Obsessive Thoughts and Tourette Syndrome

Reader’s Question

Please help me help my girlfriend. She is extremely smart and has a very high IQ. She has a mild case of Tourette’s (body twitching and mild vocals like a hiccup). The Tourette’s seems to get worse when she is stressed out. She also told me she has thoughts of cutting off all her hair, putting her hand in a sink disposal, shooting herself in the leg, and putting her cat in the microwave. She loves her cats more than anything in the world and doesn’t know why she has these destructive thoughts. She had been taking Prozac and has been trying to ween herself off. She always had the destructive thoughts but now she is having them more. She also has mood swings that don’t seem to last that long. To me it’s like there are two of her. One in which we can talk about nothing for hours and everything is positive and happy and one where anyone around her can’t say anything right. She has been in a lot of relationships and none of them seemed to go anywhere. I have been through a divorce and don’t want to go through another one. I am planning on asking her to marry me but am worried that she could all of a sudden start having destructive thoughts towards me. I need help understanding what could be causing this and what I can do to help her. She said it all started when she became an adult. She is now 26. I love her more than anything and don’t want to lose her because she decides to act on one of these thoughts. I am trying to be as supportive as possible but I need help understanding so that I can be more supportive and to help her get the help she needs.

Thanks,
guywhowanttoknowmore

Psychologist’s Reply

The public impression of Tourette Syndrome (TS) is often defined by the obvious vocal or physical tics. TS is considered a neurological disorder that is associated with the brain’s neurotransmitters/chemicals, especially Dopamine and Serotonin.

In TS, tics are one group of symptoms. It is also very common to have another group — Obsessive thoughts and compulsive behaviors. Your girlfriend is being tormented by obsessive thoughts — the cat in the microwave for an example — as the brain produces thoughts known to be upsetting. Sadly, the brain produces obsessive thoughts that are person-specific, as though the brain knows what will bother the TS person individually. Bald men with TS don’t have obsessive thoughts about cutting their hair off for example.

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Prozac is an antidepressant that is often prescribed for TS as it decreases obsessive thoughts (related to Serotonin) and also works with Dopamine where the tics originate. Your girlfriend is doing the worst thing she can do — trying to come off a medication designed to decrease those destructive thoughts. When Prozac is reduced, the obsessive, destructive, and “evil” thoughts will increase.

Encourage your girlfriend to remain on her medication and meet with her physician to discuss her obsessive thoughts. These destructive thoughts are a symptom of neurotransmitter dysregulation (being “out of whack” where I come from) and can be treated. The situation is similar to the physical or vocal tics — if they suddenly increase, a medication consultation may be required. Provide her with the support she needs to arrange a consultation. Also encourage her to view the thoughts as a symptom of the disorder — not a reflection of her personality or internal psychology. It would also be helpful to research the connection between TS and Obsessive-Compulsive Disorder on the Internet. That information may help her understand the thoughts as symptoms — not something she needs to obey.