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Do you or someone you love live with tics or a tic disorder? Tics can seem so mild that you question whether they're actually a problem, or so severe that they scare the pants off you! And when you've looked up tic disorders or Tourette Syndrome on the Internet or YouTube, you've probably found a lot of conflicting, and sometimes stigmatizing information.
So what's the real deal about tics? Psychologist Kelly Ann Cartwright, a specialist in tic disorders who grew up with tics herself, answers the most common questions she hears in her practice.
What are tics?
A tic is a sudden, short-lasting, nonrhythmic movement or vocalization. These sounds or movements occur suddenly during what is otherwise normal behavior. Tics are usually repeated; a person could do several of the same tic in a row or might find themselves doing the same tic hours or days apart. Tics are considered semi-voluntary. While many people with tics can temporarily hold-in their tics, doing this can be quite uncomfortable (imagine trying not to blink or trying not to scratch a mosquito bite), and might not be possible for all of their tics.
Movement-based tics (called motor tics) can include excessive, repeated or forceful blinking or eye movements, nose or mouth movements, head jerks or turning, shoulder shrugging or any other movement a person can do with their body. Motor tics are called complex when they involve more than one group of muscles, such as a facial tic involving eyes, nose, mouth and jaw, or short series of movements performed in the same order.
Sound-making tics (called vocal tics or phonic tics) can include sniffing, throat clearing, coughing, humming, or any other sound a person can make. Vocal tics are considered complex when they involve language (such as syllables, words, phrases or animal sounds) or repeating of some sort. Some tics can be invisible to the observer, such as abdominal tensing, toe crunching inside shoes or ear popping.
What are tic disorders and Tourette Disorder / Tourette Syndrome?
When tics start before the age of 18 and continue for more than a year (even if they seemed to disappear for a period of time), a person may have a tic disorder such Chronic Tic Disorder (if only motor tics or only vocal tics occur) or Tourette Disorder (when both motor and tics have occurred). A diagnosis of Tourette is not more severe than a diagnosis of chronic tic disorder, it simply means that both types of tics have occurred at some point.
A core feature of chronic tic disorder and Tourette Disorder is that tics evolve or change over time. They “wax and wane” in frequency, number and intensity, meaning they can vary widely in these respects. The localization (where in the body or which sound) also tends to evolve or change over time. In Tourette Disorder, the nature (motor or vocal) of the tics may also evolve or change over time, with periods characterized by relatively more or less severe motor or vocal tics, periods where both are prominent, and periods where both are milder.
It's important to note that a person can have tics without having a tic disorder. It's estimated that up to 25% of children have tics at some point in their development, as a normal part of development, but not all of these will develop a tic disorder.
How common are tic disorders?
Quite common!
A recent global study showed that approximately 1 in a hundred (1%) children or adults will have a tic disorder. To put this into a Canadian perspective, this statistic represents up to 17,500 Montrealers, 81,000 persons across Québec or 375,000 Canadians!
Why are tics often not diagnosed?
Despite their prevalence, tic disorders often go undetected. One reason may be that tic disorders can be easy to miss, for example:
if tics are of mild severity;
if tics are disguised as voluntary movements or perceived by others as “quirks”;
if the person regularly holds in their tics around other people; or
if the person with tics also has other, more noticeable/severe difficulties that may overshadow the tics in the minds of parents, teachers, spouses or other important people in their lives.
For these and other reasons, many people with tic disorders go undiagnosed for years, or even for their entire lifetime. Unaware of the medical and nonmedical treatments that exist, many may struggle to hide more severe tics and feel resigned to suffer in silence.
When should tic disorders such as Tourette disorder be treated?
Most tic disorders will not require any treatment. Tics are considered to warrant treatment if they are painful or dangerous, if they begin to interfere with the ability to function at home, at school, at work or in social relationships, or if they have a negative impact on well-being and quality of life, including feelings of anxiety or depression.
Even if tics don’t require treatment, specialized psychological treatment for tics can help a person manage their tics differently, to feel more comfortable with them and to feel more in control.
Head on over to Part 2, which focuses on the treatments available for tics!