Tourette’s syndrome, involuntary tics

Tourette syndrome (GTS) is characterized by tics. Short-term, repetitive vocal and/or motor movements that last longer than a year. Georges Gilles de la Tourette, who lived from 1857 to 1904, is a French doctor who first encountered the phenomenon and published about it. The syndrome is named after him. Since the 1960s, more has been published about it and more and more is known about it. The tics can also manifest themselves in swearing and offensive words.

Tourette’s syndrome

Severe tics

Tourette is a neuro-psychiatric disorder. One in a hundred people has it. Most people are familiar with the syndrome because of the severe tics and coprolalia , the shouting or saying of inappropriate, rude, obscene or aggressive words. But the syndrome also has many milder sides. It often manifests itself in a short cough or blinking. Coprolalia only occurs in a minority of patients. Coprolalia can have many negative consequences for people’s personality development. People feel very unhappy at home, at school and in the social environment.

Random and involuntary

It has long been thought that tics occur involuntarily, but according to Lang, patients say that they actually feel that they cause the tic themselves, so that it is random. The urge for the tic is involuntary, but the production of it is not. The patient can suppress the urge, but the tension then becomes so great that they still perform the tic. With targeted mental effort, such as reading or working on the computer, the tics manifest themselves less. Also during sleep. They increase with stress and excitement. The tics usually develop between the ages of two and fifteen. The diagnosis is made around the age of eleven (Buitelaar et al.).

Appearances

Motor tics

Tourette’s usually begins with simple motor tics such as blinking, jerking shoulders or jerking movements of the arms or legs. This also includes nodding the head, curling the toes and snapping the fingers.

Vocal tics

These may include: growling, clearing the throat, coughing, clicking the tongue, hissing. Shouting curse words or repeating words or sentences can also occur.

Other characteristics may appear alongside it

People have tension problems, sleep problems and anxiety or panic attacks or are depressed. People are highly sensitive, have difficulty concentrating or are impulsive. One may have obsessive thoughts or outbursts of anger. And people can exhibit risky behavior. Tourette’s is more common in combination with ADHD, OCD or ASD.

Obsessions and complaints

Obsessive are compound tics such as the feeling of having to touch, smell or lick people or things (compulsions).
GTS may cause learning difficulties, depression, antisocial behavior and aggressive behavior (Cohen et al.). It is three times more common in boys than in girls.

The diagnosis of GTS

  • One or more vocal and multiple motor tics are present or have been present. (a tic is a rapid, repetitive movement or vocalization).
  • The tics occur many times a day, intermittently, lasting more than a year. Tics may be temporarily absent.
  • People suffer from tics, especially socially and professionally.
  • The disorder is not attributable to narcotics or another medical condition (APA).

APA is the American Psychological Association.

Causes

Hereditary

Mainly genetic and biological factors cause Tourette’s. The vulnerability to develop GTS is hereditary. And a low birth weight (biological factor) also produces more tics. Male first-degree relatives of a person with GTS are more likely to develop GTS. First-degree female relatives are more likely to develop obsessive-compulsive disorder.

Guidance and treatment

Diagnosis of Tourette’s

A psychologist, psychiatrist or neurologist can diagnose the syndrome.

Information and guidance

Information for parents and child about the manifestations of GTS, often reassuring, turns into guidance: learning to deal with the tics and their acceptance. School and surroundings must be informed. Children should not have to walk on their toes, as this will increase tics. Psychotherapy, individually or in a family setting, is healing for dealing with the loss of control over one’s own body. Contact with fellow sufferers can also provide support.

Tourette’s cannot be cured

People with Tourette can learn to relax. You can do sports and ensure rest and regularity. Stress should be avoided and it is best to pay as little attention to it as possible.

Behavioral therapy

Two behavioral therapeutic methods appear to be effective. The first is called Exposure and Response Prevention and consists of holding back the tics for a long time. Counteracting tics is also practiced by habit reversal (Habitat reversal). Groups of muscles are activated to counteract the movement of the tic. A structured environment, with expected situations, reduces tension and therefore also tics.

Medication

Medication is only given if the tic is serious or is perceived as serious. This also applies when behavioral therapy fails. Antipsychotics are then given more often. GTS therefore decreases, but does not disappear. People are cautious about antipsychotics because they have many side effects.

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