Tourette Syndrome (TS) is a neuropsychiatric tic disorder characterized by the presence of two motor and one vocal tic over the course of a year. TS is largely misunderstood as a tendency to yell vulgarity, but this is simply not the case. Here’s the real deal on the motor and vocal tics involved in TS.
Tics and the Promontory Urge
Tics as a result of TS are generally first seen in childhood. While TS may appear anywhere between 2 years and 18 years, around the age 6 or 7 is the most common time of development. Whether motor or vocal, tics are essentially an overwhelming need to perform some sort of movement or make some sort of sound. Although “uncontrollable” is a term often used, this isn’t necessarily true. Rather, the compulsion to express tic is irresistible.
Tics are generally heralded by a “promontory urge.” There’s a sensation of discomfort, such as a tingling or itching, somewhere on or throughout the body. This is essential to behavioral treatment, as recognizing the promontory urge can help with habit-reversal training; this method of therapy utilizes the indication to find ways to avoid the expression of the tic.
Each tic is either a motor or vocal (also called phonic) tic. Motor tics are compulsory movements formed repetitively without context. There are two types of motor tics: simple and complex. A simple motor tic is exactly what it sounds like: the movement is very simple, usually using only a few muscles. Common examples of simple motor tics include: nodding, head bobbing, nose twitching, blinking, and shrugging, among other things.
Complex motor tics are repetitive and compulsory movements that involve more than one muscle group, often appearing almost choreographed. There may be a series of movements, and complex motor tics often give the impression of being more purposeful than simple motor tics. Examples of complex motor tics include: patterned steps, skipping, jumping, obscene gestures, and touching objects.
A vocal or phonic tic is the compelled expression of noise. Like motor tics, there are both simple and complex phonic tics. Simple tics generally involve only sound, while a complex phonic tic is comprised of a word or phrase expressed repetitively and out of context (although they are essentially familiar and make sense). Examples of simple vocal tics might include shouting, hooting, throat clearing, or grunting.
Common complex vocal tics might be comprised of repetition or a specific word or group of words. Common types of phonic tics include:
- Coprolalia: A vocal tic involving the uncontrollable compulsion to use inappropriate or vulgar words and phrases out of context. Coprolalia might involve profanity, racial slurs, or other obscene language. While coprolalia is a well known tic often considered a common tic in TS, less than 15% of vocal tics actually involve coprolalia.
- Echolalia: A vocal tic involving the uncontrollable compulsion to repeat the phrases, words, or sounds of others, possibly multiple times. Echolalia is seen in other psychiatric and degenerative disorders.
- Palilalia: A vocal tic involving the uncontrollable compulsion to repeat the phrases, words, or sounds of the self. The repetition is instant and also seen in other disorders.