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Obsessive–Compulsive Disorder and Tourette’s Disorder Symptom Presentations: Differential Diagnosis and Treatment Considerations

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Abstract

Purpose of Review

This review summarizes the shared and distinct clinical features of obsessive-compulsive disorder Tourette’s disorder (TD), and their comorbidity, in addition to state of the literature on differential diagnosis of these disorders, and best-practice treatment guidelines for their comorbid presentation.

Recent Findings

OCD and TD are each marked by recurrent behaviors and maintained via alleviation of adverse internal processes. They also share clinical features, comorbidities, and etiology, complicating diagnosis. Differential diagnosis draws on consideration of the nature of repetitive behaviors, obsessions, and sensory phenomena through validated assessment measures. Comorbid OCD and TD are associated with earlier age of symptoms, greater male preponderance, and more symmetry, repeating, touching, tapping, blinking, staring behaviors, and sensory. Tourettic OCD (TOCD) represents a unique challenge in which tic-like compulsions are accompanied by sensory phenomena. For TOCD, a longer cognitive behavioral therapy course may be warranted, with supplemental habit reversal training provided as needed; augmentation of selective serotonin reuptake inhibitors with neuroleptics is recommended. Repetitive transcranial magnetic stimulation, deep brain stimulation, and cannabis-based medicines provide novel means of targeting their comorbidity.

Summary

Understanding of broader symptom context and use of validated assessment measures can inform diagnosis and treatment decisions for OCD and TD. More research is needed to explore combined treatments and novel therapeutics for comorbid OCD and TD.

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Funding

Research reported in this publication was supported in part by funding from the National Institute of Mental Health (NIMH) K23 MH113884 to Dr. Ricketts.

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Authors and Affiliations

  1. Department of Psychiatry and Biobehavioral Sciences, University of California, 760 Westwood Blvd., Los Angeles, CA, USA

    Valerie S. Swisher, John Piacentini & Emily J. Ricketts

  2. Department of Psychological and Brain Sciences, University of Iowa, Iowa City, USA

    Talia Y. Leman

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Valerie S. Swisher and Talia Y. Leman wrote the original draft. John Piacentini and Emily J. Ricketts reviewed and revised the draft. All authors read and approved the final manuscript.

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Correspondence to Emily J. Ricketts.

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Competing Interests

Miss Swisher and Miss Leman declare no conflicts of interest. Dr. Ricketts has received research funding from the National Institute of Mental Health (NIMH), Brain and Behavior Research Foundation, and the TLC Foundation for Body-Focused Repetitive Behaviors. She has received honoraria and research funding from the Tourette Association of America (TAA). She has received honoraria from the Centers for Disease Control and Prevention and Springer Nature. Dr. Piacentini receives research support from NIMH, Patient-Centered Outcomes Research Institute (PCORI) and the TLC Foundation for Body-Focused Repetitive Behaviors, advisor fees and equity from Lumate Health; publication royalties from Guilford Press, Oxford University Press, and Elsevier; and travel/speaking honoraria from the TAA and International OCD Foundation.

Conflict of Interest

Miss Swisher and Miss Leman declare no conflicts of interest. Dr. Ricketts has received research funding from the National Institute of Mental Health (NIMH), Brain and Behavior Research Foundation, and the TLC Foundation for Body-Focused Repetitive Behaviors. She has received honoraria and research funding from the Tourette Association of America (TAA). She has received honoraria from the Centers for Disease Control and Prevention and Springer Nature. Dr. Piacentini receives research support from NIMH, Patient-Centered Outcomes Research Institute (PCORI) and the TLC Foundation for Body-Focused Repetitive Behaviors, advisor fees and equity from Lumate Health; publication royalties from Guilford Press, Oxford University Press, and Elsevier; and travel/speaking honoraria from the TAA and International OCD Foundation.

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Swisher, V.S., Leman, T.Y., Piacentini, J. et al. Obsessive–Compulsive Disorder and Tourette’s Disorder Symptom Presentations: Differential Diagnosis and Treatment Considerations. Curr Dev Disord Rep 10, 222–231 (2023). https://doi.org/10.1007/s40474-023-00284-6

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