Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences?

Cath, Danielle C; Spinhoven, Philip; Hoogduin, Cees A.L; Landman, Andrea D; van Woerkom, Theo C.A.M; van de Wetering, Ben J.M; Roos, Raymund A.C; Rooijmans, Harry G.M

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Volume 101, Issue 2 , Pages 171-185, 25 March 2001

Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences?

Danielle C Cath
- Department of Psychiatry, GGZ Buitenamstel Outpatient Services, Lassusstraat 2, 1075 GV Amsterdam, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Corresponding author. GGZ Buitenamstel Outpatient Services, Lassusstraat 2, 1075 GV Amsterdam, The Netherlands. Tel.: +31-20-6700305; fax: +31-20-5737458
Philip Spinhoven
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Division of Clinical and Health Psychology, Leiden, The Netherlands
Cees A.L Hoogduin
- Department of Psychology, Nijmegen University, Nijmegen, The Netherlands
Andrea D Landman
- Psychiatric Hospital Endegeest, Oegstgeest Department of Psychiatry, Oegsteest Endegeest, The Netherlands
Theo C.A.M van Woerkom
- Department of Neurology, Leyenburg Hospital, The Hague, The Netherlands
Ben J.M van de Wetering
- Erasmus University Medical Center, Rotterdam, The Netherlands
Raymund A.C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
Harry G.M Rooijmans
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

Received 17 February 2000; received in revised form 30 October 2000; accepted 14 January 2001.

Abstract

Gilles de la Tourette Syndrome (GTS) and obsessive–compulsive disorder (OCD) share obsessive–compulsive phenomena. The aims of this study were to compare the OC symptom distribution between GTS and OCD and to investigate whether a subdivision of these phenomena into obsessions, compulsions and ‘impulsions’ is useful in distinguishing GTS and OCD patients. Thirty-two GTS, 31 OCD (10 with tics, 21 without tics) and 29 control subjects were studied using the Leiden repetitive behaviors semi-structured interview to assess GTS as well as OCD-related behaviors. Each reported repetitive thought or action was evaluated on the presence of anxiety and on goal-directedness. This information was used to define whether the behavior was an obsession, compulsion, or ‘impulsion’. Both the GTS and OCD study groups showed higher scores than control subjects on rating scales measuring depression, OC behavior and anxiety. In GTS, Y–BOCS severity scores and trait anxiety were lower than in the OCD groups. Furthermore, GTS patients differed from OCD patients in the distribution of symptoms. Aggressive repetitive thoughts, contamination worries and washing behaviors were reported more frequently by tic-free OCD, while mental play, echophenomena, touching and (self)-injurious behaviors were reported more frequently by GTS. OCD individuals with tics were intermediate, but closer to tic-free OCD. GTS individuals reported significantly more ‘impulsions’ and fewer obsessions and compulsions than OCD individuals with and without tics. Factor analysis revealed three factors accounting for 44% of the variance, resulting in an ‘impulsive’ factor related to GTS, a ‘compulsive’ factor related to OCD and an ‘obsessive’ factor related to tic-free OCD. In conclusion, OCD individuals reported more anxiety and goal-directedness associated with their behaviors than did GTS subjects. The distinction between obsessions, compulsions and impulsions is of importance in identifying Tourette-related vs. non-Tourette-related repetitions.

Keywords: Obsessions, Compulsions, Impulsions, Factor analysis, Repetitive behaviors