In terms of the neural mechanisms contributing to SP, an analogy has been drawn between “urges-for-action” (Table 2), which may be similar to urges leading to repetitive behaviors in OCD and TS [80–81]. Neuroimaging studies report activation in the insula, parietal somatosensory regions and motor/premotor regions to be involved in the build-up and suppression of urges-for-action [80–82], with a common region of mid-posterior insula and cingulate motor area (CMA) active during urges-for-action in non-psychiatric participants and the urge to tic in TS [81, see also 83–84]. A recent study examining the urge to blink in OCD found that patients exhibited increased activity in mid and anterior insula and CMA during eyeblink suppression [85], supporting the notion that the urges-for-action network is also dysfunctional in OCD.
