Tics are repetitive and stereotyped movements or vocalizations. Stereotyped means that the movements or vocalizations follow one or more patterns. For example, some individuals with tics will have a hand flapping movement that is typical for them; others will have a facial grimace that they perform regularly. Most individuals will have several different tic patterns. A vocalization is defined as any sound created by the vocal cords or by air passage through the vocal system. Vocal tics include words, but they also include sniffing, coughing, grunting, and throat clearing. Tics that involve movements only are referred to as motor tics.
Most individuals with tics will describe an urge to perform the movement or the vocalization. This feeling is referred to as a premonitory urge. Patients have described the premonitory urge as a sensation similar to the feeling that a sneeze is coming. They feel the urge to perform the tic and then feel some relief after the tic is completed (much like a sneeze). Younger children with tics might not be able to describe this feeling.
Tics can increase with emotional stress, physical stress, and during periods of relaxation or boredom. Tics are also suppressible, meaning that the individual can focus on preventing them. Tics might disappear completely during periods of intense focus (for example, a difficult math test).
Tics can be categorized as simple or complex. Simple motor tics involve movements that are restricted to a single body part. Examples of simple motor tics include eye blinking, shoulder shrugging, neck stretching, and facial grimace. Simple vocal tics include throat clearing, grunting, coughing, and sniffing, but not tics with words. In contrast, complex motor tics involve a cluster of movements or vocalizations that often appear to have a purpose. A complex motor tic might involve a sequence of touching different objects or performing certain gestures. Complex vocal tics typically involve words. There are several categories of complex vocal tics:
- Echolalia: repeating words spoken by others
- Palilalia: repeating one’s own previously spoken words
- (And, by far the most interesting) Coprolalia: uttering socially objectionable words and phrases, which includes cursing and insulting others. Coprolalia is a highly publicized feature of Tourette’s’s syndrome, but it is relatively rare.
Tourette’s’s (too-RET) syndrome is diagnosed when a patient has two or more motor tics and at least one vocal tic that begin prior to age 18 years, occur daily or nearly every day, and have continued for more than one year.1
The next blog posts will discuss Tourette’s’s syndrome in greater detail, other features associated with tics, and tic treatments.
¹American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, D.C.: American Psychiatric Association; 2013