Tourette's Syndrome
Overview
Tourette's Syndrome is a neurological disorder characterised by repetitive, involuntary movements and vocalizations known as tics. These tics can range from simple to complex and can involve any body part or system. Simple tics may include eye blinking, head jerking, or throat clearing, while complex tics could consist of a series of movements or vocal utterances that occur in the same order each time.
Named after Dr. Georges Gilles de la Tourette, who first identified the condition in 1885, Tourette's Syndrome often begins in childhood, typically between ages 5 and 7. However, it can persist into adulthood. The condition affects all races and ethnic backgrounds, and it's estimated that about 1 in every 100 people globally exhibits some form of tics, though not all these cases are severe enough to require treatment.
The cause of Tourette's Syndrome is unknown, but it's thought to involve abnormalities in certain brain regions and neurotransmitters, particularly dopamine. While no specific gene or set of genes has been conclusively linked to the disorder, genetic factors are believed to play a significant role, as the condition often runs in families.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, defines Tourette's Syndrome based on the presence of both multiple motor tics and one or more vocal tics, persisting for more than a year, with onset before age 18. According to the International Classification of Diseases (ICD-11), Tourette's Syndrome is classified under neurodevelopmental disorders, emphasising its onset in childhood and its long-term nature.
Key Features
Motor Tics: Motor tics are sudden, brief, and repetitive movements that occur in specific muscle groups. These movements can range from simple tics, such as eye blinking, shoulder shrugging, or head jerking, to complex tics involving coordinated movements of multiple muscle groups, such as jumping, touching objects, or making obscene gestures.
Vocal Tics: Vocal tics involve involuntary sounds or utterances, such as throat clearing, grunting, sniffing, or repetitive words or phrases (known as echolalia) that may or may not be socially inappropriate. Complex vocal tics can include coprolalia, which involves the involuntary utterance of socially unacceptable or taboo words or phrases.
Waxing and Waning Symptoms: Tourette syndrome is characterised by waxing and waning symptoms, meaning that tics can fluctuate in severity and frequency over time. Tics may worsen during periods of stress, excitement, fatigue, or illness, and improve during periods of relaxation or concentration.
Onset and Diagnosis: Tourette syndrome typically begins in childhood, usually between the ages of 2 and 12 years old, with the onset of motor tics followed by vocal tics. The diagnosis of TS is based on the presence of both motor and vocal tics, occurring for at least one year, with onset before age 18, according to the DSM-5 diagnostic criteria.
Associated Conditions: Many individuals with Tourette syndrome may also experience other neurological or behavioral conditions, including attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety disorders, learning disabilities, and mood disorders.
Severity and Impact: The severity of Tourette syndrome varies widely among individuals, ranging from mild to severe. While some people may experience minimal interference in daily functioning, others may be significantly impaired by their tics, leading to difficulties in school, work, social relationships, and overall quality of life.
Chronic Course: Tourette syndrome is a chronic condition, meaning that it persists throughout the individual's lifetime. While tics may fluctuate in intensity and frequency over time, many individuals continue to experience symptoms into adulthood, although tics often decrease in severity in late adolescence and early adulthood.
Types of Tourette syndrome include:
Tourette Syndrome: This is the classic form of TS, characterised by the presence of both motor and vocal tics, occurring for at least one year, with onset before age 18.
Transient Tic Disorder: Transient tic disorder involves the presence of motor and/or vocal tics that occur for less than one year. This condition is commonly seen in childhood and typically resolves on its own without the need for treatment.
Chronic Tic Disorder: Chronic tic disorder is similar to Tourette syndrome but involves either motor or vocal tics (not both) occurring for at least one year, with onset before age 18.
Tourette Syndrome Plus: Some individuals may have Tourette syndrome along with other neurological or behavioral conditions, such as ADHD, OCD, or autism spectrum disorder. This combination of conditions is sometimes referred to as "Tourette syndrome plus."
How We Can Help
As psychologists, we play a pivotal role in managing Tourette's Syndrome. While targeted interventions and treatments for tics are often provided by occupational therapists, psychologists may assist via emotional support, behavioral intervention, and coping strategies to deal with the disorder.
Behavioral therapy, particularly Comprehensive Behavioral Intervention for Tics (CBIT), has shown significant efficacy in reducing tic severity. CBIT includes components like habit reversal training and functional intervention, helping individuals to manage their tics effectively.
Additionally, psychoeducation can help individuals and families understand the disorder, reducing fear and stigma. Therapy can also address comorbid conditions like ADHD, OCD, and anxiety disorders, which are common in people with Tourette's.
Importantly, a supportive therapeutic relationship can promote acceptance, resilience, and positive mental health, despite the challenges Tourette's Syndrome may bring.
If you or someone you love is showing signs of Tourette's Syndrome, don't hesitate to seek help. Our team of highly skilled and compassionate psychologists is here to assist you. We believe that everyone deserves a life of comfort, understanding, and wellbeing. Give us a call today. Let's take that first step towards managing Tourette's Syndrome together.