Tourette syndrome and other tic disorders

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therapist.com team

Last updated: 10/23/2023

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Tics are movements or sounds that are sudden, repetitive, and nonrhythmic. The urges behind tics are involuntary, but some people can suppress them. It’s similar to how you might feel the urge to cough, scratch, or fidget, then resist that urge. Some people, though, have tics that are challenging or even impossible to control.

Tics tend to develop in childhood or adolescence. As many as one in five kids have a tic at some point in their childhood.¹ In many cases, the tics aren’t serious, and children tend to outgrow them—but sometimes they’re a sign of a neurological or developmental disorder.

There are two main types of tics:

• Motor tics involve movement of the face, arms, legs, or other parts of the body. Examples include shrugging, head jerking, or grimacing.
• Vocal tics involve sounds like throat clearing, sniffing, humming, or grunting. Less common vocal tics include repeating other people’s words, swearing (coprolalia), or repeating your own words (echolalia).

Tics can also be either simple or complex. Simple tics involve a single body part, like blinking an eye. Complex tics are more coordinated movements that involve several muscle groups at once, such as hopping or twirling.

Types of tic disorders

Tic disorders are a group of neurological conditions that differ based on the type, frequency, and severity of tics.

A person with provisional tic disorder has one or more motor or vocal tics that last less than a year.

In persistent (chronic) motor or vocal tic disorder, motor tics or vocal tics (not both) continue for more than a year.

With Tourette syndrome (TS), the most severe form of tic disorder, both motor and vocal tics happen chronically.

Studies estimate that one out of every 162 children in the United States has TS, but only around half of kids with the disorder get a diagnosis.² People with TS often have co-occurring conditions such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), depression, or sleep problems.³

Signs and symptoms

Common signs and symptoms of tic disorders include:

• Uncontrollable movements or vocal outbursts, often associated with stress
• Trouble suppressing tics in social situations
• Embarrassment or shame about tics

Keep in mind that having a tic doesn’t necessarily mean a person has a tic disorder. Only a qualified health care professional can provide a diagnosis.

How tic disorders can affect daily life

Severe tic disorders can cause problems at school, at work, and in other public settings. Disruptive tics can make it hard to concentrate, interact in social situations, and make friends.

Children with TS may receive support in their schools and communities, but they often still face teasing and exclusion, which can reduce their opportunities to develop social skills.⁴ Treatment, stable friendships, and social support can help both kids and adults with tic disorders improve their social skills, self-esteem, and resilience. In addition, many people with TS cope and adapt by tapping into their creativity or sense of humor, or by focusing on hobbies and activities they enjoy.⁵

Risk factors and triggers

Experts don’t know exactly what causes tic disorders, but genes and environmental factors both seem to play a role. Tourette syndrome can be passed from parents to children, and boys are three to four times more likely to display symptoms compared to girls.^{6, 7} Smoking and stress during pregnancy, low birth weight, the use of forceps during delivery, and certain infections may also be linked to TS.⁸

Whether tics are associated with a disorder or not, research suggests that emotions like anxiety, tension, stress, and frustration can trigger or worsen them.⁹

Diagnosing tic disorders

To diagnose a tic disorder, a doctor or mental health professional considers a person’s symptoms, age, medical history, and family history. For a TS diagnosis, the person must have had both motor and vocal tics for a year or longer, with symptoms starting before age 18.¹⁰ An MRI or CT scan may also be used to rule out other potential symptom causes.

Treatment options

Treatment may not be needed for mild tics that don’t interfere with daily functioning. There’s currently no cure for TS, but medications and behavioral therapies can help manage symptoms.

Medications such as antipsychotic drugs, selective serotonin reuptake inhibitors (SSRIs), alpha-2 agonists, and botulinum toxins may be used to reduce tics in both adults and children. They may cause side effects that can vary from person to person.

Habit reversal training (HRT) helps people learn to recognize when their tics are most likely to occur and redirect themselves toward different behaviors. This may help reduce the frequency of tics.

Comprehensive behavioral intervention for tics (CBIT) is a blended type of therapy that includes habit reversal training, education, and relaxation techniques.¹¹ It’s used to help people identify and adjust thoughts or beliefs that contribute to tics, learn new behaviors to replace tics, and manage their stress levels.

Exposure and response prevention (ERP) is a type of exposure therapy where a person is gradually exposed to situations and sensations that trigger their tics while they learn how to resist the urge to perform the tics. The goal is to reduce fear and anxiety while providing new coping skills and strategies.

Support groups can give people with tic disorders, as well as their family members, an opportunity to connect with a community that can offer understanding, tips, and encouragement. The Tourette Association of America has directories for both local and online support groups.

If you or a loved one has symptoms of a tic disorder, or if a tic is interfering with your everyday life, contact your doctor or a mental health professional to talk about your symptoms. Visit our directory to find a licensed therapist who can help.