1.Tourettic OCD: OCD but without the intrusive thoughts or anxiety preceding the rituals, the compulsions can be fuelled by physical premonitory sensations. The rituals and compulsions in Tourettic OCD can look almost identical to some of those in classic OCD. For example, both people with Tourettic OCD and people with Classic OCD can have long complex rituals, flick light switches on and off, avoid certain areas of the floor, tap things, open and close doors etc.
Examples:
In Classic OCD: A person may wash their hands repeatedly because they are afraid of germs.
In Tourettic OCD: People may wash their hands as they feel like they are being pulled towards the sink by a physical feeling and wash to get an uncomfortable sensation off of their hands.
In Classic OCD: People may open and close doors because they are afraid that something bad may happen if they don't, even if they know this is irrational.
In Tourettic OCD: People may open and close doors as they feel some sort of physical 'energy' around the door and have to get it off, even though they know this is not real and that nothing bad would happen if they didn't do it.
In Classic OCD: A person may tap things when they feel anxious to neutralise an intrusive thought and try to push it away.
In Tourettic OCD: A person may tap things because they have the physical urge to do so and if they don't then an uncomfortable sensation builds up. A person doesn't feel fearful or anxious if they don't do it, but they feel physically uncomfortable but they have no intrusive thoughts associated with it so know that nothing is going to happen if they do not do it.
In Classic OCD: People may avoid certain areas of the floor because if they don't, they may feel like their parents could get ill.
In Tourettic OCD: People may avoid a certain area on the floor because they feel like there is a physical barrier there (even though they know there's not) but they have to jump over it because it would feel physically uncomfortable to pass it.
In Classic OCD: A person may kick themselves every time they get up from sitting down to 'keep them safe'.
In Tourettic OCD: A person may kick themselves when they get up from sitting down as they have the physical urge to do so and it is like a situational tic that only happens when they get up from sitting down.
Tourettic OCD can sometimes be seen as pure compulsive OCD, as people do not have the intrusive thoughts and anxiety preceding the rituals, although technically urges can be seen as a form of obsession.
People with Tourettic OCD can still have generalised anxiety and classic OCD in addition to Tourettic OCD.
Cognitive Behavioral Therapy may not work for people with Tourettic OCD as it is not thought based, there are no thoughts to challenge. As well as this, some people report that Exposure Response Prevention (ERP) can make them worse if they have Tourettic OCD due to the suppression element. The premonitory urge may just accumulate and may come out as rage attacks instead, for example. This is why Tourettic OCD is managed in a similar way to tics, even though the rituals in Tourettic OCD may not look like tics.
Psychologists may get confused when working with someone with Tourettic OCD as they may not understand that a person may not have intrusive thoughts or anxiety associated with their rituals. They may label these people as having 'limited insight' into their intrusive thoughts and fears, but the reality is that there may not even be any. Psychologists may also be baffled as to how a person doesn't seem to experience anxiety or fear when the Tourettic OCD rituals are resisted, even though resisting rituals can still be incredibly difficult.
Classic OCD is more common in both the Tourette's / tics community and in the general population, but some people will have Tourettic OCD. You can have Tourettic OCD without Tourette's.
Tourettic OCD rituals can be preceded by phantom tics (see below).
2.Phantom Tics: This is where people feel the urge to tic, a premonitory sensation, outside of their own body. For example, people might feel an 'energy' sticking to or clumping around door handles or on objects. People may feel a sensation, an urge, on other people. Some people may also feel the sensation floating around them. People with premonitory urges may have a tic that involves touching, scratching, hitting or rubbing the area where the out of body sensation is felt. Complex Tourettic OCD rituals may be preceded by phantom tics, people may feel them all around them and may feel like the urge is like an elastic band pulling them to do certain things. People with phantom tics know that the out of body sensation isn't real, but still feel it. People can feel this sort of phantom urge on an object or person from the other side of the room, so they do not need to be close to someone to feel it. If people do believe that the urge is really something there, then it may be more psychosis linked rather than tic linked. Young children may struggle to articulate what a phantom tic feels like so they may make up terms to describe it, when I was younger I would call it 'sticky magic' and sometimes I would get stuck on the floor or sofa and it would feel like it was pinning me down.
3. Sensory Issues: Some people with Tourette’s and tic conditions have sensitivity to bright lights, loud sounds, certain tastes and textures. It can be to do with co-occurring Sensory Processing Disorder. Some people also have what is known as visual stress or Irlen®️ syndrome. This is a condition linked to light sensitivity, where people may have visual distortions when reading, such as seeing the words being blurry or moving around. Some people may find that the white of the page dominates the black text and this can cause discomfort. Some people will have it where they see areas of too much white space going through the text and some people may see an outline or halo around the text they are trying to read. This is because the brain has difficulty processing certain wavelengths of light, and this can affect reading. People with this condition may use coloured overlays to read. Other symptoms can include headaches, migraines, anxiety and fatigue when under bright and fluorescent lights. Some people experience ADHD symptoms that are alleviated when the light is dimmer and when the light sensitivity is addressed. Some people may have difficulties with reading comprehension and hand eye coordination, it is like their brain is so focused on processing certain wavelengths of light, that it struggles to do other things. Those who have both tics and visual stress may find that their tics decrease when the light sensitivity is addressed. People with Irlen®️ Syndrome often have to wear specially tinted coloured glasses and this can alleviate some of the visual stress symptoms. It is a brain condition and not an issue with the eyes. People with this condition do not necessarily have every symptom.
Some people with tics find that their tics are worse in buildings with fluorescent lighting, so in most public buildings such as shops and schools. This can occur even if a person does not have Irlen®️ Syndrome. It is possible that this could be due to the flicker rate of the fluorescent lighting triggering a neurological response even if our eyes do not pick up the flickering. Sometimes if you film in a place with fluorescent lighting you can see some flickering, but our eyes do not pick it up. It is possible that this could be picked up by the brain and exacerbate neurological symptoms. Some people find that wearing certain shades of sunglasses (the shade will be different for everyone) may reduce tics that are exacerbated by fluorescent lighting. For me, this was dark amber/rose/brown glasses, but grey, black and yellow tinged glasses did not have a positive effect. When I was wearing the right shade, the urge to tic just melted away.
4.Rage Attacks: Sudden episodes of anger and destructive behaviour. A person having a rage attack may kick things, swear, hit things, break things and scream. These are involuntary just like tics and you have to wait for it to pass. A person should NEVER be disciplined for having a rage attack as they are a neurological symptom and not a choice. Discipline does not prevent them and punishing someone for it can have disastrous effects on someone's self-esteem as they may feel like they are a horrible, mean and nasty person for something that they cannot control. Please do not try to reason with us in a rage attack, as we cannot take in what you are saying. We lose control of our rational thinking and actions.
Rage attacks may not always be anger based, some people describe them more like complex tics.
5.Disinhibition: Having no mental breaks and saying things without thinking, or being excessively sassy and silly or having emotional outbursts.
6. Echopraxia: Involuntarily copying other people’s movements.
7. Tic Attacks: Sudden episodes of extreme motor tics that can not be suppressed or can only be suppressed for a couple of seconds. It can sometimes look like a seizure or dystonia. Sometimes people may have to go to the Emergency room for tic attacks if they last for hours or cause pain and injury. Sometimes tic attacks may not look like a seizure or dystonia but can look like an episode of motor and vocal tics that are worse than usual and which make it difficult for a person to do things they usually do. Tic attacks can last for a few minutes to many hours. Some people cannot talk during a tic attack, some people can. Tic attacks can be frightening to experience and see someone experience.
It is also possible to have episodes of constant and loud vocal tics without a break and some people call these 'vocal tic attacks'.
8. Internal Tics: tics that can occur inside the body and may be hidden to those on the outside. Examples include a stomach clenching and churning tic or a peeing tic (bladder tic). There are also breathing tics where people may breath in patterns, hold their breath, exhale forcefully or feel like they can't satisfy the breath.
9. Writing Tics: Tics where you involuntarily make a mark on a paper or write or draw something on a surface. People may scribble on their page or write random phrases. Coprographia is a type of writing tic where people cannot help but to write and / or draw obscene words, phrases and / or images.
10. Sensory Tics: These consist of involuntary sensations such as an energy surge or an itchy blood sensation like the premonitory urge that comes before a tic, but is not accompanied by an involuntary movement or vocalisation. It can be compared to a tactile hallucination of sorts as the sensation occurs on its own without a visible tic. It can be like there is a tic that cannot escape or cannot be released. It can sometimes be worsened by tic suppression.
11.Executive Dysfunction: Problems with organisation, prioritizing and starting tasks as well as other functions. This can be a big ADHD trait but can also occur as part of Tourette Syndrome, Autism and PANDAS/PANS without co-occurring ADHD.
Note: A lot of these traits occur in PANDAS / PANS, that is what causes them for me. That is why I use the term 'Tic conditions' as well as Tourette's.
Disclaimer: I am NOT a medical professional, this is NOT to be used as a substitute for diagnosis or treatment from a qualified physician, this is to be used for educational purposes only. For medical advice, please see a medical practitioner. I do NOT claim to treat, cure or mitigate any condition.
