How Do 'Not Just Right' Experiences Relate to Tics and OCD in Tourette Syndrome?

What you need to know

• ‘Not just right’ experiences (NJREs) are sensations that something isn’t quite as it should be
• NJREs are more strongly associated with obsessive-compulsive symptoms than with tics in people with Tourette syndrome
• Understanding NJREs can help distinguish between tics and compulsions, which can be challenging to differentiate

Understanding Tourette Syndrome and Related Experiences

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics. Many people with TS also experience what are known as premonitory urges - sensations that occur before tics. These urges can take different forms, including a feeling of pressure or tension, or a sense that something isn’t quite right.

This study focused on a particular type of experience called “not just right experiences” (NJREs). NJREs refer to feelings that something within oneself or in the surrounding environment is not exactly as it should be. While these experiences are common in people with obsessive-compulsive disorder (OCD), they can also occur in individuals with TS.

The Challenge of Distinguishing Tics from Compulsions

One of the difficulties in diagnosing and treating TS is that tics can sometimes be hard to distinguish from compulsions, which are repetitive behaviors associated with OCD. Both tics and compulsions can be preceded by urges or uncomfortable sensations. This overlap can make it challenging for clinicians to determine whether a particular behavior is a tic or a compulsion, especially in patients who have both TS and OCD.

The Study: Examining NJREs in Tourette Syndrome

To better understand the relationship between NJREs, tics, and OCD symptoms in people with TS, researchers conducted a study with 111 adult patients diagnosed with Tourette syndrome. The participants completed several questionnaires measuring:

1. Tic severity
2. Premonitory urges before tics
3. Not just right experiences
4. OCD symptoms
5. Quality of life

The researchers then analyzed the relationships between these different measures to see how closely NJREs were associated with tics versus OCD symptoms.

Key Findings: NJREs More Closely Linked to OCD Than Tics

The study’s main finding was that NJREs were more strongly related to OCD symptoms than to tics in people with Tourette syndrome. Here are some specific results:

1. NJREs showed a stronger correlation with measures of OCD symptoms than with measures of tic severity.

2. Premonitory urges (measured by a scale called the PUTS) were more closely related to tic severity than NJREs were.

3. Patients with clinically significant OCD symptoms reported more intense NJREs compared to those without OCD.

4. The intensity of NJREs increased with the number of psychiatric comorbidities (additional mental health conditions) a patient had.

Understanding the Significance of These Findings

These results are important for several reasons:

1. Diagnostic Clarity: The findings suggest that the presence of frequent or intense NJREs in a person with TS might indicate a higher likelihood of co-occurring OCD. This could help clinicians more accurately diagnose and treat patients with complex symptom presentations.

2. Treatment Implications: Understanding that NJREs are more closely linked to OCD symptoms than to tics could influence treatment decisions. For example, therapies specifically targeting OCD might be more effective for addressing NJREs than treatments focused solely on tic reduction.

3. Distinguishing Tics from Compulsions: The study provides a potential tool for differentiating between tics and compulsions. If a repetitive behavior is strongly associated with NJREs, it may be more likely to be a compulsion than a tic.

4. Quality of Life: The research also found that both NJREs and premonitory urges were associated with lower quality of life in people with TS. This highlights the importance of addressing these experiences in treatment plans.

The Complexity of Tourette Syndrome

It’s important to note that while this study provides valuable insights, it also underscores the complexity of Tourette syndrome. Many people with TS experience a range of symptoms and associated conditions, including tics, premonitory urges, NJREs, and OCD symptoms. These experiences can interact and overlap in complex ways.

The study also found that the number of psychiatric comorbidities a person had was associated with more intense NJREs. This suggests that NJREs might be a general indicator of psychological distress or complexity, rather than being specific to either TS or OCD.

Implications for Patients and Families

For individuals with Tourette syndrome and their families, this research offers several important takeaways:

1. Recognizing NJREs: If you or a loved one with TS frequently experiences feelings that things aren’t “just right,” it may be worth discussing these experiences with a healthcare provider. They could be a sign of co-occurring OCD symptoms.

2. Comprehensive Assessment: The study highlights the importance of comprehensive assessment for people with TS. In addition to evaluating tics, healthcare providers should assess for OCD symptoms, NJREs, and other related experiences.

3. Personalized Treatment: The complex relationship between tics, OCD symptoms, and experiences like NJREs underscores the need for personalized treatment approaches. What works best may vary from person to person depending on their specific symptom profile.

4. Quality of Life Focus: Given that both NJREs and premonitory urges were associated with lower quality of life, it’s important for treatment plans to address these experiences, not just visible tics.

Conclusions

• Not just right experiences (NJREs) are more closely associated with OCD symptoms than with tics in people with Tourette syndrome.
• The presence of intense NJREs in a person with TS might suggest co-occurring OCD symptoms.
• Comprehensive assessment and personalized treatment approaches are crucial for addressing the complex symptom profiles often seen in Tourette syndrome.