Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Are stims a form of Tourette’s syndrome?

By Erica Digap

Jul 17, 20239 min read minute read

Reviewed byPatrick McGrath, PhD

Most of us might have a nervous habit or two, but if you’re constantly engaging in a repetitive behavior that’s hard to resist, you might be wondering whether there’s something deeper going on. 

Some people find themselves dealing with urges to engage in repetitive movements and actions that are hard to put a stop to, and these actions can even become so frequent and frustrating that they interfere with your daily life. You might find yourself constantly rocking back and forth, or humming, or blinking hard. Whatever the case might be, these repetitive and ritualistic behaviors have become a constant and irresistible part of your routine. You think you might have a word for it, too. Maybe you’ve heard others refer to similar habits as stims

But confusingly, the stims that you exhibit look almost identical to tics, or the involuntary movements and/or vocalizations that are the clinical criteria for Tourette Syndrome. They might even have overlaps with compulsions, the ritualistic behaviors that are among the defining symptoms of obsessive-compulsive disorder (OCD)

So what exactly is going on? Are you dealing with a stim? A sign of Tourette’s? OCD-related compulsions? We talked with licensed therapist April Kilduff, MA, LCPC, LMHC, licensed therapist and OCD specialist at NOCD, to untangle the similarities and differences between stims and the tics that characterize Tourette’s syndrome. 

What are stims? 

Self-stimulating behavior, or stimming, is a repetitive action or behavior that people engage in to self-soothe. Stimming can look like a lot of different things; some common examples include hand flapping, rocking back and forth, snapping, and hair twirling. 

Stimming is commonly associated with autism. However, stims are very often a form of emotional expression, and it’s important to understand that virtually everyone stims sometimes. So, for example, if you find yourself repetitively tapping your fingers on your desk when you’re agitated, bouncing your leg up and down when you’re nervous, or chewing on your fingernails when you’re stressed, you are stimming. 

These cases are situational, Kilduff explains. But if you are autistic, your stims can be more frequent and intense. Many autistic people process sensory stimuli like sights, sounds, feelings, and smells, differently than others, making them either very sensitive or less sensitive to those stimuli. Stimming is a tool that they can use to regulate their sensory experience. 

For example, an autistic person who is overwhelmed by the sights and sounds of their current environment might snap repetitively, which creates a predictable and soothing sensory input.  Stims can also be a way for an autistic person to express their emotions, being not only soothing, but actually enjoyable.

What’s the difference between stims, compulsions, and tics? 

Stims are sometimes mistaken for other repetitive behaviors like compulsions or tics, so it’s important to be able to differentiate between the three to understand what you may be experiencing.  

As we’ve already covered, stims are repetitive self-soothing behaviors that are done to regulate emotions and sensory sensitivities. When someone is “stimming,” they are engaging in repetitive and often rhythmic behaviors and actions that give them predictable stimuli to focus on or express their emotions. While everyone can stim, frequent and significant stims are most often associated with autism. 

Tics, on the other hand, are more neurologically based, are often fairly involuntary, and are the main characteristic symptom of Tourette’s. They can be motor tics (for example, involuntary movement of the face, shrugging, or jerking), phonic tics (involuntary vocalizations like throat clearing, grunting, and sometimes words), or a combination of the two. Tourette syndrome is a condition of the nervous system in which both vocal and motor tics are present. 

Tics can vary in intensity, and some are so intense that people can break bones because of what they’re doing repeatedly. These are neurologically driven and can be thought of as existing on a varied spectrum between voluntary and involuntary. 

People who experience tics often have a premonitory urge, or a physical tension that builds up before they do the behavior. Kilduff likens the premonitory urge to the feeling that you get right before you’re about to sneeze: “Tics aren’t in response to any specific thing, nor does it seem to serve a very specific function. It’s just a thing you need to get out, like a sneeze.” 

Distinct from both stims and tics, compulsions are repetitive, ritualistic behaviors that are seen in people with obsessive-compulsive disorder (OCD). People with OCD experience obsessions, or repetitive and intrusive thoughts and urges that can feel significant and cause significant distress and anxiety. As a result, people with OCD then perform compulsions, or repetitive and ritualistic behaviors and actions. These compulsions are developed as a way to cope with intrusive thoughts and emotions like anxiety and fear. Someone who engages in a particular compulsive behavior might find that they have to do this behavior to ease their anxiety. 

“Compulsions are very specific things that a person feels must be done in a very specific way, and they are always driven by anxiety,” Kilduff explains. “The goal is always to quickly get rid of that distress and to try and get certainty or reassurance or to prevent a bad thing from happening.” However, she also emphasizes that compulsions are still voluntary behaviors, although it might not feel like it to someone with OCD. “It might not feel like a choice to them, but they do, indeed, have 100% control over their behavior.” 

In short: stims are voluntary self-soothing behaviors that can be seen in many people, but when they’re frequent and intense, they’re most often associated with autism. Compulsions are also voluntary behaviors, but they are driven by anxiety or other uncomfortable emotions like guilt and shame, and are seen in people with OCD. Finally, tics are semi-voluntary and neurologically driven physical and/or vocal movements that are most commonly seen in people with Tourette syndrome or other tic disorders. 

How Autism and Tourette Syndrome differ

Tics and stims can look very similar because they’re both repetitive, neurologically-driven behaviors. Neither of these behaviors is driven by specific anxieties or fears either, as is true for OCD compulsions. So how can you tell the difference between tics and stims—and more specifically, between Tourette Syndrome and autism? 

There are clear overlaps between autism and Tourette’s. For example, both autism and Tourette’s are seen first in childhood, and are diagnosed more frequently in males than in females. Their physical manifestations can also look very similar (ie: tics and stims), and both behaviors can often be seen more frequently in instances where emotions are running high. It’s also possible to have both autism and Tourette’s, as they can be comorbid conditions. 

One simple way to differentiate between tics and stims is to evaluate whether or not that repetitive behavior can be “swapped” into something else. For autistic people, it’s possible to find “substitute stims”: in other words, you may be able to switch one repetitive behavior for another that still helps soothe themselves. This can be helpful for managing stims that are disruptive, or for diverting away from stims that can potentially harm the person who is doing them. However, because tics are largely involuntary behaviors, you can’t choose how you tic. While competing responses are practiced during treatment for tics, the purpose is to help people learn to discontinue their tic habit, rather than merely find another outlet for healthy behavior, as is the case with stims.

In short: no, stims are not a sign of Tourette’s syndrome. While the behaviors can look very similar, they have different root causes and act in different ways. A simplified way to think about it is that stims serve a function (self-soothing) while tics don’t seem to serve any real purpose for people with Tourette’s. 

How stims and compulsions differ

While both stims and compulsions can look like repetitive behaviors, there are also some very clear differences. For example, while both stims and compulsions serve a purpose, the repetitive behaviors in OCD have a very specific function: these rituals are done to temporarily ease the anxiety and fear of an intrusive and obsessive thought or fear. Meanwhile, the repetitive stimming behaviors of an autistic person have a self-soothing quality but aren’t linked to specific obsessions or fears in the same way that an OCD compulsion is.   

Anxiety is very commonly seen in autistic people, with some studies reporting that up to 84% of autistic people experience some form of impairing anxiety. Stims can be one way that an autistic person deals with their anxieties. However, OCD is a separate diagnosis altogether that is categorized by obsessions and compulsions. With OCD, you might experience intrusive, “worst-case scenario” thoughts that bring about huge amounts of fear and anxiety. As a result, someone with OCD will engage in ritualistic behaviors to ease the fear, and this can lead to a repetitive cycle. Up to 37% of children and adolescents with ASD will also have OCD. 

In both instances, someone is going to be upset if you disrupt their rituals, but for different reasons. “In an autistic person, if their repetitive behavior relates to something they’re hyper-fixated on (their special interest) they’re going to be annoyed that you just interrupted something that was helpful and pleasant for them,” explains Kilduff. If an autistic person is not allowed to do their stims, it can lead to shutdowns or anger since they aren’t able to manage their sensory experience in this controlled and predictable way. “Meanwhile, if you interrupt a compulsion for someone with OCD, they’re going to be mad because in their mind, now they have to do it again to prevent the bad thing from happening.” 

What to do when you can’t stop stimming?

If you find yourself constantly engaging in repetitive behaviors, it’s important to first distinguish what they actually are: stims, tics, or compulsions. If you are concerned and find it hard to stop doing the behavior, you should talk to a mental health professional. 

If you can’t stop stimming, this isn’t a bad thing in and of itself, nor does there necessarily need to be any treatment for it. But if your stims are disruptive or even dangerous, working with a therapist can help. The point is not to get rid of the stim, but to better manage it, says Kilduff. 

So instead, treatment may involve finding better ways to manage your behavior the way you want to. This could look like finding substitute stims if people have a self-injuring stim like hitting themselves—you would want to find a behavior that addresses the purpose of the stim, but also find ways for them to self-soothe without causing injuries to themselves. 

Similarly, there is no cure for Tourette’s syndrome, nor is it reasonable to expect treatment to stop tics completely. However, there are medications and behavioral treatments that can help manage those tics and can be implemented if someone has tics that are disruptive. For example, habit reversal training (HRT) is a common treatment for Tourette’s and tic disorder that can help people recognize the premonitory urge before a tic. 

Meanwhile, exposure and response prevention (ERP) therapy is the gold standard of OCD treatment. In ERP, you work with a therapist to learn to cope with your triggers while resisting the subsequent compulsions. The goal here ultimately is to discontinue the behavior entirely, in order to teach people with OCD that they don’t need to engage in those compulsive behaviors. 

If you are going through ERP therapy with a therapist as an autistic person, working with a therapist who specializes in both can help. NOCD’s clinical team has licensed therapists who specialize in OCD and receive ERP-specific training. It also has specialists who are well-versed in adapting your ERP treatment for autistic people and their sensory needs.
NOCD therapists are also specialty-trained in treating tic disorders using habit reversal training therapy, helping people regain control of their lives from this misunderstood and often severe condition. Schedule a free call to learn how NOCD’s clinical team can help with your unique needs.

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