
Yet other studies have found no difference in CBT outcomes for those with chronic tics (Storch et al., 2008; Keeley et al., 2008).
Given these discrepant findings, it remains unclear if examining tic status dimensionally or using a broad conceptualization of “tic-related” OCD has utility for understanding the heterogeneity of OCD.
Method
Sample
Statistical Analysis
Results
Insight
Strengths
Limitations
Implications
The findings of this study support assessing for tic-related OCD dimensionally in clinical practice, rather than relying solely on categorical DSM diagnoses of chronic tic disorders. Given tic disorders often emerge earlier than OCD, a history of tics or subtle tics observed during evaluation may indicate shared underlying neural substrates.
Patterns observed here also suggest that simply observing tics during an intake likely does not indicate more severe, complex, or treatment-resistant OCD. Clinicians can feel more confident educating families that the presence of motor tics does not mean their child’s OCD will necessarily be harder to treat or require significant adaptation of first-line interventions like SSRIs and CBT.
However, the findings do not preclude the potential need for treatment considerations if tics are impairing in their own right or prove disruptive toERPexercises.
However, accommodations like mindfulness skills to manage premonitory urges or botox for more severe tics could likely complement standard CBT.
Additional research is still needed on markers and mechanisms that may differentiate subgroups within the heterogeneous tic-related OCD population and predict who is most likely to have tic exacerbations during treatment.
For example, future studies could examine underlying neural substrates and neurotransmitter dysfunction, distinguishing simple transient tics from chronic and complex tics in the context of OCD. Identifying distinct endophenotypes could allow truly personalized intervention based on an individual’s tic profile.
Research building on existing neurobiological models highlighting the role of dysfunctional corticostriatal loops may prove particularly informative for ultimately matching specific symptom profiles to targeted treatments with the best empirical support.
References
Primary reference
Conelea, C. A., Walther, M. R., Freeman, J. B., Garcia, A. M., Sapyta, J., Khanna, M., & Franklin, M. (2014). Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.Journal of the American Academy of Child & Adolescent Psychiatry,53(12), 1308-1316.https://doi.org/10.1001/jama.2011.1344
Other references
Diniz, J. B., Rosario-Campos, M. C., Hounie, A. G., Curi, M., Shavitt, R. G., Lopes, A. C., & Miguel, E. C. (2006). Chronic tics and Tourette syndrome in patients with obsessive-compulsive disorder.Journal of Psychiatric Research, 40(6), 487–493.https://doi.org/10.1016/j.jpsychires.2005.09.006
Hanna, G. L., Piacentini, J., Cantwell, D. P., Fischer, D. J., Himle, J. A., & Van Etten, M. (2002). Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents.Depression and Anxiety, 16(2), 59–63.https://doi.org/10.1002/da.10041
Ivarsson, T., Melin, K., & Wallin, L. (2008). Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD).European Child & Adolescent Psychiatry, 17(1), 20–31.https://doi.org/10.1007/s00787-007-0631-z
Keeley, M. L., Storch, E. A., Merlo, L. J., & Geffken, G. R. (2008). Clinical predictors of response to cognitive-behavioral therapy for obsessive-compulsive disorder.Clinical Psychology Review, 28(1), 118–130. https://doi.org/10.1016/j.cpr.2007.04.003
Leckman, J. F., Grice, D. E., Barr, L. C., de Vries, A. L. C., Martin, C., Cohen, D. J., McDougle, C. J., Goodman, W. K., & Rasmussen, S. A. (1994). Tic-related vs. non-tic-related obsessive compulsive disorder.Anxiety, 1(5), 208–215. https://doi.org/10.1002/anxi.3070010504
Leckman, J. F., Riddle, M. A., Hardin, M. T., Ort, S. I., Swartz, K. L., Stevenson, J. O. H. N., & Cohen, D. J. (1989). The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity.Journal of the American Academy of Child & Adolescent Psychiatry,28(4), 566-573.
Lewin, A. B., Chang, S., McCracken, J., McQueen, M., & Piacentini, J. (2010). Comparison of clinical features among youth with tic disorders, obsessive-compulsive disorder (OCD), and both conditions.Psychiatry Research, 178(2), 317–322.https://doi.org/10.1016/j.psychres.2009.10.022
Storch, E. A., Merlo, L. J., Larson, M. J., Geffken, G. R., Lehmkuhl, H. D., Jacob, M. L., Murphy, T. K., & Goodman, W. K. (2008). Impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive-compulsive disorder.Journal of the American Academy of Child & Adolescent Psychiatry, 47(5), 583–592.https://doi.org/10.1097/CHI.0b013e31816774b1
Zohar, A. H., Pauls, D. L., Ratzoni, G., Apter, A., Dycian, A., Binder, M., King, R., Leckman, J. F., Kron, S., & Cohen, D. J. (1997). Obsessive-compulsive disorder with and without tics in an epidemiological sample of adolescents. American Journal of Psychiatry, 154(2), 274–276.https://doi.org/10.1176/ajp.154.2.274
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
