Tics are involuntary and sudden repetitive movements or sounds performed by an individual. They are common in children and teenagers. Although there are many types of tics and tic disorders, tics are generally mild and may completely disappear over time.
However, some types of tic can persist and occur frequently causing several problems such as social embarrassment, physical discomfort, or emotional impairments, which could impact daily life activities.
If an individual has more severe or frequent tics, they may have a neurological condition that causes them to perform tics. This condition is known as tic disorder.
Studies show that tics can vary widely and increase or decrease in intensity over time. Individuals may experience simple or complex motor tics and vocal tics.
- Simple tics: These are brief and sudden repetitive movements that involve just a few muscle groups. Research indicates that simple tics are more common than complex tics.
- Complex tics: These are coordinated and distinct patterns of movement that involve several different muscle groups in areas throughout the body.
It is important to differentiate between motor and vocal tics to formulate a treatment plan. Both types of tics can be equally distressing, but sometimes can have different causes, and require an individual treatment plan.
Motor Tics
Motor tics are sudden movements or actions that are difficult to control easily. These tics involve body movements like shoulder shrugging. These movements often happen repeatedly and can vary in severity from mild to disruptive. It has been observed that motor tics develop before vocal tics and simple tics develop before complex tics.
Motor tics are divided into two main types depending on their complexity:
Motor tics are sudden movements or actions that are difficult to control easily. These tics involve body movements like shoulder shrugging. These movements often happen repeatedly and can vary in severity from mild to disruptive. It has been observed that motor tics develop before vocal tics and simple tics develop before complex tics.
Motor tics are divided into two main types depending on their complexity:
Simple motor tics:
Simple motor tics include quick and brief movements. These tics generally use only one group of muscles.
Some of the examples are mentioned below:
- Eye blinking, eye rolling, and other eye movements
- Facial grimacing
- Shoulder shrugging
- Shoulder or head jerking
Complex motor tics:
Complex motor tics are more coordinated and involve multiple muscle groups.
Some of the examples are mentioned below:
- Facial grimacing combined with a shoulder shrug and a head twist
- Touching or sniffing an object
- Hopping
- Jumping
- Bending
- Twisting
Vocal Tics
Vocal tics are repeated sounds or noises that cannot be controlled. These sounds can vary from simple noise to complex phrases. These tics are generally seen in children and teenagers. Vocal tics are not harmful but can be embarrassing for some people. They can be a part of an underlying health condition or a side effect of medication.
Vocal tics are divided into two main types depending on their complexity:
Vocal tics are repeated sounds or noises that cannot be controlled. These sounds can vary from simple noise to complex phrases. These tics are generally seen in children and teenagers. Vocal tics are not harmful but can be embarrassing for some people. They can be a part of an underlying health condition or a side effect of medication.
Vocal tics are divided into two main types depending on their complexity:
Simple vocal tics:
Simple vocal tics involve brief sounds. These sounds or noises can be sudden and may not be loud.
Some of the examples are mentioned below:
- Repetitive throat clearing
- Sniffing
- Barking
- Grunting
Complex vocal tics:
Complex vocal tics involve words or phrases that may look more intentional but cannot be controlled. These tics include repeated and inappropriate words and are longer in duration.
Some of the examples are mentioned below:
- Repeating your own words or phrases.
- Repeating other people’s words or phrases (echolalia).
- Using obscene, vulgar, or profane words (coprolalia).
Types of Tic Disorder
Tic disorders are stereotypic behaviors that involve sudden repetitive movements or sounds that cannot be controlled. These are generally short-term in duration and can appear at any age but are mostly found in young children. These disorders are a group of neurological conditions that involve the functioning of both the brain and nerves.
Tic disorders are frequently associated with comorbid neuropsychiatric symptoms and can become more problematic than tic symptoms. There are several types of tic disorders depending on the duration, severity, and whether the tic is motor or vocal.
Transient Tic Disorder
Transient tic disorder is also known as provisional tic disorder. In these disorders, tics appear for a short time. An individual with a transient tic disorder may have motor or vocal tics or both for less than one year. It is the most common type of tic disorder.
Studies show that most children with transient tic disorder experience a reduction or complete disappearance of tics within one year. Motor tics are more commonly found in transient tic disorders. Studies show that tics are more common among children with learning disabilities, for example; tics are commonly found in children within the autism spectrum.
Some of the key points of transient tic disorder are mentioned below:
- One or more motor tics or vocal tics.
- Tics present for no more than one year.
- Tics that begin before 18 years of age.
- Symptoms may occur due to a medical condition that can cause tics.
- No other tic disorder diagnosis.
These tics include simple movements like eye blinking, shoulder shrugging, or facial movements. This disorder does not need a blood test or imaging test for diagnosis. Treatment is required when tics cause distress or interfere with daily life.
Studies show that tics may develop into chronic tic disorder or even Tourette’s syndrome if they last for more than a year. Therefore, early identification is important.
Chronic Tic Disorder
Chronic tic disorder is also known as persistent tic disorder. In this tic disorder, an individual may have motor or vocal tics (not both) for more than one year. It includes tics that are sudden repetitive movements or sounds that can not be controlled. It is less common than transient tic disorder.
Tics that appear before the age of 18 and last for 1 year or more may be classified as chronic tic disorder. Studies show that it affects less than 1% of school-age children. It has been observed that there are greater chances of recovery if the child is younger at the onset of chronic tic disorder. In such cases, tics generally disappear within 6 years. However, it becomes difficult to resolve symptoms if they persist beyond the age of 18.
Some of the key points of chronic tic disorder are mentioned below:
- One or more motor tics or vocal tics, but not both.
- It includes tics that happen many times each day for more than 12 months.
- It includes tics that begin before 18 years of age.
- Symptoms do not occur due to a medical condition that can cause tics.
- No Tourette’s syndrome diagnosis.
This disorder does not need a lab test or scan, diagnosis is simply based on observations. Healthcare providers suggest treatment options such as Comprehensive Behavioral Intervention for Tics (CBIT) to manage severe cases.
Chronic tic disorder can be challenging as it can cause embarrassment or anxiety. Studies show that most of the cases improve with time but it still impacts social life and self-esteem. Early diagnosis and treatment can help an individual in managing the symptoms.
Tourette’s syndrome
Tourette’s syndrome is a complex neurological disorder that causes an individual to make involuntary movements or sounds known as tics. In this disorder, an individual may experience motor and vocal tics (both) for more than one year. It is the most severe and least common tic disorder. Tourette’s syndrome is often accompanied by other medical conditions such as Attention Deficit Hyperactivity Disorder (ADHD) or Obsessive Compulsive Disorder (OCD).
Tourette’s syndrome may appear in early childhood mainly between the ages of 5 and 10. Studies show that around 0.3% to 0.8% of children in the U.S. are affected by Tourette’s syndrome. It has been observed that males are three to four times higher risk of getting this disorder than females.
Some of the key points of Tourette’s syndrome are mentioned below:
Two or more motor tics and at least one vocal tic, but not necessarily at the same time.
- It includes tics for at least one year that can happen many times a day.
- It includes tics that start before 18 years of age.
- Symptoms do not occur due to a medical condition, medication, or drug that can cause tics.
There is no single test available to test Tourette’s syndrome. Diagnosis mainly consists of analysis and observations of the symptoms. There is no cure but treatment options can help in managing the tics in severe cases. Behavioral therapy is considered to be effective in treating Tourette’s syndrome.
It is challenging to live with Tourette’s syndrome, especially in social settings which can sometimes lead to embarrassment and misunderstandings. Therefore, treatment can help manage symptoms and help you live a peaceful life.
What Causes Tics
The exact cause of tics is still unknown because their occurrence is complex and can be caused by more than one factor and can differ from one person to another person. Studies show that tics may result from changes in the area of the brain that controls movement. It has been observed that different types of tics can have various causes.
It is important to identify these causes so that they can be treated effectively. This also helps healthcare providers to understand the underlying factors contributing to tic behaviors.
Some of the causes are mentioned below:
Genetic factors:
Studies show that tics tend to run in families, so there may be a hereditary basis for these disorders. It has been observed that there are certain genes that may develop tic disorders in individuals, especially when there is a family history of tics, OCD, or ADHD.
It was concluded that the most severe tic disorder, Tourette’s syndrome may be due to an inherited dominant gene.
Neurological factors:
There are some neurotransmitters that play an important role in movement such as dopamine. It has been observed that tics can be caused due to changes in the brain that control movement. Studies show that abnormal dopamine activity in the brain areas like the basal ganglia may contribute to the onset of tics.
Environmental factors:
It has been observed that a stressful or stimulating environment can sometimes increase the frequency and intensity of tics. There are some factors that can worsen the tics such as stress, anxiety, and fatigue.
Certain environmental factors can contribute to the development of Tourette’s such as smoking during pregnancy, low birth weight, and other pregnancy complications.
Infections and autoimmune response:
Studies show that streptococcal infection can contribute to the tics through autoimmune response.
Developmental Influences:
It has been observed that tics often emerge during early childhood and it is a phase that is important for significant brain development. Neurological or environmental factors may interact with the developmental changes that may trigger the onset of tics. This may result in the cases of tics in early childhood like at the age of 5 to 10.
Diagnosis of Tic Disorder
All three Tic disorders can present with different types of tics and careful history-taking is required to differentiate between different types of tic disorders. Diagnosis of tic disorders depends on the signs and symptoms of tics.
There are four characteristics that doctors use to identify and diagnose tic disorders:
- The age when tics began
- Duration of the tics
- Severity of the tics
- Whether tics are motor or vocal or both
Some signs and symptoms that are used to diagnose tic disorder such as:
- The child must be under 18 at the onset of symptoms for a tic disorder to be diagnosed.
- The symptoms must not be caused by other medical conditions or medicines.
Different measures to identify type of tic disorder:
- Transient tic disorder diagnosis: In this disorder, one or more tics should be present and occur for less than 12 months in a row.
- Chronic tic disorder diagnosis: In these disorders, one or more tics should occur daily for 12 months or more. Individuals suffering from chronic tic disorder will experience either motor tics or vocal tics or both.
- Tourette’s syndrome diagnosis: In this syndrome, there is the presence of both motor and vocal tics, that occur almost daily for 12 months or more.
DSM 5 Criteria for Tic Disorder
The Diagnostic and Statistical Manual of Mental Disorders is often known as the “DSM,”. It is a reference book on mental health and brain-related conditions and disorders. The American Psychiatric Association (APA) is responsible for the writing, editing, reviewing, and publishing of this book.
The number “5” attached to the DSM’s name refers to this book’s fifth and latest edition. It categorizes around 298 mental disorders based on an established set of criteria, which includes behavioral or emotional patterns and the duration of these patterns.
Similarly, the DSM-5 also mentions the specific criteria for diagnosing type of tic disorder. This helps clinicians in determining whether a person’s symptoms fit into one of the categories of tic disorders. These criteria consider some of the factors such as the presence of tics, their duration, or age of onset.
Following are the DSM-5 specifications for the diagnosis of tic disorders:
- Tics must be motor, vocal, or both. Motor tics are sudden and involve quick movements of muscles. While vocal tics involve sounds made by the individuals.
- It is considered tic only if it occurs many times a day and nearly every day for at least one year. However, the duration requirement can change for different types of tic disorders.
- The tics must cause significant distress or impairment in important areas of functioning such as academic, social, or occupational life. This impairment helps in understanding the impact of the disorder on daily life activities.
- The onset of tics must occur before the age of 18 years. Therefore, tic disorders are generally considered pediatric conditions.
- It is also mentioned that the symptoms must not be attributable to any other medical condition. For instance, tics can not be due to medication side effects, or neurological conditions.
DSM-5 criteria help in categorizing the disorder into specific types such as transient tic disorder, chronic tic disorder, or Tourette syndrome. It is important to diagnose properly as each of these disorders has a different treatment approach, and early identification can help in managing symptoms more effectively.
FAQ
How Do I know if I Have a Tic Disorder
There are different types of tics, and experiencing tics does not always mean you have a tic disorder. Tic disorder involves sudden movements or sounds that are repeated and are hard to control. There are mainly two types of tics, motor tics and vocal tics. Motor tics involve symptoms like blinking, jerking, or shrugging. While vocal tics involve sounds like grunting, humming, or repeating words.
It can be considered a tic disorder if these tics have been happening for more than a year and they seem to be affecting daily life. This disorder can get worse if left untreated. It is advised to consult a healthcare provider for a proper diagnosis and a scheduled treatment plan.
Are Tics Dangerous
There are many types of tics. Usually, tics are not usually dangerous but they can sometimes be uncontrollable and disruptive to daily life. They are often harmless but can cause some people to feel self-conscious or stressed, especially in social situations. It can result in lower self-esteem.
If the movements are frequent and forceful, tics can sometimes lead to physical discomfort, like pain. In rare cases, tics can interfere with certain activities but do not usually cause serious physical harm. Studies show that tics can be manageable with the right medical support.
How many Tics do you need to have Tourette's
A person must have two or more motor tics (for example, blinking or shrugging the shoulders) and at least one vocal tic (for example, humming, clearing the throat, or yelling words or phrases) to be diagnosed with Tourette’s syndrome, although they do not have to happen at the same time.
Having occasional tics does not mean a person has Tourette’s but if the tics are ongoing and involve both movement and sound it could be a sign of this condition. Therefore, consulting a healthcare provider can be helpful.
Are Tics Treatable
There are many types of tics. Some are transient and do not need treatment, while chronic frequent tics can be distressing and require treatment. Treatment of tics depends on the type of tic, frequency, severity, and underlying cause.
Most tics are at least partially treatable and reduce in frequency, severity, or resolve with medication. Sometimes supplements can be helpful for tics, especially tics associated with OCD and social anxiety.
Therapy is an important part of treatment for tics. CBT, supportive therapy, and Exposure therapy have been useful for all types of tics. Therapy teaches individuals how to manage their tics, and reduces feelings of shame, embarrassment, and anxiety associated with the tics. Anxiety reduction can reduce the frequency of all types of tics.
Conclusion
Tics can be extremely distressing to the sufferer. Help is available. If you or a loved one requires treatment for tic disorder visit our homepage to booka an appointment.
