Tourette syndrome is a neurological disorder that can cause sudden unwanted and uncontrolled rapid and repeated movements or vocal sounds called tics. Tourette’s is considered a mental health disorder. Three tic disorders are included in the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders): 1) Tourette syndrome (TS, sometimes called Tourette disorder), 2) Persistent (sometimes called chronic) motor or vocal tic disorder, and 3) Provisional tic disorder.
Tourette’s causes people to have tics, which are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop from doing these things. For example, a person might keep blinking over and over or same the same word repeatedly.
Tourette’s Symptoms
Psychical tics can be either simple or complex. Simple tics involve just a few parts of the body. Examples of simple tics include squinting the eyes or sniffing. Complex tics usually involve several different parts of the body and can have a pattern. An example of a complex tic is bobbing the head while jerking an arm, and then jumping up. A person can have tics ranging from simple, temporary tics lasting a few weeks or months, to having many complex tics that are long-lasting. Symptoms of TS usually begin when a child is 5 to 10 years of age. The first symptoms often are motor tics that occur in the head and neck area. The types of tics and how often a person has tics changes a lot over time. Even though the symptoms might appear, disappear, and reappear, these conditions are considered chronic.
If the tic is vocal, the repeated word is often offensive. This type of vocal tic is called coprolalia, the involuntary utterance of obscenities, profanities and derogatory remarks, is an extreme example of a vocal tic experienced by some people with Tourette’s.
The most commonly accepted explanation of what causes coprolalia involves the same faulty wiring of the inhibitory mechanism of the brain that causes involuntary movements that typify Tourette’s. Other theories involve damage to the amygdala, a region of the brain that normally mitigates anger and aggression. Because cursing is a form of verbal aggression, amygdala damage can result in the inability to control aggression, including verbal aggression, or cursing.
Only 10 percent of Tourette’s patients actually exhibit uncontrollable and socially inappropriate cursing. Most have milder tics like rapid blinking, shoulder-shrugging and throat-clearing. When the compulsion overcomes them, coprolalia sufferers cannot stop from yelling inappropriate or culturally taboo remarks or phrases. They might even blurt out ethnic slurs, even if they aren’t racist. Brain injuries, strokes, dementia, seizures and other forms neurological damage can trigger the onset of coprolalia as well.
Tourette’s was once regarded as rare until research revealed that about 1% of school-age children and adolescents are estimated to have it, though coprolalia occurs only in a minority. There is no specific tests for diagnosing Tourette’s so it’s not always correctly diagnosed. Extreme Tourette’s in adulthood is rare, but for a minority of people, severely debilitating tics can persist into adulthood. Studies have shown that Tourette’s does not affect intelligence or life expectancy.
Other mental health conditions, such as attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD), and autism spectrum disorders can co-occur in persons with Tourette’s. In some people, tics decrease during adolescence and early adulthood, and sometimes disappear entirely. However, for many people tics continue into adulthood and, in some cases, can become worse.
Among those with an older age of onset, more substance abuse and mood disorders are found. Adults who have severe, often treatment-resistant tics are more likely to also have mood disorders and OCD. In addition, coprolalia is more likely in people with severe tics plus multiple comorbid conditions.
Risk Factors and Causes
Doctors and scientists do not know the exact cause of Tourette’s. Research suggests that it is an inherited genetic condition. Autoimmune processes may affect the onset of tics or exacerbate them. Both OCD and tic disorders are hypothesized to arise in a subset of children as a result of a post-streptococcal autoimmune process. Its potential effect is described by the hypothesis called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections). PANDAS and the newer pediatric acute-onset neuropsychiatric syndrome (PANS) hypotheses are the focus of clinical and laboratory research. There is also a broader hypothesis that links immune-system abnormalities and immune dysregulation with Tourette’s.
Sudden Onset of Tic-Like Behaviors
Sometimes people have tic-like behaviors that look like tics, but are distinctly different from those in Tourette’s. The people who develop these tic-like behaviors are often experiencing movement symptoms for the first time, with no previously reported history of tics. These types of tic-like behaviors are more common among teenagers and more often seen in girls than boys. Sometimes these tics are seen in groups of children. Many experts believe this sudden onset of tic-like behaviors happens for different reasons, and tic-like behaviors may need different treatment compared to tic disorders like Tourette’s.
Treatment for Tourette Syndrome
There is no known cure for Tourette’s and no single effective medication. For most people, medication for tics is not needed, and therapy is the first-line treatment if tics cause pain or injury; interfere with school, work, or social life; or cause stress. Psycho-education is an important part of treatment. Many people with Tourette’s have tics that do not get in the way of their daily life and, therefore, do not need any treatment.
Randi Fredricks, Ph.D.
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision. Washington, DC: American Psychiatric Association, 2022.
Bloch, MH, Leckman, JF. Clinical course of Tourette Syndrome. J Psychosom Res. 2009; 67(6): 497-501.
Centers for Disease Control and Prevention. Prevalence of diagnosed Tourette Syndrome in persons aged 6-17 years – United States, 2007. MMWR Morb Mortal Wkly Rep. 2009; 58(21): 581-5.
Bitsko, RH, Holbrook, JR, Visser, SN, Mink, JW, Zinner, SH, Ghandour, RM, Blumberg, SJ (2014). A National Profile of Tourette Syndrome, 2011-2012. J Dev Behav Pediatr 35(5), 317-322.
Dale RC (December 2017). “Tics and Tourette: a clinical, pathophysiological and etiological review”. Curr. Opin. Pediatr. (Review). 29 (6): 665–673.
Cravedi E, Deniau E, Giannitelli M, et al. (2017). “Tourette syndrome and other neurodevelopmental disorders: a comprehensive review”. Child Adolesc Psychiatry Ment Health (Review). 11 (1): 59. doi:10.1186/s13034-017-0196-x.
Darrow SM, Grados M, Sandor P, et al. (July 2017). “Autism spectrum symptoms in a Tourette’s disorder sample”. J Am Acad Child Adolesc Psychiatry (Comparative study). 56 (7): 610–617.e1.
Denckla MB (August 2006). “Attention-deficit hyperactivity disorder (ADHD) comorbidity: a case for “pure” Tourette syndrome?”. J. Child Neurol. (Review). 21 (8): 701–703.
Hsu CJ, Wong LC, Lee WT (January 2021). “Immunological dysfunction in Tourette syndrome and related disorders”. Int J Mol Sci (Review). 22 (2): 853.
Jay, Timothy. “Why we curse : a neuro-psycho-social theory of speech.” Philadelphia : John Benjamins Pub. Co., 2000.
Ludolph AG, Roessner V, Münchau A, Müller-Vahl K (November 2012). “Tourette syndrome and other tic disorders in childhood, adolescence and adulthood”. Dtsch Ärztebl Int (Review). 109 (48): 821–828.
