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Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study


To evaluate the clinical features of obsessive-compulsive disorder (OCD) patients with comorbid tic disorders (TD) in a large, multicenter, clinical sample.


A cross-sectional study was conducted that included 813 consecutive OCD outpatients from the Brazilian OCD Research Consortium and used several instruments of assessment, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale Global Tic Severity Scale (YGTSS), the USP Sensory Phenomena Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders.


The sample mean current age was 34.9 years old (SE 0.54), and the mean age at obsessive-compulsive symptoms (OCS) onset was 12.8 years old (SE 0.27). Sensory phenomena were reported by 585 individuals (72% of the sample). The general lifetime prevalence of TD was 29.0% (n = 236), with 8.9% (n = 72) presenting Tourette syndrome, 17.3% (n = 141) chronic motor tic disorder, and 2.8% (n = 23) chronic vocal tic disorder. The mean tic severity score, according to the YGTSS, was 27.2 (SE 1.4) in the OCD + TD group. Compared to OCD patients without comorbid TD, those with TD (OCD + TD group, n = 236) were more likely to be males (49.2% vs. 38.5%, p < .005) and to present sensory phenomena and comorbidity with anxiety disorders in general: separation anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, attention-deficit hyperactivity disorder, impulse control disorders in general, and skin picking. Also, the “aggressive,” “sexual/religious,” and “hoarding” symptom dimensions were more severe in the OCD + TD group.


Tic-related OCD may constitute a particular subgroup of the disorder with specific phenotypical characteristics, but its neurobiological underpinnings remain to be fully disentangled.

Corresponding author
*Address for correspondence: Maria Alice de Mathis, Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785 – 05403-010 São Paulo, SP, Brazil. (Email
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Both Pedro de Alvarenga and Maria Alice de Mathis and have contributed equally to this manuscript.

This study was 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 Sao Paulo): grant no. 08/57598-7 to Dr. De Mathis, grant no. 2005-55628-8 to Dr. Miguel, and grant no. 06/61459-7. Additional support was provided by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ, Brazilian Council for Scientific and Technological Development): grant no. 521369/96-7 to Dr. Miguel.

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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2.KG Niederauer , DT Braga , FP Souza , . Quality of life in individuals with obsessive-compulsive disorder: literature review. Rev Bras Psiquiatr. 2007; 29(3): 271278.

4.AR Torres , MC Lima . Epidemiology of obsessive-compulsive disorder: a review. Rev Bras Psiquiatr. 2005; 27: 237242.

5.LF Fontenelle , MV Mendlowicz , M Versiani . The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30: 327337.

6.EC Miguel , JF Leckman , S Rauch , . Obsessive-compulsive disorder phenotypes: implications for genetic studies. Mol Psychiatry. 2005; 10(3): 258275.

7.EC Miguel , MT Mercadante , S Grisi , . The national science and technology institute in child and adolescence developmental psychiatry: a new paradigm for Brazilian psychiatry focused on our children and their future. Rev Bras Psiquiatr. 2009; 31(2): 8588.

8.MA de Mathis , JB Diniz , AR Torres , . What is the optimal way to subdivide obsessive-compulsive disorder? CNS Spectr. 2006; 11(10): 762769.

11.MA de Mathis , MC do Rosario , JB Diniz , . Obsessive-compulsive disorder: influence of age at onset on comorbidity patterns. Eur Psychiatry. 2008; 23(3): 187194.

12.EC Miguel , YA Ferrão , MA Rosário , . The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC) recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results. Rev Bras Psiquiatr. 2008; 30(3): 185196.

14.WK Goodman , LH Price , SA Rasmussen , . The Yale-Brown Obsessive Compulsive Scale I: development, use, and reliability. Arch Gen Psychiatry. 1989; 46(11): 10061011.

15.MC Rosario-Campos , EC Miguel , S Quatrano , . The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions. Mol Psychiatry. 2006; 11(5): 495504.

16.JF Leckman , MA Riddle , MT Hardin , . The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989; 28(4): 566573.

18.AT Beck , CH Ward , M Mendelson , . An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561571.

19.AT Beck , N Epstein , G Brown , RA Steer . An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988; 56(6): 893897.

21.EC Miguel , L Baer , BJ Coffey , . Phenomenological differences appearing with repetitive behaviors in obsessive-compulsive disorder and Gilles de la Tourette syndrome. Brit J Psychiatry. 1997; 170: 140145.

22.MC Rosario-Campos , JF Leckman , MT Mercadante , . Adults with early-onset obsessive-compulsive disorder. Am J Psychiatry. 2001; 158(11): 18991903.

23.JB Diniz , MC Rosario-Campos , RG Shavitt , . Impact of age at onset and duration of illness on the expression of comorbidities in obsessive-compulsive disorder. J Clin Psychiatry. 2004; 65(1): 2227.

24.JB Diniz , MC Rosario-Campos , AG Hounie , . Chronic tics and Tourette syndrome in patients with obsessive-compulsive disorder. J Psychiatr Res. 2006; 40(6): 487493.

26.YA Ferrão , EC Miguel , DJ Stein . Tourette's syndrome, trichotillomania and obsessive-compulsive disorder: how closely are they related? Psychiatry Res. 2009; 170(1): 3242.

27.CJ McDougle , WK Goodman , JF Leckman , . The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. J Clin Psychopharmacol. 1993; 13(5): 354358.

28.CJ McDougle , WK Goodman , JF Leckman , . Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder: a double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry. 1994; 51(4): 302308.

30.G Hasler , VH LaSalle-Ricci , JG Ronquillo , . Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res. 2005; 135(2): 121132.

31.JF Leckman , MH Bloch . A developmental and evolutionary perspective on obsessive-compulsive disorder: whence and whither compulsive hoarding? Am J Psychiatry. 2008; 165(10): 12291233.

32.MH Bloch , A Landeros-Weisenberger , MC Rosario , . Meta-analysis of the symptom structure of obsessive-compulsive disorder. Am J Psychiatry. 2008; 165(12): 15321542.

33.MH Bloch . Emerging treatments for Tourette's disorder. Curr Psychiatry Rep. 2008; 10(4): 323330.

35.DC Cath , P Spinhoven , TC van Woerkom , . Gilles de la Tourette's syndrome with and without obsessive-compulsive disorder compared with obsessive-compulsive disorder without tics: which symptoms discriminate? J Nerv Ment Dis. 2001; 189(4): 219228.

36.MN Potenza , LM Koran , S Pallanti . The relationship between impulse-control disorders and obsessive-compulsive disorder: a current understanding and future research directions. Psychiatry Res. 2009; 170(1): 2130.

38.DA Geller . Obsessive-compulsive and spectrum disorders in children and adolescents. Psychiatr Clin North Am. 2006; 29(2): 353370.

39.S Walitza , H Zellmann , B Irblich , . Children and adolescents with obsessive-compulsive disorder and comorbid attention-deficit/hyperactivity disorder: preliminary results of a prospective follow-up study. J Neural Transm. 2008; 115(2): 187190.

40.T Petter , MA Richter , P Sandor . Clinical features distinguishing patients with Tourette's syndrome and obsessive-compulsive disorder from patients with obsessive-compulsive disorder without tics. J Clin Psychiatry. 1998; 59(9): 456459.

41.BJ Coffey , EC Miguel , J Biederman , . Tourette disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis. 1998; 186: 201206.

42.HJ Grabe , S Ruhrmann , C Spitzer , . Obsessive-compulsive disorder and posttraumatic stress disorder. Psychopathology. 2008; 41(2): 129134.

43.P de Silva , M Marks . The role of traumatic experiences in the genesis of obsessive-compulsive disorder. Behav Res Ther. 1999; 37(10): 941951.

44.LF Fontenelle , L Cocchi , BJ Harrison , . Towards a post-traumatic subtype of obsessive-compulsive disorder. J Anxiety Disord. 2012; 26: 377383.

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CNS Spectrums
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