Dancing with Shadows: A Journey into Tourettic OCD

By: Suzanne Feinstein, PhD

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Tourettic Obsessive-Compulsive Disorder (TOCD) is a subtype of OCD that is often characterized by compulsions without the preceding intrusive thoughts or anxiety. These compulsions can include counting, symmetry/evening up, arranging, ordering, positioning, touching, and tapping. The driving force behind these behaviors is not a feared outcome, but rather, intense physical and/or psychological discomfort, often described as something feeling incomplete or “not right”.

Understanding TOCD

TOCD is unique in that it lacks the elaborate obsessional belief structure that typically drives compulsive behaviors in other forms of OCD. In TOCD, compulsions are not mere responses to intrusive thoughts or fears. Instead, the compulsions are more akin to tics, spontaneous movements are driven by an internal rhythm. 

Like a dancer responding to the beat of a drum, individuals with TOCD find themselves compelled to act, not out of fear, but out of a need for something to feel ‘just right’.

The rhythm that drives this dance is discomfort, a sense of incompleteness that pervades the individual’s consciousness. It is a sensation that is both physical and psychological, a feeling that something is ‘off’ and needs to be ‘fixed’. This discomfort is the music to which the dance of TOCD is set, a relentless beat that demands action.

This sensory-driven OCD is thought to be tic-like in nature and may be more distinctly characterized by an overlap between OCD and tic disorder/Tourette’s syndrome. 

The Pursuit of Completion in TOCD

The need for a sense of completion is a fundamental aspect of TOCD. Individuals with this disorder often experience intense discomfort or tension when something feels incomplete or “not right”. This discomfort can become so overwhelming that it drives compulsions to minimize the perceived potential for harm and decrease the psychic distress. The behaviors are then carried out in a pursuit of completion and a quest for the elusive feeling of ‘rightness’. 

Each compulsion is a step in this proverbial dance, a move designed to alleviate the discomfort and bring about a sense of completion. Yet, like a shadow, this sense of completion often remains just out of reach, driving the individual to continue the dance.

Examples of Tourettic OCD include:

  1. Flicking light switches on and off until there is a sense of completion in the body
  2. Nodding your head a certain number of times until it feels right
  3. Saying a ‘good’ word to neutralize  or ‘even things out’ after saying or thinking a ‘bad’ word
  4. Avoiding cracks in the pavement due to a feeling of discomfort or a need for that ‘just right’ feeling
  5. Opening and closing doors repeatedly until a certain feeling of relief is achieved
  6. Tapping on objects until a feeling of symmetry or ‘rightness’ is achieved
  7. Repeating a certain word or phrase until it sounds right 

Treatment Options

Treatment for Tourettic OCD often involves a combination of therapeutic approaches and medication. Here are some common components of a treatment plan:

  1. Psychotherapy: This is a key component of treatment and often involves techniques from Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT)
  2. Exposure and Response Prevention (ERP): This is a type of CBT that involves gradually exposing the person to the thoughts, images, and situations that make them anxious and preventing the accompanying compulsion
  3. Habit Reversal Training (HRT): This involves monitoring the frequency and conditions of any tics, and then learning competing responses to carry out when the urge to perform the tic occurs.
  4. Medication: Selective serotonin reuptake inhibitors (SSRIs) and neuroleptics may be used to help manage symptoms.
  5. Self-Help Tips: These can include stress management techniques, regular exercise, a healthy diet, and adequate sleep. 

It is important to note that treatment should be individualized, taking into account the severity of the symptoms, the person’s age, and their personal response to therapy. Always consult with a healthcare provider for a personalized treatment plan.

Conclusion

In conclusion, TOCD is a unique subtype of OCD characterized by compulsions driven by a need for a sense of completion rather than a feared outcome. The dance of TOCD is a dance of seeking balance in a world that often feels off-kilter. Understanding this need for completion is a crucial first step in helping those who live with TOCD and can inform more effective treatment strategies.

Advanced Behavioral Health, LLP helps people tackle their Tourettic OCD using scientifically–proven CBT techniques. Call 646-345-3010 or email Dr. Suzanne Feinstein at drfeinstein@behaviortherapynyc.com for a free 15 minute consultation to see if you qualify for treatment.

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