The relationship between types and severity of repetitive behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder.
BACKGROUND
This study investigated which categories of obsessive-compulsive and Tourette-related behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder (OCD) without tics are experienced as most severe across the study groups and what the differences are in symptom distribution between the study groups.


METHODS
Fourteen subjects with both Tourette's disorder and OCD, 18 subjects with Tourette's only, 21 subjects with OCD (no tics), and 29 control subjects were studied using a semistructured interview designed to equally assess Tourette- and OCD-related behaviors according to DSM-III-R criteria. Each reported repetitive behavior was evaluated on the presence of anxiety and on goal-directedness. Anxiety-related items were categorized as obsessions or compulsions and non-anxiety-related items as impulsions. Severity of each reported item was assessed with respect to time per day consumed and amount of distress and interference induced by the item. Following these criteria, each reported item was classified as a symptom, a subthreshold symptom, or just as being present.


RESULTS
Across the study groups, obsessions were experienced as more severe than (Tourette-related) impulsions and compulsions. Within the study groups, patients with both Tourette's disorder and OCD reported more symptomatic Tourette-related impulsions, such as mental play, echophenomena, and impulsive or self-injurious behaviors; less overall symptomatic obsessions; and less symptomatic washing than patients with OCD (no tics). The differences among individuals with Tourette's with or without OCD reflected differences in symptom severity rather than differences in symptom distribution.


CONCLUSIONS
Obsessions are more time consuming, distressing, and interfering than compulsions and impulsions. Furthermore, the symptomatic repetitive behaviors were distributed differently among patients with both Tourette's disorder and OCD and patients with OCD (no tics). Patients with Tourette's and OCD are phenomenologically more similar to Tourette's than to OCD. These differences possibly represent differences in underlying pathophysiology between Tourette's and tic-free OCD.
Department of Psychiatry, Psychiatric Center Amsterdam, The Netherlands. daniellc@pca-znw.nl
D C
DC
Cath
P
P
Spinhoven
B J
BJ
van de Wetering
C A
CA
Hoogduin
A D
AD
Landman
T C
TC
van Woerkom
R A
RA
Roos
H G
HG
Rooijmans
D000328:Adult; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009770:Obsessive Behavior / Q000175:diagnosis / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000523:psychology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D019956:Stereotypic Movement Disorder / Q000175:diagnosis* / Q000523:psychology; D005879:Tourette Syndrome / Q000175:diagnosis* / Q000523:psychology