Gilles de la Tourette's syndrome with and without obsessive-compulsive disorder compared with obsessive-compulsive disorder without tics: which symptoms discriminate?
Stereotyped repetitive behaviors occur in Gilles de la Tourette's Syndrome (GTS) and obsessive-compulsive disorder (OCD). The present study was undertaken to compare the distribution of obsessive-compulsive and Tourette-related impulsive behaviors in GTS with (+) OCD, GTS without (-) OCD, tic-free OCD, and control subjects. Fourteen GTS + OCD, 18 GTS-OCD, 21 OCD-tic, and 29 control subjects were evaluated using a semistructured interview designed to assess GTS and OCD-related repetitive behaviors. Each reported item was evaluated on the presence of anxiety and goal-directedness. This information was subsequently used to define whether the repetitive behavior was an (anxiety-related) obsession or compulsion, or a (non-anxiety-related) OC-like behavior, impulsion. GTS + OCD subjects reported more overall Tourette-related impulsions than OCD-tic subjects, i.e., more mental play, echophenomena, and touching behaviors but similar frequencies of typical obsessive-compulsive behaviors. Further, GTS + OCD subjects exhibited more overall repetitive behaviors than GTS-OCD subjects, i.e., more Tourette-related impulsions as well as more obsessive-compulsive behaviors. The distribution of symptoms is similar in GTS with and without OCD, and differs from tic-free OCD. These differences suggest that GTS with OCD constitutes a form of GTS, not of OCD, although the possibility that GTS + OCD patients constitute a subgroup distinct from GTS and from OCD can not be excluded by this phenomenological study. Specific non-anxiety-related impulsions seem to discriminate between GTS and OCD-tic individuals. These impulsions possibly reflect differences in underlying mechanisms between GTS and OCD-tics.
Cath
D C
DC
Department of Psychiatry, GGZ Buitenamstel Outpatient Services, Amsterdam, The Netherlands.
Spinhoven
P
P
van Woerkom
T C
TC
van de Wetering
B J
BJ
Hoogduin
C A
CA
Landman
A D
AD
Roos
R A
RA
Rooijmans
H G
HG
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D010555:Personality Inventory / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020323:Tics / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005879:Tourette Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology