Tic vs Compulsion

[Mary M]

My dd12 exhibits several odd physical behaviors. How can I tell the difference between a tic and a compulsion. I looked online and found some explanations but should I even care if it is a tic or a compulsion? Are they so close on some gradient that it doesn't matter? Thank you for your wisdom...I trust the opinions on this forum so much more than any doctor at this point.

[MomWithOCDSon]

My dd12 exhibits several odd physical behaviors. How can I tell the difference between a tic and a compulsion. I looked online and found some explanations but should I even care if it is a tic or a compulsion? Are they so close on some gradient that it doesn't matter? Thank you for your wisdom...I trust the opinions on this forum so much more than any doctor at this point.

 

Does your child have any other clear OCD traits? Contamination issues? Rituals in terms of in what order a certain process must be conducted?

 

My son is 99% OCD behaviors; the tics are minor and tend to only show up during moments of high anxiety in exacerbation; those tend to be throat clearing, a tossing back of his head, "hand-rolling" (stretching his fingers out and then rolling them into a soft fist, over and over again). For him, he seems completely unaware of the tics (therefore, mostly involuntary?), whereas, the compulsions he's fully aware of.

 

In my experience, compulsions are generally more complex than tics (I'm sure someone here with a kid with a significant tic behavior will correct me on that one!); compulsions for my DS are usually about a full "process," so he has to think about it in order to put it in play, like how and when he will wash his hands, how, when and where he will wear shoes versus slippers, etc. They are not the quick, single-process thing that the tics appear to be.

 

Is it important to know the difference? Maybe. Dr. Cunningham, in her AO presentation, mentioned and showed in a bar graph the fact that PANDAS kids tend to have elevated Dopamine Receptor 2 levels, while "standard" TS kids do not; therefore, if your child presents with predominantly tics and you've wondered, via various markers and tests, whether or not you really have PANDAS on your hands or more of a TS diagnosis, then discriminating between tics and compulsions would be important, and then, just maybe, getting the Cunningham test would be important.

[Chemar]

Dr. Cunningham, in her AO presentation, mentioned and showed in a bar graph the fact that PANDAS kids tend to have elevated Dopamine Receptor 2 levels, while "standard" TS kids do not; therefore, if your child presents with predominantly tics and you've wondered, via various markers and tests, whether or not you really have PANDAS on your hands or more of a TS diagnosis, then discriminating between tics and compulsions would be important, and then, just maybe, getting the Cunningham test would be important.

 

that is very interesting....

 

I wonder where a child with Tourettic OCD fits in there, which it seems does manifest in a number of people with "genetic" TS. It is often impossible to distinguish tics and compulsions or obsessions there

The compulsions and obsessions are often in the same "range" as "classic" OCD, but they frequently seem to "morph" with tics so that what start out as tics can begin to show more OCD characteristics and sometimes the OCD things turn into tics. (always hard to explain but anyone with a child who has this recognizes it immediately)

 

http://focus.psychiatryonline.org/cgi/content/full/5/3/361

[Mary M]

My dd12 exhibits several odd physical behaviors. How can I tell the difference between a tic and a compulsion. I looked online and found some explanations but should I even care if it is a tic or a compulsion? Are they so close on some gradient that it doesn't matter? Thank you for your wisdom...I trust the opinions on this forum so much more than any doctor at this point.

 

Does your child have any other clear OCD traits? Contamination issues? Rituals in terms of in what order a certain process must be conducted?

 

My dd has absolutely paralyzing OCD. She started with just a little but over the last few months the OCD symptoms have grown to include almost everything in the book. Even asked the psych (jokingly) if she was suggesting new symptoms to our dd at the appts as they seemed to increase with each appt.

 

I guess her tics would be her sound--like nose blowing but no discharge, an odd barking throat clearing, spitting, and after reading what you wrote--this odd behavior when she sits, I think.

[Mary M]

Is it important to know the difference? Maybe. Dr. Cunningham, in her AO presentation, mentioned and showed in a bar graph the fact that PANDAS kids tend to have elevated Dopamine Receptor 2 levels, while "standard" TS kids do not; therefore, if your child presents with predominantly tics and you've wondered, via various markers and tests, whether or not you really have PANDAS on your hands or more of a TS diagnosis, then discriminating between tics and compulsions would be important, and then, just maybe, getting the Cunningham test would be important.

 

We got the Cunningham test results May 26-CamK=166 --Kathy said that means PANDAS.

 

This week we got the antineuronals but we're not sure of their meaning.

I read an old post from Buster helping to explain the numbers. The post indicated that normal antilyso and high antitubulin could suggest sydenham's chorea. But your explanation will help too. So since her antidop 2 is low...does it work in the inverse...are we also seeing TS?

 

If I'm interpreting this correctly my dd's

 

antilyso=within normal limits at 160

antitubulin=highest number within normal range

antidop1=4000 (twice normal high)

antidop2-2000 (lowest possible number)

 

 

Or is the science still so new that no real inference can be made?

 

I appreciate everyone's knowledge!

Anti-Lysoganglioside 2 hours

Patient 160

positive control >1280

negative control 80

normal range 80-320

normal mean 147

 

Anti-Tubulin 2 hours

patient 1000

positive control 16000

negative control 250

normal range 250-1000

normal mean 609

 

Anti-Dopamine 1 2 hours

patient 4000

positive control 8000

negative control 1000

normal range 500-2000

normal mean 1056

 

Anti-Dopamine 2 2 hours

patient 2000

positive control 32000

negative control 2000

normal range 2000-16000

normal mean 6000

[simplygina]

My dd12 exhibits several odd physical behaviors. How can I tell the difference between a tic and a compulsion. I looked online and found some explanations but should I even care if it is a tic or a compulsion? Are they so close on some gradient that it doesn't matter? Thank you for your wisdom...I trust the opinions on this forum so much more than any doctor at this point.

 

I spent about a year trying to figure out if a few of my son's behaviors were OCD or tics. It wasn't until this past Fall, when he reacted to his brother's strep with a bunch of very obvious tics (throat clearing, groaning, repeating others, neck jerks & shoulder shrugs) that I realized they were, in fact, tics. However, like others have mentioned, they are all mixed up with his OCD.

 

for instance, he will have a tic, but since his main OCD compulsions are having every thing even & doing things until they feel "just right", he will continue to do the tic voluntarily until his OCD is satisfied. on the flip side, sometimes things start as an OCD issue but end up being a tic that he can longer control. It is hard to tell with him sometimes because his OCD usually isn't based on an obsession to begin with (he doesn't worry that someone will die or get sick for instance if he doesn't do a certain thing). It is more tic like in the sense that he just feels like he has to do it or it is extremely uncomfortable (he gets a "weird" feeling in his tummy). For a while he had to walk with even steps & do a twirl every so often. The stepping this was definitely OCD, but I still don't know if the twirl was a tic or OCD.

 

Either way, OCD & tics are really very similar in the sense that it is an overwhelming urge to do something that there really is no reason to do. one is more a thought & the other physical urge, but both are a kind of broken switch causing an urge to do something over & over again. once the compulsion or tic is complete, the tension is released (momentarily...sometimes like 1-2 seconds, sometimes much longer) until the broken switch tells the individual it needs to do it again.

 

I've heard it called Tourettic OCD & it definitely fits my son's behaviors.

[MomWithOCDSon]

We got the Cunningham test results May 26-CamK=166 --Kathy said that means PANDAS.

 

This week we got the antineuronals but we're not sure of their meaning.

I read an old post from Buster helping to explain the numbers. The post indicated that normal antilyso and high antitubulin could suggest sydenham's chorea. But your explanation will help too. So since her antidop 2 is low...does it work in the inverse...are we also seeing TS?

 

If I'm interpreting this correctly my dd's

 

antilyso=within normal limits at 160

antitubulin=highest number within normal range

antidop1=4000 (twice normal high)

antidop2-2000 (lowest possible number)

 

 

Or is the science still so new that no real inference can be made?

 

I appreciate everyone's knowledge!

Anti-Lysoganglioside 2 hours

Patient 160

positive control >1280

negative control 80

normal range 80-320

normal mean 147

 

Anti-Tubulin 2 hours

patient 1000

positive control 16000

negative control 250

normal range 250-1000

normal mean 609

 

Anti-Dopamine 1 2 hours

patient 4000

positive control 8000

negative control 1000

normal range 500-2000

normal mean 1056

 

Anti-Dopamine 2 2 hours

patient 2000

positive control 32000

negative control 2000

normal range 2000-16000

normal mean 6000

 

Mary, I'm DEFINITELY no scientist; I remember Buster's earlier post, also, but the implications, frankly, escape me; we haven't done the Cunningham test ourselves as of yet.

 

I would contact Dr. Cunningham to double-check what she currently believes the low DP2 to infer. I made a note during her AO conference presentation as I noted previously -- that her results seem to show that PANDAS kids have high DP2 while Tourette's kids do not -- because another friend of mine has a child who's primary presentation is tics without high titers, and thus she's been on the fence for quite some time about whether he actually has PANDAS or Tourettes. I thought that particular note might be helpful to her in making treatment decisions going forward.

 

Buster will probably have some thoughts, and Dr. Cunningham will certainly have some answers from her research. I know she is getting ready to publish something on the topic, but I'm not sure when.

[Phasmid]

This is how I differentiated my son's tics vs. compulsions:

 

If it was a repetitive, muscular movement that could not be controlled even if he tried, it was a tic. Example would be a repetitive shoulder shrug, neck twist, or facial muscle contraction.

 

On the other hand, his compulsions included a very strong urge, somewhat controllable if I asked him to control it, to look at the sun, or to say a word repeatedly, or phrase. Other compulsions were a sense of dire urgency to have the fan on in his room or he wouldn't be able to breath (during winter). Also, the fear of having wind blow against his face as the wind could suck away his breath and he would suffocate, so he would cover his face if the wind was blowing. Compulsions to touch things repeatedly.

 

I don't think there is any use in distinguishing the two however.