OCD and Tourette’s Syndrome: Understanding the Overlap and the Role of Therapy

Written By Laura Meza Valencia

Obsessive-Compulsive Disorder (OCD) and Tourette’s Syndrome are both neuropsychiatric conditions that can significantly impact quality of life. Though distinct in their diagnostic criteria, they often co-occur, and understanding how they interact is key to effective treatment.

What Is OCD?

OCD is characterized by:

  • Obsessions: Persistent, intrusive thoughts, urges, or images that cause anxiety or distress.

  • Compulsions: Repetitive behaviors or mental rituals performed to neutralize distress or prevent a feared outcome.

OCD is more than just liking things tidy or preferring orderliness — it can be debilitating without treatment. Obsessive-Compulsive Disorder affects approximately 1–2% of the population worldwide, often emerging in childhood, adolescence, or early adulthood. Individuals with OCD may feel trapped in a cycle of distressing, intrusive thoughts (obsessions) and repetitive actions or mental rituals (compulsions) performed to alleviate anxiety or prevent a feared outcome. These compulsions can consume hours of a person’s day — such as repeatedly washing hands, checking locks, counting, or seeking reassurance — making it difficult to attend school, maintain employment, form relationships, or even engage in basic self-care. Over time, the disorder can erode a person’s confidence, increase feelings of shame or isolation, and significantly reduce quality of life. Without effective treatment, OCD can become a chronic and deeply impairing condition.

What Is Tourette’s Syndrome?

Tourette’s Syndrome is a neurological disorder marked by motor tics (e.g., blinking, shrugging, head jerking) and vocal tics (e.g., throat clearing, sniffing, grunting). These tics usually start in childhood and vary in frequency and intensity. Many individuals with Tourette’s can temporarily suppress their tics, often with a significant build-up of internal tension.

Tourette’s and OCD frequently co-occur, and clinicians have long noticed shared traits between them — including sensory phenomena, premonitory urges, and behavioral repetitions.

What Is Tourettic OCD?

Tourettic OCD (TOCD) is not presently a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but it has emerged in clinical and research settings to describe a unique overlap of symptoms that span both Obsessive-Compulsive Disorder (OCD) and chronic tic disorders such as Tourette’s Syndrome (TS). 

Key features often seen in TOCD include:

  • Compulsions that resemble tics: These are repetitive or complex behaviors that may look like tics but are driven by a subjective sense of urgency, internal tension, or “just-right” sensations. Unlike classic OCD compulsions (which often serve to neutralize a feared consequence), these behaviors may simply relieve a sensory urge. 

  • Urges and “premonitory sensations”: Individuals frequently report an internal build-up of a physical or sensory pressure (e.g., a feeling in the throat, a sense of needing to touch or tap) preceding the behavior. This mirrors the premonitory urge seen in tics but intersects with the anxiety–compulsion cycle of OCD. 

  • Difficulty distinguishing “tic” vs. “compulsion”: Because the behaviors have qualities of both tics and compulsions, clinical differentiation may be challenging. The behaviors are often more complex than simple motor or vocal tics and may include sequences, touches, arrangements, and repetitions until the “just-right” feeling is achieved. 

  • Symptom clusters and phenomenology distinct from classic OCD or TS: Some research suggests that TOCD may manifest with an earlier age of onset, a stronger male predominance, and more behaviors related to symmetry, touching, or repeating until exactness is felt — rather than classic contamination or checking obsessions. 

Given this overlap, TOCD is best conceptualized as an intermediate neuropsychiatric profile — a “hybrid” of sorts sitting between the more clearly categorized OCD and tic-disorder spectrums.

Understanding the Brain Science Behind TOCD

Up to 50% of individuals with Tourette’s Syndrome also experience symptoms of Obsessive-Compulsive Disorder (OCD) — and vice versa. This isn’t just coincidence. Increasing research points to shared neurological roots that can help explain why the two often appear together.

Conditions like OCD and Tourette’s involve the brain’s habit and motor regulation systems, particularly those responsible for controlling repetitive thoughts, actions, and impulses. These brain systems act like the mind’s “brakes and steering,” helping us stop unwanted thoughts or behaviors, and switch tasks smoothly.

In individuals with OCD or tics — and especially in those with Tourettic OCD (TOCD) — these systems may misfire, making it difficult to regulate certain movements, thoughts, or sensations.

Key Brain Regions Involved

  • Basal ganglia & striatum: These areas help regulate habits and movement. They’ve been found to function differently in both OCD and Tourette’s, which could explain why both disorders involve repetitive behaviors. 

  • Frontal cortex: This part of the brain helps with impulse control, emotional regulation, and decision-making. In OCD, it can become overactive during moments of anxiety. In Tourette’s, it may not effectively regulate the motor responses that lead to tics.

  • The CSTC “loop system”: This stands for cortico-striato-thalamo-cortical loops — circuits in the brain that control thoughts, actions, and emotions. Disruptions in these loops are common in both OCD and tic disorders and may lead to repeated or compulsive behaviors. 

  • Sensory processing areas (insula & anterior cingulate cortex): People with Tourette’s often describe a “build-up” sensation before a tic (called a premonitory urge). Similarly, people with OCD may feel something is “not quite right” until they perform a compulsion. These sensations are processed in overlapping parts of the brain. 

  • Inhibitory control systems: Both conditions are linked to difficulty suppressing automatic responses. In OCD, this might look like repeating a behavior even when it’s unwanted. In Tourette’s, it may be a tic that emerges despite trying to hold it in. These challenges point to a shared difficulty in “putting on the brakes” neurologically. 

In TOCD, symptoms may straddle both diagnoses — tics that feel ritualistic, or compulsions that stem from physical tension or urges. This isn’t just a matter of overlap in symptoms, but overlap in brain function and wiring. Understanding this shared neurological foundation can help guide more effective, individualized treatment approaches.

How Therapy Can Help

Treatment for TOCD often requires an integrative and individualized approach, drawing from evidence-based techniques and broader therapeutic frameworks that address the whole person — not just the symptoms.

Evidence-Based Foundations

Integrative and Existential Approaches

Because OCD and Tourette’s often involve deep internal tension, questions of control, and fear of uncertainty, many clients benefit from a more existential or meaning-centered approach.

  • Existential Therapy: Helps individuals explore how anxiety, freedom, and meaning intersect with their symptoms — reducing the sense of isolation and fear that can accompany OCD. 

  • Acceptance and Commitment Therapy (ACT): Encourages clients to accept internal experiences and commit to behaviors aligned with personal values, rather than fighting or avoiding distress.

  • Mindfulness-Based Cognitive Therapy (MBCT): Cultivates awareness of thoughts and sensations without judgment, reducing the emotional reactivity that maintains compulsions. 

When therapy is tailored to the individual’s symptom profile — whether OCD-dominant, tic-dominant, or blended — the results can be transformative. Early intervention is especially important in adolescents, where symptoms can interfere with school, social life, and emotional development.

Tourettic OCD on Baylen Out Loud

The docu-series Baylen Out Loud follows Baylen Dupree, a young woman living with Tourettic OCD — a complex and often misunderstood condition that blends symptoms of both Obsessive-Compulsive Disorder and Tourette’s Syndrome. Through the show, viewers witness the challenges and resilience involved in managing this dual diagnosis.

Baylen’s story has helped bring national attention to the overlap of Tourette’s Syndrome and OCD, opening important conversations about mental health, stigma, and the need for specialized treatment. Her visibility has created space for others to recognize similar symptoms and seek help.

If you or someone you know is struggling with OCD, tics, or Tourettic OCD, you can request a consultation with a specialist at the Center for Cognitive & Behavioral Health.

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Disclaimer

This blog post is intended for educational purposes only and does not constitute or replace psychotherapy, diagnosis, or medical advice.

All references to individuals are based on publicly shared information; no private therapy details are disclosed

If you or someone you know is experiencing symptoms of OCD, Tourette’s Syndrome, or a related condition, please reach out to a qualified mental health professional. Early support can make a meaningful difference.

Laura Meza Valencia
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