Gilles de la Tourette's syndrome with and without obsessive-compulsive disorder compared with obsessive-compulsive disorder without tics: Which symptoms discriminate?

Stereotyped repetitive behaviors occur in Gilles de la Tourette's Syndrome (GTS) and obsessive-compulsive disorder (OCD). The present study was undert aken to compare the distribution of obsessive-compulsive and Tourette-relat ed impulsive behaviors in GTS with(+) OCD, GTS without (-) OCD, tie-free OC D, and control subjects. Fourteen GTS + OCD, 18 GTS-OCD, 21 OCD-tic, and 29 control subjects were evaluated using a semistructured interview designed to assess GTS and OCD-related repetitive behaviors. Each reported item was evaluated on the presence of anxiety and goal-directedness. This informatio n was subsequently used to define whether the repetitive behavior was an (a nxiety-related) obsession or compulsion, or a (non-anxiety-related) OC-like behavior, impulsion. GTS + OCD subjects reported more overall Tourette-rel ated impulsions than OCD-tic subjects, i.e., more mental play, echophenomen a, and touching behaviors but similar frequencies of typical obsessive-comp ulsive behaviors. Further, GTS + OCD subjects exhibited more overall repeti tive behaviors than GTS-OCD subjects, i.e., more Tourette-related impulsion s as well as more obsessive-compulsive behaviors. The distribution of sympt oms is similar in GTS with and without OCD, and differs from tie-free OCD. These differences suggest that GTS with OCD constitutes a form of GTS, not of OCD, although the possibility that GTS + OCD patients constitute a subgr oup distinct from GTS and from OCD can not be excluded by this phenomenolog ical study. Specific non-anxiety-related impulsions seem to discriminate be tween GTS and OCD-tic individuals. These impulsions possibly reflect differ ences in underlying mechanisms between GTS and OCD-tics.