Tourette's Disorder and OCD
Understanding the Connection and How to Treat Both
Natalie Noel, LMHC | Anxiety & OCD Treatment Specialists | Tampa, FL
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Your child has Tourette’s. But lately, something else has been happening. They arrange things until they feel “just right.” They go back and check things over and over. They repeat sentences until they sound exactly correct. They ask “Are you sure?” dozens of times a day. And the anxiety when things are not quite right feels unbearable.
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This is not just Tourette’s. This is Tourette’s and OCD one of the most common and most challenging combinations in child mental health.
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At Anxiety & OCD Treatment Specialists, we specialize in both. We treat them together in the same plan, with a therapist who understands how they interact.
Quick Answer: How Common Is OCD in Tourette's?
Approximately 50 percent of people with Tourette’s Disorder also have OCD. The connection is so strong that researchers consider the two conditions to be on the same neurological spectrum. OCD in the context of Tourette’s often has a distinct character more sensory-driven, more ‘just right’ focused, and less fear-based than classic OCD. Both conditions respond to specialized behavioral treatment and treating them together produces better outcomes than treating either one alone.
Why Do Tourette's and OCD Occur Together So Often?
The co-occurrence of Tourette’s and OCD is not a coincidence. Both conditions involve abnormalities in the same brain circuits particularly circuits involving the basal ganglia and the frontal lobe, which regulate movement, habit formation, and the urge to act.
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In Tourette’s, these circuits produce tics repetitive movements and sounds driven by premonitory urges. In OCD, they produce obsessions intrusive thoughts and compulsions repetitive behaviors performed to reduce anxiety. The neurological overlap is deep, which is why the two conditions travel together so frequently.
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Genetics also plays a role. Research shows that OCD and Tourette’s share genetic risk factors, and first-degree relatives of someone with Tourette’s are at significantly higher risk for both conditions.
How Is OCD Different in the Context of Tourette's?
OCD looks somewhat different when it co-occurs with Tourette’s than when it appears on its own. Understanding these differences is important for accurate diagnosis and effective treatment.
| OCD Without Tourette's | OCD With Tourette's |
|---|---|
| Often driven by fear contamination, harm, doubt | Often driven by sensory discomfort 'not just right' |
| Compulsions are a response to anxiety | Compulsions may feel more like urges than anxiety responses |
| Mental obsessions are common | Sensory and symmetry obsessions are more common |
| Neutralizing is usually anxiety-driven | Behaviors feel driven by the need to feel 'complete' |
| Avoidance is often central | Touching, arranging, and repeating are very common |
| Insight is usually present | Can be harder to distinguish from tics |
One of the most common presentations we see is a child with Tourette’s who also has ‘just right’ OCD a need for things to look, feel, or sound exactly correct. This can include repeating words or phrases until they sound right, touching objects until they feel balanced, or arranging items until the sensation of wrongness goes away. The distress when things are not right is real and significant and it requires specific treatment, not just tic management.
Tics vs. Compulsions How Do You Tell the Difference?
One of the most common questions families ask is: “Is this a tic or a compulsion?” The line can be blurry particularly in Tourette’s-related OCD but there are meaningful differences:
| Tics | OCD Compulsions |
|---|---|
| Triggered by a premonitory urge (physical tension) | Triggered by an obsession or sensory 'wrongness' |
| Brief happen and are done | May be prolonged repeated until it feels right |
| Not driven by a specific feared outcome | Aimed at preventing a feared outcome or bad feeling |
| Not aimed at fixing a thought or reducing fear | Driven by anxiety or the need for relief |
| Wax and wane change in type and location | Tied to specific feared thoughts or scenarios |
| Reduced by CBIT competing responses | Reduced by ERP sitting with the anxiety |
In practice, the distinction is not always clear-cut. Some behaviors have features of both particularly the repetitive touching, tapping, and arranging that can be driven by either a premonitory tic urge or an OCD-driven ‘not just right’ feeling. A specialist trained in both conditions can assess carefully and design treatment that addresses what is actually driving the behavior.
How Are Tourette's and OCD Treated Together?
When both Tourette’s and OCD are present, treatment combines two approaches CBIT for tics and ERP (Exposure and Response Prevention) for OCD. At Anxiety & OCD Treatment Specialists, we are trained in both and integrate them seamlessly into a single treatment plan.
CBIT for Tics
CBIT (Comprehensive Behavioral Intervention for Tics) teaches people to recognize the premonitory urge before a tic and respond with a competing behavior that disrupts the tic cycle. It is the most effective behavioral treatment for Tourette’s and other tic disorders. See our CBIT page for a full explanation.
ERP for OCD
ERP (Exposure and Response Prevention) is the gold-standard treatment for OCD. It works by gradually facing the thoughts, situations, and sensory experiences that trigger OCD without performing the compulsions that temporarily reduce distress. Over time, the brain learns that the compulsions are not needed and that the anxiety decreases on its own.
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For ‘just right’ OCD in the context of Tourette’s, ERP involves tolerating the uncomfortable feeling of things being “off” without fixing them resisting the urge to re-arrange, re-touch, or re-say until the feeling passes. This is challenging but highly effective. See our ERP page for more details.
Why a Specialist in Both Matters
Treating Tourette’s and OCD together requires a therapist who understands how to distinguish tics from compulsions, when to use CBIT versus ERP, and how to sequence and integrate both approaches within a single treatment plan. A general therapist familiar with only one condition may miss the other or apply the wrong approach to the wrong behavior leading to slower or incomplete progress.
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We specialize in exactly this combination. Both conditions are core areas of our clinical expertise.
In-Person and Virtual Sessions
In-person
730 S Sterling Ave, Suite 306, Tampa, FL 33609
Virtual
Available throughout Florida
CBIT works very well via video sessions. Your therapist can observe tics, teach competing responses, and coach practice in real time through a video appointment. Many families find virtual sessions convenient sessions can happen at home where tics are most visible and where practice naturally occurs.
Frequently Asked Questions
How do I know if my child has OCD, Tourette's, or both?
A proper assessment by a specialist trained in both conditions is the best way to find out. Signs that both may be present include: tics that have been present for more than a year alongside repetitive behaviors that are driven by a sense of wrongness, a need for symmetry, or a fear-based thought. Many families live with both conditions for years before getting an accurate picture and treatment becomes much more effective once both are properly identified.
Can CBIT make OCD worse, or can ERP make tics worse?
When done correctly by a trained specialist, neither should worsen the other. In fact, reducing tic burden through CBIT often reduces overall anxiety which can make OCD easier to treat. Similarly, reducing OCD compulsions through ERP can reduce the mental load and distress that make tics worse. The two treatments are complementary when integrated thoughtfully.
My child's OCD symptoms appeared suddenly alongside tics. Should I be worried about PANDAS?
A sudden, dramatic onset of OCD or tic symptoms particularly following a streptococcal infection like strep throat should be evaluated medically. This pattern is associated with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). A pediatrician or pediatric neurologist should be consulted promptly. Behavioral therapy plays a supporting role in PANDAS treatment, but medical evaluation comes first. See our PANDAS and PANS page for more information.
Both Conditions Are Treatable. We Treat Both.
Tourette’s and OCD together can feel overwhelming. But when both are treated by a specialist who understands their connection with the right combination of CBIT and ERP meaningful improvement is absolutely achievable. Our team is trained in both and ready to help your family.