Tic Disorders

As described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), a tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization. Tics can either be simple (involving only a few muscles or simple sounds) or complex (involving multiple groups of muscles working together in orchestrated bouts or words or even sentences).

For example, a simple motor tic can range from eye blinking to nose wrinkling to neck jerking to facial grimacing to abdominal tensing; whereas a complex motor tic can range from hand gestures to repeatedly smelling an object to facial contortions, to deep knee bends, to retracing steps to assuming and holding unusual postures.

Simple vocal tic are usually meaningless sounds such as throat clearing, grunting, sniffing or snorting; while complex vocal tics usually involve speech and language and often include the sudden, spontaneous expression of single words or phrases. It is important to note here that one of the complex vocal tics, Coprolalia, which involves the uttering of obscenities, is present in less than 10% of individuals with a tic disorder.

Although usually experienced as irresistible urges, tics can be suppressed for varying lengths of time. Further, individuals may view that tics are somewhere between ‘voluntary’ and ‘involuntary’ in that tics are often experienced as a giving in to a mountain tension or bodily need, similar to the feeling of an oncoming sneeze.

Tics vary in intensity, disruptiveness, and frequency. Some tics may barely last a second while others last for hours. Some tics may be hardly noticeable or even suppressible by the individual. It is interesting to note that tics occur more frequently while relaxing (i.e., watching TV) than while working on an activity (i.e., reading or sewing). It is also interesting to note that tics tend to be exasperated during periods of stress.

There are four (4) types of Tic Disorders: Tourette’s Disorder, Chronic Motor or Vocal Tic Disorder, Transient Tic Disorder, and Tic Disorder Not Otherwise Specified. 

Tourette’s Disorder

Tourette’s Disorder is characterized by multiple motor tics and one or more vocal tics. These tics may appear simultaneously or at different periods of time and may occur many times a day, recurring during a period of a year or more. The patient never experiences a tic-free period of more than 3 consecutive months during this period. The onset is before the age of 18. 

Chronic Motor or Vocal Tic Disorder

Chronic Motor or Vocal Tic Disorder is the presence of either motor or vocal tics, but not both. These tics may appear simultaneously or at different periods of time and may occur many times a day, recurring during a period of a year or more. The patient never experiences a tic-free period of more than 3 consecutive months during this period. The onset is before the age of 18.

 Transient Tic Disorder

Transient Tic Disorder is the presence of single or multiple motor tics and/or vocal tics. These tics occur many times a day, every day, for about four (4) weeks. However, the tics do not last longer that 12 consecutive months. The onset is before the age of 18.

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