A “Tic” is a stereotyped, repetitive movement, often in the past refereed to as a “habit spasm”. Tics occur in a variety of conditions, most of which fall in a spectrum between a simple tic disorder, and Tourette’s Syndrome.
In adults and some children, a clear history of a urge preceding the movement, and relief after the movement can be obtained. Also, the movements can be suppressed (at the expense of inner stress or increasing discomfort) for variable lengths of time. It is not unusual for children to inhibit or suppress the movements at school and then once home the tics “come out” in dramatic frequency. Although the movements can be suppressed they can’t be stopped. It typically worsens the comfort of an individual if they are asked or forced into trying to stop them.
Tics can be classified as:
- Simple tics – only a single body part is involved. These include eye blinks, shoulder shrugs, and cheek twitches.
- Complex tics – these consist of complex movements or a series of movements often involving more than one muscle group. One example would be jumping and spinning around in the air.
- Simple vocal tics – brief noises including sniffing, grunting, throat clearing, coughing etc.
- Complex vocal tics – these include more complex noises in the form of words (profanities), or phrases intruding into normal speech. Echolalia (repetition of what is heard) and palilalia (tendency to repeat phrases) are other examples.
This by definition is a chronic multi-focal tic disorder, with vocalizations lasting 12 months or more.
This most commonly starts at around age 6-10, progresses to often be most severe during puberty, and then stabilizes into adulthood. Exceptions to this typical pattern do occur and in some cases begin in adulthood.
Tourette’s syndrome is frequently associated with obsessive-compulsive traits. At times this feature can be more problematic than the movements. Obsessive behavior can include a variety of habits, rituals, or patterns of behavior. Some examples include repeatedly checking if a locked door is locked, having to have things arranged in a specific order or pattern, excessively washing hands, or having to spend an excess of time at a task to ensure it is perfect, as anything less can create stress or anxiety
This is a genetic (inherited) illness. It is autosomal dominant (there is a 50% chance that the children of an affected parent can inherit the tendency) with variable penetrance (not all who get the gene get Tourette’s).
There is no cure. Treatment is not always needed if the movements are mild, and not socially distressing. If treatment is required the following medications are most often used.
To control movements: clonidine, guanfacine, aripiprazole (Abilify), tetrabenazine, clonazepam, olanzepine, risperidone, haloperidol, valproic acid, and rarely and only if severe, pimozide.
To control obsessive traits: chlormipramine, fluoxetine, and other Selective Serotonin Reuptake Inhibitors (SSRIs).
For more information about Tourette’s syndrome: