OCD with Tourette Syndrome or Tics
Tourettic OCD looks different, responds differently, and needs a clinician who treats both
Up to half of people with Tourette syndrome have obsessive-compulsive symptoms, and OCD that arrives with tics is not the same illness as OCD that arrives alone. The obsessions are less often fears and more often urges: a mounting sense that something is not right until an action is repeated, a symmetry restored, a surface touched, a count completed. The line between a complex tic and a compulsion can be genuinely hard to draw, and it matters, because the treatments diverge. This is the overlap I have spent most of my clinical career on, and it is the stream of the national adult Tourette syndrome service at Queen Square that I lead.
- From premonitory urge to obsessional drive
- Tics are preceded by a premonitory urge, a bodily tension relieved by the movement or sound. In tourettic OCD that urge becomes an obsessional drive: “just right” and “not just right” experiences, ordering and symmetry, touching, tapping, evening-up, counting, and repeating actions until a sensation is satisfied, rather than the contamination or harm fears of classical OCD. Recognising this pattern changes the treatment plan from the first appointment.
- Why standard treatment can fall short
- Tic-related OCD responds less well to serotonergic medication alone, and some serotonergic drugs can make tics worse; I have published on sertraline exacerbating tics in exactly this group. It responds better to augmentation with a low-dose dopamine-blocking medication, and to behavioural treatment adapted to tics: habit reversal training and comprehensive behavioural intervention for tics, alongside exposure and response prevention for the obsessional symptoms. Which components to combine, and in what order, is the substance of my assessment.
- What I offer
- A neuropsychiatric assessment of both the tic disorder and the OCD, including the conditions that commonly travel with them: ADHD, autism, anxiety and depression; a medication plan that treats the OCD without inflaming the tics; habit reversal and exposure-based therapy delivered or directed by me; and, for severe cases, access to the multidisciplinary Tourette syndrome service at the National Hospital, where I am also a co-investigator on the trial of deep brain stimulation for severe Tourette syndrome.
- NHS and private routes
- GPs and specialists anywhere in the UK can refer directly to my NHS Tourette syndrome and OCD clinic at Queen Square. Privately, I see patients at Queen Square Private Consulting Rooms, in person or by video, from the age of thirteen.
To arrange an assessment
Private Secretary
020 8123 0234 ·
secretary@drhimanshutyagi.com