Tourettic OCD vs Classic OCD
What is Tourettic OCD?
Tourettic OCD is when someone has OCD-like compulsions and rituals without the intrusive thoughts or anxiety preceding them. Instead, the compulsions can be fueled 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 and complex rituals, flick light switches on and off, avoid certain areas of the floor, tap things, open and close doors etc.
It is interesting as OCD is said to be an anxiety disorder, but in Tourettic OCD the rituals have nothing to do with anxiety, worries or fears. A person just has the physical urge to perform the compulsion, but does NOT fear that anything bad is going to happen if they do not perform the ritual.
Examples - Tourettic OCD vs Classic OCD:
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 neutralize 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.
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 generalized anxiety and classic OCD in addition to Tourettic OCD.
The rituals in Tourettic OCD can be very time consuming, taking up most of the day, similar to in Classic OCD.
Is it managed differently to Classic OCD?
Cognitive Behavioral Therapy is often helpful for people with Classic OCD, but it 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
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, which are out of body sensations.
Tourettic OCD can occur in people with PANDAS/PANS.