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Tijdschrift voor Psychiatrie 53 (2011) 5, 275 - 285

Review article

Obsessive compulsive disorder with tics: a new subtype?

L.A. Fibbe, D.C. Cath, A.J.L.M. van Balkom

background Obsessive compulsive disorder (ocd) is a heterogeneous disorder. With the help of phenomenological research, attempts are being made to create more homogeneous subtypes.
aim To search the literature in order to compare the symptoms of ocd patients with tics and without tics, and thereby determine whether ocd with tics can be distinguished clinically from ocd without tics.
method Search terms were used in conjunction with PubMed and Psychinfo in order to locate studies in which ocd patients without tics were compared with ocd patients with tics.
results In the 26 studies found in our search 872 ocd patients out of a total of 2801 ocd patients (i.e. 31%) had a comorbid tic disorder. ocd patients with tics displayed similarities and differences at symptom level. ocd patients with tics were associated with male gender and early age of onset. Tic-like symptoms such as touching, twitching, repeating, symmetry behavior and rubbing were seen more frequently in ocd patients with tics. ocd patients without tics more often displayed contamination obsessions and engaged in compulsive washing. On the other hand, the obsessions of patients with tics and without tics were very similar. The goal-directedness of compulsions differed between ocd patients with tics and those without tics. By analogy with ‘the premonitory urges’ that often precede tics, ocd patients with tics more often reported ‘just-right’ perceptions prior to their compulsions. ocd patients without tics more often reported anxiety prior to their compulsions. Compulsions seemed to be aimed at reducing tension and feelings of anxiety.
conclusion On the basis of the clinical symptoms ocd with tics does seem to be a subtype of ocd. However further research is needed into the aetiology, effective treatment and the course of the disorder before ocd with tics can be accepted conclusively as a subtype of ocd.

keywords comorbidity, just-right, obsessive compulsive disorder, premonitory, symptom dimensions, subtype, tic disorder