Symptoms of TS
The key features of Tourette Syndrome (TS) are tics; both repeated movements and sounds that are chronic (long-term) and involuntary. Most people with TS will experience co-occurring symptoms such as Obsessive Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD) and Anxiety.
Tics usually start in childhood around the age of six to seven years and tic symptoms often fluctuate in severity and frequency. Although the nature of tics is that they come and go, such patterns are also influenced by environmental factors including stress, excitement and relaxation.
Tics can occur in nearly any part of the body and in any muscle; some individuals report of ‘internal tics’ such as deep abdominal muscle tension and ‘stomach tics’
The biggest misconception around TS is that everybody with the condition swears. Coprolalia is the clinical term for tics that produce socially unacceptable words; and only 10% of people with TS have this symptom.
Tics can be divided into Simple and Complex categories. Below is an example of common motor and vocal tics:
Limb and head jerking
Touching objects and other people
Obscene movements or gestures (copropraxia)
Repeating other people’s gestures (echopraxia)
Uttering words or phrases out of context
Saying socially unacceptable words (coprolalia)
Repeating a sound, word or phrase
Many individuals experience a physical sensation – a premonitory feeling/urge – that precedes a tic. It has been compared to other physical sensations such as the need to itch or sneeze, or a burning, electrical feeling inside. Supressing a tic can increase the premonitory urge, and once a tic has been performed the premonitory urge often reduces. For some people multiple attempts of a tic are necessary until it ‘feels right’ and the premonitory urge diminishes.
Can tics be controlled?
Although tics are involuntary, many people are able to suppress their tics for a short time. A helpful way of understanding this is to compare it to blinking. For a short period of time it is possible to keep your eyes wide open and avoid blinking - and with practice you will get better at doing it for longer – but eventually you will have to blink as the urge is too strong to control. Supressing tics works in the same way. It can take a great measure of concentration - especially to begin with - to resist the urge to tic, but with practice a certain level of control can be applied.
It is common for children to suppress their tics at school; the environment lends itself to an atmosphere of general conformity, rules and structure. So it is not surprising that when a child returns home to a more relaxing familiar environment, their tics often ‘explode’ as they no longer feel they have to suppress them.
Co-occurring features and conditions
Over 85 percent of people with TS have more than just tics. Co-occurring symptoms may include obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), anger/rages and anxiety. When a person presents with tics and co-occurring symptoms this is clinically referred to as ‘mixed neurodevelopment symptoms’. Such additional symptoms may cause more problems than tics as they can be less visible.
You can read in more detail about co-occurring symptoms here
Tourette Syndrome is on the spectrum of conditions known as Tic Disorders. Other conditions on this spectrum include:
- Transient tic disorder or provisional tic disorder –motor tics usually confined to the face and neck although other body parts may be affected; sometimes vocal tics are also present. Tics only last a few weeks or months.
- Chronic tic disorder – tics tend to persist rather than be transitory and can include blinking, sniffing or neck movements. Tics occur for more than 1 year
- Tourette Syndrome – multiple motor tics and one or more vocal tics present for at least 12 months although not always concurrently.
- A tic disorder not specified - tics are present, but do not meet the criteria for any specific tic disorder