Tourette Syndrome and Obsessive Compulsive Disorder often occur together. In fact, the Centers of Disease Control and Prevention states that more than one third of persons with Tourette Syndrome also have Obsessive Compulsive Disorder. Often tics and compulsions can look similar and be difficult to distinguish. Actually to an observer it may be impossible to determine whether a behaviour is a compulsion or a tic without asking the person performing the behaviour and even then it may remain a mystery.
The key to distinguishing a tic from a compulsion is the motivation behind the act.
As an example, lets break down a simple motor tic which could very well be a simple compulsive behaviour .
The behaviour is blowing on the back of the right hand.
If the behaviour is a tic the person may feel a premonitory urge to perform the tic. The premonitory urge could be a tickle on the hand, a sensation in the elbow joint prompting the movement, a sensation in the lips to purse, a feeling in the chest prompting a need to exhale a breath. Premonitory sensations may be any feeling or urge that prompts the tic, creating the itch that needs to be scratched. (see premonitory urge for further discussion). The person scratches that itch and the tic is performed.
If the behaviour is a compulsion the person is prompted by a different mechanism to perform the exact same behaviour. The person may have an obsession that there may be dust on the back of the hand, a thought that they may need to blow on the back of the hand to prevent something bad from happening, a feeling of anxiety or emotional unease unless they blow on the back of their right hand. The person then performs the behaviour, (not a tic), and temporarily relieves the uneasiness or anxiety.
As you see from this scenario, the behaviour from the outside observer is identical. To the person, the behaviour may be triggered from and performed for very different reasons. It could also be that the person themselves may be unaware of the difference as well. Distinguishing the “why” the behaviour occurs requires some cognitive awareness, maturity and insight. A child, for example, may not be able to determine the “why” and just know that they have to do the act. A person with many tics and compulsions may have a low reserve of mental energy to distinguish the “why” of the behaviour. A person who has little understanding or insight about their differences may also be unable articulate whether they are compelled due to anxiety to perform the act or if the act is a sudden, intermittent, unpredictable, repetitive, nonrhythmic movement that is classified as a tic.
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