"Just Right" Perceptions and Obsessive-Compulsive Symptoms in Tourette Syndrome and Chronic Tic Disorder: Implications for Tourettic Obsessive-Compulsive Disorder.

OBJECTIVES: Perceptions that something is not "just right" and feelings of incompleteness are forms of premonitory urges that extend beyond simple bodily sensations; they involve subjective interpretations of those sensations and may therefore be regarded as mental phenomena. These phenomena may precede tics but can also trigger compulsive behaviors. Investigating these phenomena is essential for understanding intermediate clinical phenotypes between tic disorders and obsessive-compulsive disorder (OCD).

METHODS: We retrospectively reviewed the medical records of 71 patients older than 10 years with tic disorders who attended the department of psychiatry at a hospital. Clinical assessments included the Korean versions of the Premonitory Urge for Tics Scale, Yale Global Tic Severity Scale, and (Children's) Yale-Brown Obsessive-Compulsive Scale.

RESULTS: Among patients with Tourette syndrome, 71.21% reported experiencing "just right" perceptions. Both the frequency and severity of "just right" perceptions were significantly greater in patients with tic disorders and comorbid OCD (n=8) than in those without comorbid OCD (n=63). In addition, the severity of premonitory urges showed a significant correlation with the severity of obsessive-compulsive symptoms.

CONCLUSION: "Just right" perceptions are not only an intrinsic characteristic of tic disorders but are also associated with repetitive behaviors in OCD. These results provide preliminary clinical support for Tourettic OCD as an intermediate phenotype between tic disorders and OCD.