OCD Tics: Causes, Treatment & How to Cope

What Is OCD?

Obsessive-compulsive disorder (OCD) is a mental health disorder that causes repeated unwanted thoughts and urges. Usually, the obsessive thoughts people with OCD experience are based on worries, doubts, and fears they have. To cope with these thoughts and the anxiety they create, people with OCD develop compulsive routines and rituals to feel a greater sense of security and control.^3,4 Over time, OCD obsessions and compulsions begin taking up more time, energy, and attention, limiting the ability to function and follow a normal routine.

The main symptoms of OCD include:³

• Obsessions: OCD obsessions are repeated, unwanted, intrusive thoughts that cause a lot of distress or anxiety. Depending on the subtype of OCD, these obsessions can involve a variety of themes, including contamination, taboo thoughts, and even thoughts of suicide or violence.
• Compulsions: OCD compulsions are repetitive routines, rituals, and mental acts that a person does to counteract their OCD obsessions and the anxiety they cause. Examples of compulsions common in OCD include checking, handwashing, reassurance seeking, counting, and repeating mantras or prayers.

What Are Tics?

Tics are (can be) sporadic and involuntary movements called motor tics, or sounds called vocal or phonic tics. Motor tics are uncontrolled movements like blinking, muscle spasms, jerky movements, or grimacing. Vocal tics are sounds, words, or vocalizations people make, like coughing or snorting, finishing someone’s sentence, or repeating certain words or sounds. Over 90% of people who have tics report premonitory urges or ‘weird feelings’ beforehand but don’t always feel able to suppress them.^1,5,6

While everyone experiences tics on occasion, people with conditions like OCD, Tourette’s, anxiety disorders, or ADHD may have tics more frequently and severely. Frequent or severe tics can significantly disrupt a person’s life and routine, making it embarrassing or difficult to interact with people, go to work, and lead normal lives. Tics happen sporadically but are often triggered by stress, strong emotions like excitement or nervousness, or being under or overstimulated.^2,5

Can OCD Cause Tics?

Tics are not a symptom of OCD, but it’s common that they co-occur.^3,6 Studies suggest that up to one in three people diagnosed with OCD experience tics at some point, but these can vary in terms of frequency and severity.¹ For many, OCD and tics develop together in childhood but wax and wane over time. It’s common for children with OCD to develop tics between the ages of 5-7 years old and then grow out of them by age 20.¹

It’s believed that OCD and tics so frequently appear together because they’re related to similar abnormalities in the brain. These same areas of the brain have also been linked to other tic disorders like Tourette’s syndrome. Also, it’s common for people with either tics or OCD to report similar psychological symptoms, including high levels of anxiety, intrusive thoughts, and repetitive compulsive behaviors.¹

Differences Between OCD Tics & OCD Obsessions or Compulsions

There are many similarities between the symptoms of obsessive compulsive disorder and the symptoms of a tic disorder.^2,6For example, both conditions involve strong, uncomfortable urges that are experienced as tension, pressure, or anxiety. The main difference is that in OCD, these urges lead to conscious behaviors or routines (called OCD compulsions) while in tic disorders, they lead to unconscious and involuntary movements or sounds.²

Examples of OCD Tics

It can help to have some specific examples of what counts as a “tic,” especially since it’s pretty normal to experience occasional tics. Tics are usually categorized into two groups, one for motor tics that involve involuntary movements and another for vocal tics that involve involuntary sound or speech. Some people with OCD tics experience only one type of tic, while others report a mixture of both motor and vocal tics.^5,6

Here are some examples of motor and vocal tics that can show up in OCD:⁵

Some people who experience severe tics frequently have a tic disorder. Tic disorders are disorders that involve frequent involuntary motor and/or vocal tics that are severe enough to significantly interfere with a person’s normal life and routine.^2,3 For most people, the tics they experience are only occasional, and not severe enough to warrant a diagnosis.

OCD Tics Vs. Tourette’s Syndrome

OCD and Tourette’s syndrome share some of the same risk factors and symptoms and may even be caused by similar abnormalities in the brain related to dopamine.^1,2,5 There’s a relatively high rate of co-occurrence with these conditions, and there’s even a subtype of OCD called Tourettic OCD that involves a blend of symptoms from both conditions.⁷

Still, for most people, the disorders and tics related to each are slightly different in the following ways:^3,5,7,8

• OCD tics and Tourette’s tics both start in childhood, but most people with OCD tics outgrow them (80% or more) vs people with Tourette’s tics (40-50%)
• Tourette’s tics usually involve both motor and vocal tics, while OCD tics can involve just one type or both types
• The frequency of tics is much higher (multiple times per day) in Tourette’s than it is in OCD, where tics tend to be more occasional and wax and wane
• Most people with Tourette’s do not have a period of more than three months where they experience no tics, but this is more common in people with OCD tics
• OCD tics may be easier to interrupt and suppress than tics related to Tourette’s syndrome or other tic disorders
• Tics tend to be the most severe and impairing symptom in people with Tourette’s, but not in people with OCD
• Tourette’s syndrome is more closely linked to genetics, while genetic risk factors aren’t always present in people with OCD

Co-Occurring OCD & Tourette’s Syndrome

It’s estimated that 30-60% of people who have Tourette’s syndrome exhibit symptoms of OCD, which means there is a high rate of co-morbidity between these disorders.⁷ Tic disorders usually start in early childhood, and it’s uncommon for adults with OCD to suddenly develop symptoms of Tourette’s. Also, it’s common for children to outgrow tic disorders on their own, sometimes even without formal treatment.^1,2,6,7,8

What Triggers OCD Tics?

A number of different circumstances can trigger OCD tics, but many involve stress or strong emotions. While anxiety and stress are some of the most common triggers for OCD tics, positive emotions like happiness and excitement can also be a trigger. Also, some people experience more tics during times when they’re either understimulated or overstimulated.^1,5,6

Here are some examples of situations that might trigger OCD tics:

• Being in a noisy, crowded area
• Being in a small, confined space
• Giving a public speech or presentation
• Being nervous on a date
• Being suddenly called on to speak in a group
• Having a stressful week of exams in college
• Being sweaty, hot, and uncomfortable
• Having an important Zoom call at work
• Feeling unable to speak freely in a meeting

Most people who experience OCD tics report having strange feelings or urges in the moments before they have a motor or vocal tic. These are called ‘premonitory urges’, and may be experienced a little differently by each person. For some, premonitory urges surface as physical tension or discomfort, like a feeling of ‘crawling skin’ or ‘hot flushes’. For others, the tension and pressure they feel are more mental and less physical and might arise as anxiety, impulsivity, or intrusive thoughts.^1,3,5

The Impact of Having OCD Tics

People who experience OCD tics often report high levels of distress and impairment, especially when tics happen often or are severe and obvious in nature. Tics often trigger a lot of embarrassment and insecurity in people who experience them, which can cause people to fall into patterns of avoidance coping. When people begin avoiding situations because of a fear of their tics, it tends to cause a lot of other problems in their lives and relationships and can even worsen their stress and symptoms.

Here are some examples of the way OCD tics can impact a person’s life:^1,3,8

• Increased self-consciousness, insecurity, and social anxiety
• Inability to communicate effectively with other people
• Difficulty in work or educational settings
• Worsening of mental health symptoms
• Increased social isolation and social avoidance
• Decreased self-trust and confidence in their abilities

Treatment for OCD Tics

There are treatments for OCD tics that can help reduce the frequency and severity of tics. When tics are related to a diagnosis of OCD, the two issues may respond to the same kinds of treatments. Most of the time, treatment for OCD tics involves specific therapies to help people learn to recognize, face, and respond differently to their triggers. Sometimes, medications like SSRI antidepressants or antipsychotic drugs are also used to help people get their symptoms under control.^4,2,9

Many people begin their search for treatment by using an online therapist directory or browsing online OCD resources. Some of these platforms also provide help with finding online psychiatrist options for people who are interested in learning more about medication options for OCD. Because OCD is a complex and specialized disorder, it’s a good idea to look for providers who have experience treating OCD.

Therapy for Managing OCD Tics

Therapies like Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Exposure and Response Prevention are considered frontline treatments for OCD and may also help people who experience tics. Habit Reversal Training is another type of therapy that has been proven to help many people with tics and tic disorders.^1,4,9

Here’s more information about the most proven therapies for OCD:^1,9

• Exposure response prevention (ERP): ERP for OCD is a type of cognitive behavioral therapy for OCD that helps people gradually face their triggers without engaging in compulsive responses.
• Cognitive behavioral therapy (CBT): CBT for OCD is a proven therapy that helps people understand the relationship between their thoughts, feelings, and behaviors and make modifications to the way they think and respond to situations and triggers.
• Acceptance and Commitment Therapy (ACT): ACT for OCD is a therapy that helps people learn how to use mindfulness and acceptance strategies to experience strong emotions, difficult thoughts, and urges without being completely controlled by them.
• Habit Reversal Training (HRT): HRT is a proven therapy for tic disorders that helps people recognize early signs of tics and respond differently in ways that make the tics less likely to occur.

Medication for Managing OCD Tics

In some cases, medications for OCD are a helpful addition to therapy and may make it easier for a person to manage their symptoms. The most common type of medication for OCD is SSRI drugs, which work on mood-related neurotransmitters in the brain. Sometimes, antipsychotic medications are also recommended to help people with OCD reduce the frequency of intrusive thoughts and urges. Medication is always recommended as a part of a treatment plan that includes therapy rather than being used as a standalone treatment.^2,4,6

How to Cope With OCD Tics

If you or a loved one is struggling with OCD tics, getting professional treatment is the best course of action and offers the highest chance of remission. Still, there are also some things you can do outside of therapy to help further your progress and better manage your OCD symptoms. Mindfulness, meditation, stress management, and journaling are all examples of coping skills for OCD that are often helpful additions to your regular routine.

Here are seven ways to cope with OCD tics:

1. Recognizing the Early Symptoms & Premonitory Urges

Over 90% of people who experience OCD tics report having premonitory urges in the moments before they have a tic.¹ These show up a little differently for each person, so paying attention to the feelings and sensations you have right before you have a tic is good. This way, you may be able to learn how to recognize some of the early physical or psychological signs of a tic. Eventually, you may even become able to learn different coping skills to prevent them from occurring, especially when you catch them early.

2. Managing Stress with Effective Self-Care Routines

Because most people report stress as a major trigger for tics, it’s also helpful for people with OCD tics to develop healthy self-care habits and routines. A good self-care routine is one that makes regularly scheduled time for activities that relieve stress and improve your physical and/or mental health. Mindfulness, journaling, exercise, and time with friends and family are some common examples of effective self-care. Remember that you may need to adjust your routine and make more time for self-care when you are under a lot of stress.

3. Building & Utilizing a Support Network

A lot of people who experience OCD tics feel self-conscious, embarrassed, and anxious being around other people, fearing that they will not be able to control their tics. While this is understandable, isolating yourself and withdrawing from others is likely to increase your stress and symptoms. That’s why it’s so important to work on building, maintaining, and using a strong support system of friends, family, and others who care about you and can support your recovery.

4. Developing a Mindfulness Routine

Mindfulness is the practice of paying attention to what’s going on in the here and now rather than getting stuck in your head. Since rumination and overthinking are so common in OCD, mindfulness practice is one of the best ways to work on reducing intrusive thoughts, urges, and unhelpful thought loops that worsen your symptoms. Starting a mindfulness practice has never been easier, thanks to the advent of meditation apps that are free to download and use. Most of these offer extensive libraries of short guided meditations that can help even novice practitioners develop meditation skills.

5. Using Creative Outlets

A lot of people with OCD struggle with rigid and inflexible thinking patterns that contribute to their symptoms. Developing more creative hobbies and outlets is a great way to challenge your mind to stretch and begin thinking more openly and flexibly. Creative outlets include writing, journaling, painting, graphic design, gardening, home decoration, or craft projects. Often, these kinds of creative hobbies and activities have the added bonus of helping people improve their mood and stress levels, which can also help reduce the frequency and severity of OCD symptoms and tics.

6. Challenging Yourself to Try New Things

The rigidity of people with OCD isn’t just limited to the way they think – it often also shows up in their behaviors and routines. People with OCD, and especially those who also experience tics, often avoid trying new things, meeting new people, or going to new places because of a fear of being embarrassed. Over time, their lives and routines might become very repetitive and monotonous, which can give their OCD compulsions more opportunities to take over. To counteract this, it can help to challenge yourself to leave home more often, go to new places, and try new things.

7. Learning to Trust Yourself More

It can be difficult to “trust yourself” when your body and mind don’t feel fully within your control, and you may want to overcompensate by developing a lot of rigid rules and routines. The problem is that by doing so, you make it almost impossible to build up your trust and confidence in yourself, which is only possible when you are willing to leave your comfort zone. In addition to branching out, another way to build self-trust is to practice responding differently to your urges and compulsive impulses, even doing the opposite of what you feel the urge to do. Over time, this can help you feel like you have more control, even when strong urges arise.