Review articleTourette's syndrome, trichotillomania, and obsessive–compulsive disorder: How closely are they related?
Introduction
The question of whether Tourette's syndrome (TS) and trichotillomania (TTM) are best conceptualized as obsessive–compulsive spectrum disorders has been raised by family studies on the close relationship between TS and obsessive–compulsive disorder (OCD) (Pauls et al., 1986, Rosario-Campos et al., 2005), and by psychopharmacological research indicating that both TTM and OCD respond more robustly to clomipramine than to desipramine (Zohar and Insel, 1987, Swedo et al., 1989). A range of studies have subsequently allowed comparison of the phenomenology, psychobiology, and management of TS and TTM, with that of OCD. These disorders are characterized by repetitive behaviors and may have a number of phenomenological intersections as depicted in Fig. 1 (Lochner et al., 2005, Chamberlain et al., 2006, Ferrão et al., 2006). Thus, some kinds of hair-pulling resemble tic-like behaviors or compulsions insofar as they are preceded by an urge to pull and followed by a sense of relief (Fig. 1, area A) or are preceded by obsessive thoughts (Fig. 1, area B); tics and compulsions can overlap insofar as some compulsions are preceded by sensory phenomena and some tics are in response to obsessions (Fig. 1, area B); and some patients have hair-pulling, tics, and compulsions (Fig. 1, area D).
Here we briefly review the current literature on the relationship of these disorders with OCD, beginning with Tourette's syndrome, and moving on to trichotillomania.
Section snippets
Phenomenology
The main phenomenological differences between TS and OCD are presented in Table 1. In OCD, compulsions are typically performed in response to obsessive thoughts, images, or impulses. In contrast, in TS tics are not commonly preceded by obsessions. In addition, tics are sometimes performed involuntarily, whereas compulsions are always performed intentionally. Tics that are performed voluntarily and compulsions not preceded by obsessions represent an area of overlap between OCD and TS.
Trichotillomania
The question of whether trichotillomania (TTM) is best conceptualized as an obsessive–compulsive spectrum disorder was raised when clomipramine was reported to be more effective than desipramine for patients with chronic hair-pulling (Swedo et al., 1989). This thought-provoking study replicated findings that serotonin reuptake inhibitors were more robust than noradrenaline reuptake inhibitors in the treatment of obsessive–compulsive disorder (OCD) (Zohar and Insel, 1987). A range of studies
Conclusion
How similar are TS and TTM to OCD? It seems clear from data on phenomenology, psychobiology, and treatment that TS and TTM are not simply variants of OCD. Nevertheless, some genetic (Pauls et al., 1996) and imaging (Moriarty et al., 1997) data indicate that TS and OCD may have significant overlap in their underlying mechanisms, and TS is arguably the disorder most closely related to OCD. In the case of TTM, there is less information available on underlying psychobiological mechanisms, but there
Acknowledgments
The authors thank Albina Torres, Alice de Mathis, Marcos Mercadante, Marcelo Hoexter, Juliana Diniz, Cristina Belloto, Antonio Carlos Lopes, Roseli Gedanke Shavitt, Ana G Hounie, and Maria Conceição Rosário, members of The Brazilian Obsessive–Compulsive Research Consortium, for their invaluable contribution to this article. The work was also supported by grants from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, Foundation for the Support of Research in the state of São
References (169)
- et al.
Habit reversal: a method of eliminating nervous habits and tics
Behaviour Research and Therapy
(1973) - et al.
Bipolar disorder in adult patients with Tourette's syndrome: a clinical study
Biological Psychiatry
(1998) - et al.
The relationship of obsessive–compulsive disorder to possible spectrum disorders: results from a family study
Biological Psychiatry
(2000) - et al.
Cognitive inhibition in trichotillomania and obsessive–compulsive disorder
Behaviour Research And Therapy
(2005) - et al.
Cerebrospinal fluid interleukin-6 in obsessive–compulsive disorder and trichotillomania
Psychiatry Research
(2002) - et al.
A segregation study of panic disorder in families of panic patients responsive to the 35% CO2 challenge
Biological Psychiatry
(1999) - et al.
Shape deformity of the corpus striatum in obsessive–compulsive disorder
Psychiatry Research: Neuroimaging
(2007) - et al.
Low level of dopaminergic D2 receptor binding in obsessive–compulsive disorder
Biological Psychiatry
(2004) - et al.
Association between the dopamine D2 receptor TaqI A2 allele and low activity COMT allele with obsessive–compulsive disorder in males
European Neuropsychopharmacology
(2006) - et al.
Brain magnetic resonance spectroscopy in Tourette's disorder
Journal of American Academy of Childhood and Adolescence Psychiatry
(2005)
Trichotillomania: impact on psychosocial functioning and quality of life
Behaviour Research and Therapy
A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections
Biological Psychiatry
The familial phenotype of obsessive–compulsive disorder in relation to tic disorder: the Hopkins OCD family study
Biological Psychiatry
Hoxb8 is required for normal grooming behavior in mice
Neuron
Familial and sporadic subtypes of early-onset obsessive–compulsive disorder
Biological Psychiatry
Obsessive–compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity
Psychaitry Research
Early-versus late-onset obsessive–compulsive disorder: investigating genetic and clinical correlates
Psychiatry Research
Obsessive–compulsive spectrum disorders and rheumatic fever: a family study
Biological Psychiatry
The relationship of obsessive–compulsive disorder to putative spectrum disorders: results from an Indian study
Comprehensive Psychiatry
Family-based association studies support a sexually dimorphic effect of COMT and MAOA on genetic susceptibility to obsessive–compulsive disorder
Biological Psychiatry
The Skin Picking Impact Scale (SPIS): scale development and psychometric analyses
Psychosomatics
Evidence for reduced cerebellar volumes in trichotillomania
Biological Psychiatry
Tourette's syndrome
Lancet
Cerebrospinal fluid biogenic amines in obsessive compulsive disorder, Tourette's syndrome, and healthy controls
Neuropsychopharmacology
Dissociative experiences in obsessive–compulsive disorder and trichotillomania: clinical and genetic findings
Comprehensive Psychiatry
Bilineal transmission and phenotypic variation of Tourette's disorder in a large pedigree
Journal of American Academy of Child and Adolescent Psychiatry
How to treat OCD in patients with Tourette syndrome
Journal of Psychosomatic Research
Sequence variants in SLITRK1 are associated with Tourette's syndrome
Science
Dutch Flemish Tourette Surgery Study Group. Deep brain stimulation in Tourette's syndrome: two targets?
Movement Disorder
Segregation analysis of obsessive–compulsive disorder using symptom-based factor scores
American Journal of Medical Genetics
Obsessive–compulsive symptoms in heart disease patients with and without history of rheumatic fever
Journal of Neuropsychiatry and Clinical neuroscience
Psychogenic excoriation
Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs
Glutamate transporter gene SLC1A1 associated with obsessive–compulsive disorder
Archives of General Psychiatry
Immediate and long term outcome after infrathalamic and thalamic lesioning for intractable Tourette's syndrome
Journal of Neurology, Neurosurgery and Psychiatry
Gilles de la Tourette syndrome treated by bimedial leucotomy
Canadian Medical Association Journal
Corpus callosum morphology in children with Tourette syndrome and attention deficit hyperactivity disorder
Neurology
Gilles de la Tourette's disease based on five own observations
Arch Psychiatr Nervenkr
Caudate volumes in childhood predict symptom severity in adults with Tourette syndrome
Neurology
Adulthood outcome of tic and obsessive–compulsive symptom severity in children with Tourette syndrome
Archives of Pediatric and Adolescent Medicine
A systematic review: antipsychotic augmentation with treatment refractory obsessive–compulsive disorder
Molecular Psychiatry
Neural correlates of tic generation in Tourette syndrome: an event-related functional MRI study
Brain
Visuospatial abilities, memory, and executive functioning in trichotillomania and obsessive–compulsive disorder
Journal Of Clinical And Experimental Neuropsychology
DSM-IV stereotypic movement disorder: persistence of stereotypies of infancy in intellectually normal adolescents and adults
Journal of Clinical Psychiatry
A pilot safety study of repetitive transcranial magnetic stimulation (rTMS) in Tourette's syndrome
Cognitive and Behavior Neurology
Motor inhibition and cognitive flexibility in obsessive–compulsive disorder and trichotillomania
American Journal of Psychiatry
Characteristics of 60 adult chronic hair pullers
The American Journal of Psychiatry
Familial trichotillomania
The American Journal of Psychiatry
Neuropsychological measures in women with obsessive–compulsive disorder and trichotillomania
Psychiatry and Clinical Neurosciences
Tourette's disorder with and without obsessive–compulsive disorder in adults: are they different?
Journal of Nervous and Mental Disease
A controlled study of Tourette syndrome. IV. Obsessions, compulsions, and schizoid behaviors
American Journal of Human Genetics
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