Obsessive-Compulsive Disorder and Tourette's Disorder Symptom Presentations: Differential Diagnosis and Treatment Considerations

Purpose of ReviewThis review summarizes the shared and distinct clinical features of obsessive-compulsive disorder Tourette's disorder (TD), and their comorbidity, in addition to state of the literature on differential diagnosis of these disorders, and best-practice treatment guidelines for their comorbid presentation.Recent FindingsOCD and TD are each marked by recurrent behaviors and maintained via alleviation of adverse internal processes. They also share clinical features, comorbidities, and etiology, complicating diagnosis. Differential diagnosis draws on consideration of the nature of repetitive behaviors, obsessions, and sensory phenomena through validated assessment measures. Comorbid OCD and TD are associated with earlier age of symptoms, greater male preponderance, and more symmetry, repeating, touching, tapping, blinking, staring behaviors, and sensory. Tourettic OCD (TOCD) represents a unique challenge in which tic-like compulsions are accompanied by sensory phenomena. For TOCD, a longer cognitive behavioral therapy course may be warranted, with supplemental habit reversal training provided as needed; augmentation of selective serotonin reuptake inhibitors with neuroleptics is recommended. Repetitive transcranial magnetic stimulation, deep brain stimulation, and cannabis-based medicines provide novel means of targeting their comorbidity.SummaryUnderstanding of broader symptom context and use of validated assessment measures can inform diagnosis and treatment decisions for OCD and TD. More research is needed to explore combined treatments and novel therapeutics for comorbid OCD and TD.