Tic Disorder and Its Treatment

A tic is a sudden, rapid, repetitive, non-rhythmic movement or vocalisation caused by involuntary muscle contractions. Tics can be temporary and mild for many people, but for some they become a serious problem that affects daily life. Tic disorders usually begin in childhood, although adults can also be affected. Early diagnosis and treatment help bring symptoms under control and prevent long-term problems, so it is important to start treatment before the condition becomes chronic.

A supportive, understanding attitude from family and friends is an important source of psychological support during treatment. People with tics, especially when the problem has become chronic, may lose self-confidence and come under various stresses, and tics can make them the target of teasing. For this reason they need understanding and support from those around them.

What causes tic disorders?

The exact cause is not known, but research shows that genetic and environmental factors are involved. Stress, sleep problems and some medicines are thought to be among the environmental factors. When the history is taken, families often report that the tics began after a particular event, frequently a distressing one.

Types of tics

Tics are divided into motor and vocal tics.

• Simple motor tics: last less than a second or two: blinking, wrinkling the nose, licking the lips, grimacing, sudden head jerks, shrugging the shoulders, fiddling with or clicking the fingers, shaking, tapping or stretching the feet.
• Complex motor tics: more complex, seemingly purposeful and longer-lasting: meaningful hand or facial movements, slow head movements, looking surprised or puzzled, touching objects or people, moving the fingers as if counting, stepping forwards and back, squatting, bending and twisting.
• Simple vocal tics: coughing, sniffing, throat clearing, whistling, animal or bird sounds.
• Complex vocal tics: saying syllables or words, coprolalia (swearing), echolalia (repeating what others say) and palilalia (repeating one’s own last sounds, syllables or words).

Types of tic disorder

• Tourette’s disorder: a chronic neuropsychiatric disorder that begins in childhood. Both multiple motor tics and one or more vocal tics have been present at some point during the illness, though not necessarily at the same time. Tics may come and go, or occur many times a day almost every day.
• Persistent (chronic) motor or vocal tic disorder: similar to Tourette’s disorder, but only motor tics or only vocal tics are present.
• Provisional (transient) tic disorder: one or more motor and/or vocal tics that have been present for less than a year. It is common in childhood, often eases by adolescence and frequently does not need treatment. In many cases the tics have a psychological component, worsen with stress and tend to decrease on their own.

For Tourette’s disorder and persistent tic disorder, tics must have been present for more than a year, must have begun before the age of 18 and may follow a continuous or fluctuating course.

Tic disorders can occur at any age and in either sex, but they are several times more common in boys than in girls.

Tourette syndrome

Tourette syndrome is a neurological disorder characterised by repetitive, involuntary tics, which may be sudden movements, sounds or words. It usually begins in childhood and can continue throughout life. Its cause is not fully known but is thought to result from an interaction of genetic and environmental factors. Depending on the severity and type of symptoms, people with Tourette syndrome may face difficulties at school, at work and in social settings. With correct diagnosis and treatment, many people with Tourette syndrome lead normal lives.

How are tics diagnosed?

Tic disorders are diagnosed by a psychiatrist or neurologist based on the type of tics, how long they have been present and the age at which they began. Other medical conditions that can cause abnormal movements need to be ruled out; blood tests or other investigations may be requested to assess general health for this purpose.

Treatment

Treatment aims to reduce the severity and frequency of tics and to improve quality of life. Because tics are often linked to stress, worry or tiredness, they can sometimes disappear on their own; when they cause distress or impair functioning, an assessment by a specialist is needed.

Cognitive behavioural therapies: behaviour therapy teaches the person to notice their tics and to control them. Techniques include habit reversal, comprehensive behavioural intervention for tics, relaxation techniques, desensitisation and conditioning-based methods. Behavioural approaches and stress management also help. Psychotherapy can explore the psychological factors behind the tics, particularly in children, and focus on the issues that may trigger them.

Psychopharmacotherapy (medication): when necessary, medicines with proven effectiveness are used alongside psychotherapy. Because side effects need to be weighed, medication is not always appropriate. In Türkiye, the Psychiatric Association of Türkiye publishes updated treatment algorithms for tic disorders. In rare, very severe cases that do not respond to other treatments, surgical options may be considered.

During and after treatment

Patience is important: some treatments take weeks or months to work, depending on the severity of the condition. Following your treatment plan and staying in regular contact with your doctor will help. To reduce the chance of tics returning after treatment:

• reduce stress with stress management techniques, and keep regular sleep habits
• adopt a healthy lifestyle with a balanced diet and enough exercise, and avoid smoking and alcohol
• take any prescribed medicines regularly as your doctor instructs
• complete your therapy and keep applying what you have learned