What are tics? Tics are abrupt, rapid, and recurring movements or sounds that cannot be fully controlled. They can be classified as motor or vocal and as simple or complex.
Motor tics are involuntary movements. Simple motor tics affect a single muscle group and body part (e.g., eye blinking, nose scrunching, shoulder shrugging), whereas complex motor tics affect different muscle groups in sequences (e.g., hand gestures, jumping, touching objects).
Vocal tics are involuntary sounds. Simple vocal tics are single sounds (e.g., throat clearing, sniffing, coughing), whereas complex vocal tics are syllables, words, or phrases (e.g., repeating or blurting out words).
How are tics assessed and diagnosed? A psychologist, psychiatrist, or medical doctor can diagnose tics by talking to you about your symptoms. Your healthcare provider will ask you to describe how your tics look and feel, how frequently they occur, when they started, and how much they’re interfering with your daily activities.
Your healthcare provider may use a diagnostic label to describe the severity of your tics. Provisional tic disorder means that tics have been present for less than a year. Persistent (chronic) motor or vocal tic disorder means that tics have been present for more than one year. Tourette syndrome means that both motor and vocal tics have been present for more than one year.
Tic disorders are neurodevelopmental disorders: They are brain-based, and symptoms appear before age 18. Tic disorders often co-occur with other neurodevelopmental disorders, such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and autism spectrum disorder (ASD).
Tic disorders have a typical pattern. The first tics are usually simple motor tics. As symptoms progress, complex and vocal tics can also occur. Symptoms can increase and decrease depending on stressors and environments. Males are three times more likely than females to have tic disorders. Tics usually start around 4 to 6 years old, peak around 10 to 12 years old, and decrease and even remit thereafter. By late adolescence and young adulthood, over one-third of patients diagnosed with Tourette syndrome are unaffected by tics.
In recent years, and especially since the onset of COVID-19, healthcare providers and researchers have noticed a tic phenomenon that does not follow the typical course of tic disorders. Experts are reporting an unusual rise in sudden onset “tic-like attacks” in girls and young women ages 12 to 25 who have no definite history of tics. These patients show complex motor and vocal tics (e.g., hand and arm movements, jerking or flailing limbs, unusual phrases and “hoos”) and, in some cases, feel so distressed that they seek emergency help. These patients may have underlying anxiety and mood disorders, and they are not faking their symptoms—the tics are real, uncomfortable, and upsetting. These patients do not have a primary tic disorder. Experts refer to their presentation as functional tic-like behaviour (FTLB), a functional movement disorder, or a functional neurological disorder. Essentially, their brain is unconsciously trying to release emotional stress in the form of a physical disorder. Experts think a social media culture of viewing, recording, and self-diagnosing tics might be inadvertently reinforcing these patients’ symptoms.
How are tics treated? In some cases, tics are transient and self-limiting. If tics are not interfering with daily activities, many patients and carers can manage on their own with education, social support, and stress-management techniques.
If tics persist and interfere with functioning, behavioural therapy is recommended as a first-line treatment. Comprehensive Behavioural Intervention for Tics (CBIT) involves building awareness of the urges that precede tics, learning to substitute different behaviours for tics, and making changes to environments and routines to reduce triggers for tics. Relaxation training and mindfulness can also help. If tics do not sufficiently resolve with CBIT, patients can try medication.
CBIT may also help patients who have functional tic-like behaviour; however, in these cases, additional psychiatric treatment is recommended to address underlying emotional stressors and anxiety or mood disorders. Functional tic-like behaviour will not respond to the type of medication used in Tourette syndrome.
What should I do if I think I’m experiencing tics? Speak to your primary care provider about your concerns. Even if your tics feel manageable, your primary care provider can help you monitor them and determine whether further assessment for co-occurring conditions is warranted.
You can also follow these steps for managing your tics:
Over-focusing on tics can make them worse. You should avoid criticizing, questioning, or commenting on tics when they occur (e.g., “Why are you doing that?” “Stop that!”). Instead, try to focus on the current activity.
Stress and anxiety can make tics worse. Worrying about tics is common, but it’s not helpful. Remind yourself that although tics can be uncomfortable, they are not dangerous, they will pass, and you will manage. It’s important to find healthy outlets for emotional stress, such as talking to a trusted friend or engaging in a fun or relaxing activity. Make sure to prioritize sleep, nutrition, and exercise.
Tics are “suggestible”, and consuming tic-related content on social media can make them worse. If you’re experiencing a sudden onset or worsening of tics, take a two-week break from all social media platforms, especially TikTok. Remember that TikTok is not a reliable platform for receiving medical advice (including mental health advice), and self-diagnosing tics based on social media content can be harmful.
Use social media responsibly: Learn to question sources and spot misinformation, discuss what you’re viewing with someone you trust, and “unplug” frequently from all screens.
Books The Tourette’s Survival Kit: Tools for Young Adults with Tics by Tara Murphy and Damon Millar Tic Disorders: A Guide for Parents and Professionals by Uttom Chowdhury and Tara Murphy Understanding Tourette Syndrome: A Handbook for Families by the Tourette Syndrome Foundation of Canada Online Program Tic Helper: An Online Program to Help Children with Tic Disorders