An Overview Of Tourette’s Syndrome
Tourette syndrome, sometimes known as Tourette’s syndrome, is a neurological disorder characterized by unwanted, often repetitive motor and vocal tics. These tics cannot be easily controlled and may feel uncomfortable to suppress for the individuals who experience them. Tics usually occur starting at a young age and persist through the teen years, occasionally lessening with age. In this article, we’ll be exploring Tourette’s syndrome in greater detail including symptoms, causes, and potential treatment options.
What is Tourette’s syndrome?
Tourette’s syndrome is not a mental health disorder; rather, it is a neurological condition that falls under a larger umbrella of related tic disorders. It was first described by Georges Gilles de la Tourette, who noticed a specific set of symptoms among nine different patients and eventually, after many years, had the disorder named after him. Tourette’s disorder became known as Tourette’s syndrome, or more simply, Tourette syndrome. While not considered a degenerative disorder, the severity of the disorder may change throughout an individual’s life.
Treatment may be provided for individuals with Tourette syndrome when tics impede daily functioning or interfere with everyday tasks. This could be because of tic severity or because the tic itself puts the individual in a potentially dangerous situation, causes behavioral or conduct issues, or leads to uncomfortable situations— or simply because it occurs often and is difficult to manage. Particularly problematic or disabling tics include frequently shouting curse words or repeatedly hitting oneself.
What do tics look like?
The main symptoms of tics consist of either involuntary movements or vocalizations (motor or vocal tics—also called phonic tics—respectively) and can be either simple or complex in terms of the muscle groups engaged and patterns exhibited. According to the Diagnostic and Statistical Manual of Mental Disorders, in order to be diagnosed with Tourette syndrome, you must display multiple motor tics in addition to at least one vocal tic.
Simple tics are brief and sudden and use one or a few muscle groups. What are tics? They show up as more repetitive movements and behaviors than complex tics do, which involve several muscle groups, and they do not involve a pattern of multiple sounds or movements. Simple motor tics often involve movement of the head and neck area. Common tics include twitching, tensing, grimacing, or making repetitive eye movements. Simple vocal tics could present as grunting, throat-clearing, barking, sniffing, or making other repetitive, simple sounds.
Complex tics, on the other hand, may involve multiple muscle groups or patterned movements or phrases. Complex tics are often more coordinated and last for a longer amount of time. Complex motor tics might involve any combination of the aforementioned simple tics. They might also appear to be intentional movements, such as picking things up, interacting with other people, jumping, or making large arm movements.
Complex vocal tics often involve repeating one’s own or others’ words, phrases, or sounds (this is called echolalia). In addition, rarer complex vocal tics might include the inadvertent use of vulgar language or swear words, called coprolalia. While coprolalia is often depicted in the media as the most common tic, it is quite rare for individuals with Tourette’s to experience these types of tic symptoms.
What triggers vocal or motor tics?
In addition, hearing other people sniff or clear their throat may trigger a tic in someone for whom those sounds are often involuntarily made as a tic.
Tics might also be triggered by a sensory or tactile experience relating to the part of the body in which the tic originates. For example, someone who often tenses their shoulders involuntarily through a tic may be triggered by a tight-fitting shirt.
Tics are frequently a response to a buildup of tension, and involuntarily expressing the tic can relieve said tension. While this often occurs against the individual’s will, some individuals can successfully manage their tics by learning to suppress this tension and suppress tics as a result. In these cases, it’s possible that tics decrease over time.
Alternative diagnoses to Tourette syndrome
Tourette syndrome (TS) falls under a larger umbrella of other tic disorders and, therefore, varying degrees and frequencies of tics may be categorized as other kinds of tic disorders or neurological disorders. For a healthcare professional to diagnose people with TS, at least two motor tics and at least one vocal tic must be present for at least a year. They must appear before the person is 18 years of age and be present without being caused by a substance (such as medication) or other medical condition.
Additionally, healthcare providers typically look at the patient’s medical and family history and run blood or imaging tests to make sure a person’s symptoms are not due to another condition.
If either vocal or motor tics occur for one year, but not both at the same time, then a patient may be diagnosed with persistent vocal or motor tic disorder. If tics occur but do not meet the above criteria for either disorder, or just a few parts of the criteria, a patient can still be diagnosed with provisional tic disorder, which is also known as transient tic disorder.
Potential causes of Tourette syndrome
Although the exact cause of developing Tourette syndrome is not entirely clear to doctors, it is known that it is a nervous system disorder that consists of the misfiring of chemicals in the brain. It is thought that this is due to alterations in irregularities in specific parts of the brain that can affect communication between the nerve cells. Tourette syndrome may be caused by genetics, but developmental and environmental factors might also play a part. Genetic counseling may be helpful in determining risk factors.
Comorbid disorders and Tourette syndrome
While Tourette syndrome itself is not a mental health disorder, it often occurs alongside these conditions. Common coinciding conditions include anxiety, obsessive-compulsive disorder (or OCD), attention-deficit / hyperactivity disorder (ADHD), learning disorders, behavioral issues, anger management problems, delays in the development of social skills and functioning, sensory processing issues, and sleep disorders.
These common co-occurring conditions often cause the individual more impediments in daily functioning than Tourette syndrome diagnosed on its own, and they can potentially last long into adulthood. While Tourette syndrome does not necessarily have a specific treatment method, many of these co-occurring conditions do.
These comorbid conditions may be treated through therapy or other methods. For example, obsessive compulsive symptoms and ADHD symptoms can both be treated with behavioral therapies and medication at the direction of a medical professional. Young students who experience severe symptoms may greatly benefit from a non-traditional education setting that meets their needs.
For more information on Tourette’s syndrome, take a look at the useful resources available at the Centers for Disease Control.
Treatment options for Tourette syndrome
Tourette syndrome (TS) does not have one specific treatment method, as all individuals with tics can experience them differently. For many people with Tourette syndrome, their tics do not impede their daily lives and therefore, not much treatment is required to treat tics. Some other resources may be prescribed by doctors to aid in lessening tics or the stress that can potentially lead to tics as well as any co-occurring conditions.
Pharmacological treatment for Tourette’s includes antipsychotics, stimulants (specifically medications that are often used for ADHD), or even antidepressants. An emerging treatment option for TS is deep brain stimulation, which is meant to help correct impairments in the brain’s functioning through an implant and could help reduce tics.
Online therapy with BetterHelp
Some individuals choose to attend therapy to help identify tic triggers, control symptoms, and reduce stress related to Tourette’s syndrome. Behavioral treatments can also be helpful to aid in the processing of any secondary emotional responses or other symptoms that may occur with Tourette’s.
Sites like BetterHelp (for adults) and TeenCounseling (for those 13-19 and their parents or guardians) can be effective starting points. Speaking with a therapist may allow you to cope with any emotional difficulties that coincide with Tourette’s. Online therapy affords convenient scheduling, making sessions more available. For example, teenagers can get appropriate help outside of school hours, and adults can schedule sessions before or after work. The ability to attend an appointment from a preferred space like home can potentially reduce the likelihood that a person with TS will be triggered in an unfamiliar or new environment.
The efficacy of online therapy
Online therapy can be an effective treatment for adolescents affected by Tourette syndrome. In a 2022 randomized control study, 40 youth between 9 and 16 years old (who were affected by Tourette syndrome) were sorted into two groups receiving either in-person or internet-based behavior therapy. Results revealed that both modes were equally effective in treating tics and co-occurring disorders. Online therapy, in fact, was reported to be more effective for reducing symptoms of depression than face-to-face therapy.
Takeaway
Is Tourette's a mental disorder?
Tourette’s syndrome is a neurological disorder, not a mental health condition. Tourette’s is a movement disorder of the nervous system, part of a group called tic disorders. Tics are involuntary motor movements or verbal sounds that occur outside the control of the person experiencing them. While the underlying cause of Tourette’s is unknown, researchers are certain that Tourette’s is not caused by a psychiatric condition. Just a few parts of the brain are involved in the core features of the condition.
While Tourtette’s is not a mental disorder, it commonly co-occurs with several psychiatric concerns, like obsessive-compulsive disorder and attention-deficit hyperactivity disorder. This may give the impression that those disorders cause the symptoms of Tourette’s, but this is not the case. Tourette’s is a unique diagnosis that can be given independently or alongside mental health conditions.
What are 5 symptoms of Tourette's?
The defining features of Tourette’s syndrome (TS) are motor and verbal tics, which are involuntary movements or verbalizations that happen outside of the control of the person experiencing them. It is important to note that Tourette’s can only be diagnosed when both motor and verbal tics are present. If either motor or verbal tics are present, but not both, the person may meet the criteria for a persistent tic disorder, which is a different diagnosis than Tourette’s.
Below are some of the common tic symptoms of Tourette’s syndrome:
- Simple motor tics are sudden, brief, repetitive movements that involve only a few muscle groups. Examples include eye blinking, facial expressions or grimaces, shoulder shrugging, or jerking of the head and neck area.
- Complex motor tics are coordinated patterns of movement that involve several muscle groups. Examples include hopping, bending, or twisting. Complex motor tics may also comprise multiple simple tics, such as a facial grimace combined with a head jerk.
- Simple verbal tics are verbal utterances that do not amount to speech. Examples include throat clearing or grunting.
- Complex vocal tics are verbalizations that include complete words or phrases. Much of the common knowledge surrounding Tourette’s focuses on complex verbal tics. Perhaps the most commonly-known example of a complex vocal tic is coprolalia, or involuntarily voicing vulgar or obscene language. Although coprolalia is commonly considered a defining feature of Tourette’s, it is not required for a diagnosis and appears in only 10% of people with TS.
What is Tourette's behavior?
Tourette’s behavior is typically defined as the presence of both motor and verbal tics. Both types of tics are required to qualify for a diagnosis of Tourette’s syndrome. Motor tics are spontaneous movements of various muscle groups, while verbal tics are involuntary utterances of sounds, words, or phrases.
Both motor and verbal tics can be either simple or complex. Simple motor tics involve only one muscle group and are typically quick and repetitive, such as jerking of the head. Complex motor tics involve multiple motor groups and are more intricate, such as hopping or bending the torso. Simple verbal tics involve guttural sounds like grunting, while complex verbal tics involve complete words or phrases.
There is also some evidence to suggest that Tourette’s and other tic disorders are associated with anger management problems, especially in youth. Many believe that Tourette’s causes a person to become uncontrollably obscene or vulgar, a symptom known as coprolalia. However, it is a common misconception that Tourette’s syndrome always results in swearing or other obscenities; research indicates that only 10% of people diagnosed with the condition express tics through vulgar speech.
Those with Tourette’s syndrome commonly experience comorbid disorders, which are other neurological or psychological conditions that occur alongside Tourette’s. The presence of other conditions, such as ADHD or learning disabilities, can potentially complicate the behaviors that are commonly associated with Tourette’s. A person not trained to recognize Tourette’s may associate it with behaviors caused by an entirely separate condition.
What happens during Tourette's?
The underlying pathophysiological mechanisms of Tourette’s syndrome are not fully understood, but researchers agree that tics do not arise from the parts of the brain that control free and voluntary movement. Research has indicated that it is possible to exert some force of will over the tics and control them voluntarily, but the force required to do so may be intense or unachievable in some cases.
It may be helpful to think of Tourette’s in terms of involuntary actions that occur more frequently in the general population. Almost everybody experiences occasional muscle twitches or spasms. While these arise through a completely different mechanism than Tourette’s, they are likely a good example of the level of control a person has over their tics.
What causes Tourette's?
Tourette’s is a complex disorder, and its cause is not fully understood. Researchers acknowledge that Tourette’s arises due to a combination of genetic and environmental factors, but a clear cause for each has not been found. In other words, scientists have yet to find the “Tourette’s gene” that leads to the development of the syndrome. The environmental factors that cause the condition are also frequently debated.
Developing Tourette’s syndrome is associated with risk factors like prenatal health concerns, like maternal stress, smoking, or fetal hypoxia (a lack of oxygen to the fetus in the womb). There is also some evidence to suggest that stressful events in a young child’s life may be an important cause of Tourette’s syndrome. Other theories suggest that autoimmune conditions - where the body’s immune system attacks its own cells - may have a partial role in the development of Tourette’s.
Is Tourette's a form of autism?
Tourette’s syndrome is distinct from autism spectrum disorder (ASD); they are separate conditions with different diagnostic criteria. However, some symptoms of Tourette’s syndrome overlap with symptoms of ASD, such as repetitive behavior. Furthermore, those with Tourette’s syndrome may be more likely to be diagnosed with ASD.
Evidence suggests a connection between ASD, Tourette’s, attention-deficit hyperactivity disorder, and obsessive-compulsive disorder. While all of these conditions have separate diagnostic criteria and are distinct conditions, there may be some common factors that underlie all of them.
Do people with Tourette's talk?
Those diagnosed with Tourette’s are usually capable of the same level of speech as someone without the diagnosis. Tourette’s does not directly affect speech, but verbal tics may interfere with ordinary conversation. In addition, a Tourette’s diagnosis is often accompanied by other co-occurring conditions, some of which may significantly interfere with speech.
Can you detect Tourette's?
There is not one simple test for Tourette’s. Several neurological conditions can cause tics, and careful evaluation by a trained professional is required to differentiate the symptoms of Tourette’s from similar symptoms present in other disorders. It is not possible to detect the presence of Tourette’s syndrome without a comprehensive evaluation.
Can people recover from Tourette's?
While it is not possible to “cure” Tourette’s syndrome, it is a treatable condition that often improves with effective management. Following a natural course, Tourette’s symptoms usually peak in adolescence and begin to improve in early adulthood. Medications are available that can help tics decrease in frequency and severity. Medications cannot completely eliminate tics, but they can significantly improve a person’s quality of life.
Behavioral therapy is also commonly used to help manage severe symptoms. The tics associated with Tourette’s syndrome are involuntary, but some willful control can be executed with training and practice. One of the most frequently used behavioral therapies, comprehensive behavioral intervention for tics (CBIT), has shown utility as a method to improve the quality of life of those with Tourette’s. CBIT trains the person how to be aware of their tics, initiate competing behaviors when a tic occurs, and make changes in daily life that can help reduce or prevent tics from occurring.
How is Tourette's diagnosed?
Tourette’s syndrome can only be diagnosed by a qualified professional, often a psychiatrist. Diagnosis is based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM), which is published by the American Psychiatric Association. The DSM is the most-used diagnostic manual in the United States, as well as in much of the rest of the world. It provides a framework for separating symptoms of one condition from those which could be attributed to a second condition.
Most individuals are diagnosed in childhood, and most children present with symptoms of other co-ocurring disorders. The diagnostic criteria the DSM lists for Tourettes’s syndrome are as follows:
- Multiple motor tics and one or more vocal tics must have been present during the disorder, although not necessarily simultaneously.
- The tics must have persisted for over a year since the first tic appeared, although the frequency may vary.
- Tic onset must occur before the age of 18.
- The tics cannot be explained by substance use or another medical condition.
A qualified professional will complete a detailed history of the patient and their family to determine the onset, severity, and frequency of the tics. The professional will also likely complete a targeted neurological examination to rule out sources of the tics other than Tourette’s and other tic disorders. They may also use rating scales developed specifically to differentiate tic disorders, such as the Yale Global Tic Severity Scale.
While a comprehensive evaluation is required to diagnose Tourette’s, there are a few defining hallmarks. One of them, the premonitory urge, is highly indicative of the condition. Those with Tourette’s describe their tics as irresistibly but consciously done. This is distinct from other kinds of involuntary actions, such as muscle spasms. A professional will consider the patient’s history, neurological exam, rating scales, and any other information to reach a decision regarding diagnosis.
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