CNS Spectrums

Original Research

Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study

Pedro Gomes de Alvarengaa1a, Maria Alice de Mathisa1 c1a, Anna Claudia Dominguez Alvesa1, Maria Conceição do Rosárioa2, Victor Fossaluzaa1, Ana Gabriela Houniea1, Euripedes Constantino Miguela1 and Albina Rodrigues Torresa3

a1 Department of Psychiatry, University of Sao Paulo Medical School (USP), São Paulo, Brazil

a2 Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil

a3 Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil


Objective To evaluate the clinical features of obsessive-compulsive disorder (OCD) patients with comorbid tic disorders (TD) in a large, multicenter, clinical sample.

Method A cross-sectional study was conducted that included 813 consecutive OCD outpatients from the Brazilian OCD Research Consortium and used several instruments of assessment, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale Global Tic Severity Scale (YGTSS), the USP Sensory Phenomena Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders.

Results The sample mean current age was 34.9 years old (SE 0.54), and the mean age at obsessive-compulsive symptoms (OCS) onset was 12.8 years old (SE 0.27). Sensory phenomena were reported by 585 individuals (72% of the sample). The general lifetime prevalence of TD was 29.0% (n = 236), with 8.9% (n = 72) presenting Tourette syndrome, 17.3% (n = 141) chronic motor tic disorder, and 2.8% (n = 23) chronic vocal tic disorder. The mean tic severity score, according to the YGTSS, was 27.2 (SE 1.4) in the OCD + TD group. Compared to OCD patients without comorbid TD, those with TD (OCD + TD group, n = 236) were more likely to be males (49.2% vs. 38.5%, p < .005) and to present sensory phenomena and comorbidity with anxiety disorders in general: separation anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, attention-deficit hyperactivity disorder, impulse control disorders in general, and skin picking. Also, the “aggressive,” “sexual/religious,” and “hoarding” symptom dimensions were more severe in the OCD + TD group.

Conclusion Tic-related OCD may constitute a particular subgroup of the disorder with specific phenotypical characteristics, but its neurobiological underpinnings remain to be fully disentangled.

(Received September 11 2011)

(Accepted February 23 2012)

(Online publication May 04 2012)


  • Comorbidity;
  • obsessive-compulsive disorder;
  • tic disorder;
  • Tourette syndrome


c1 Address for correspondence: Maria Alice de Mathis, Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785 – 05403-010 São Paulo, SP, Brazil. (Email


a Both Pedro de Alvarenga and Maria Alice de Mathis and have contributed equally to this manuscript.

This study was supported by grants from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, Foundation for the Support of Research in the State of Sao Paulo): grant no. 08/57598-7 to Dr. De Mathis, grant no. 2005-55628-8 to Dr. Miguel, and grant no. 06/61459-7. Additional support was provided by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ, Brazilian Council for Scientific and Technological Development): grant no. 521369/96-7 to Dr. Miguel.