Described is an operating device for a tilt and turn door or window (1) comprising a fixed frame (2) and a movable sash (3) connected to each other along a corresponding vertical upright (4, 5) by a pair of hinges, a lower hinge (6) and an upper hinge (7), and a control handle (8) positioned on the upright (9) of the sash (3) opposite to that connected to the fixed frame (2); the operating device (100) comprises a slider (10) for transmitting the movement of the handle (8) housed and slidable inside a groove (11) of an upper crosspiece (12) of the sash (3); a positioning body (13) fixed in the groove (11) of the upper crosspiece (12); the body (13) has a slot (14) with a longitudinal operating extension (L); a connecting arm (15) articulated, at a first end, to the movable portion of the upper hinge (7) and, at the other end, to the positioning body (13) by means of a pin (16) housed in the slot (14) of the positioning body (13); the arm (15) has a relative surface provided with two elements (17, 18) protruding towards the groove (11) and a free zone (19), spaced from each other along the arm (15); a selector element (20) connected to the slider (10), slidable inside the groove (11) of the upper crosspiece (12) for intercepting, according to a sequence predetermined by the relative position of the protruding elements (17, 18) and the free zone (19), the protruding elements (17, 18) and free zone (19), in such a way as to define corresponding closed, turning opening and tilted open configurations which can be adopted by the movable sash (3), the device (100) comprising means (32) for adjusting the stroke of the pin (16) of the connecting arm (15) inside the slot (14) of the positioning body (13); the adjusting means (32) being positioned on the positioning body (13) and movable between several stable positions inside the slot (14) for modifying the longitudinal operating extension (L).