Tics and Tic Disorders: What They Are, Causes & Types

Have you ever experienced sudden, repetitive, and uncontrollable movements or sounds? These could be tics, which are caused by a condition affecting the nervous system known as tic disorder. Tics are divided into two types including motor tics (involving movement) and vocal tics (involving sounds). They can range from mild and occasional to severe and persistent. Around 1 million people in the United States have Tourette Syndrome, a type of tic disorder. While all tics do not need urgent medical care, it is recommended to seek medical attention if they cause you a lot of distress, disrupt your daily life, or last for more than a year. Scroll down to learn what tics are a sign of, their types, causes, and other details.

What Are Tics?

Tics are sudden, repetitive movements or sounds that are difficult to control. They are caused by a condition of the nervous system known as tic disorder. Transient tics, a common form, are brief and temporary, often lasting less than a year. These tics affect over 20% of school-age children, typically appearing between the ages of 10 and 12.

Tic disorders are classified into different types, including:

• Provisional Tic Disorder: Tics lasting less than a year.
• Persistent or Chronic Tic Disorder: Tics that continue for more than a year.
• Tourette Syndrome: A condition involving multiple motor tics and at least one vocal tic.

In some cases, people with tic disorders may also have mental health conditions like depression, bipolar disorder, obsessive-compulsive disorder (OCD), ADHD, or substance use disorder.

Tics often improve or disappear over time, but for some, they can persist and require management for long-term well-being.

What Do Tics Feel Like?

Before a tic occurs, there may be an urge to perform the tic, similar to the need to scratch an itch or sneeze. A feeling of tension builds in the affected area, and performing the tic brings momentary relief. You may be able to postpone a tic briefly with conscious effort, but doing so can be challenging.

Controlling a tic is particularly difficult during times of emotional stress or fatigue, as these conditions often worsen symptoms. Tics may also intensify when the body is relaxed or when alone, and drawing attention to a tic can make it worse. Tics do not occur during sleep and typically lessen during focused activities, such as schoolwork or job tasks.

What Are the Potential Complications?

With appropriate treatment, tic disorders generally do not lead to complications. However, individuals with tic disorders may face an increased risk of mental health issues, such as anxiety, panic attacks, mood disorders, learning difficulties, and sleep problems. In some extreme cases, people may experience thoughts of self-harm. Other possible complications include body pain and challenges with anger management.

Tic disorders can sometimes impact self-esteem, which makes social interactions and forming friendships more difficult.

Read More: Anxiety in Children: What It Looks Like, Causes, and How to Help

How is a Tic Disorder Diagnosed?

A doctor or healthcare professional usually diagnoses tic disorders based on a standard set of criteria, including the type of tics, their duration, frequency, and the age at which they began. The healthcare provider may ask additional questions to assist with the diagnosis and identify possible causes, such as family history of tics and any medications taken for other health conditions.

In most cases, lab, blood, or imaging tests are not needed to diagnose a tic disorder. However, in rare instances, the doctor may order an MRI, CT scan, or electroencephalogram (EEG) to rule out other conditions.

You may choose to get your diagnosis from a pediatrician, primary care provider, or mental health specialist. Your doctor may also refer you to a specialist with different life-saving skills certifications if you show unusual symptoms.

What Are the 3 Kinds of Tics Disorders?

Tic disorders can affect people in different ways, from short-term symptoms to lifelong challenges. Thus, healthcare professionals must be aware of three types of tic disorders. This awareness makes it easier for them to diagnose patients accurately.

1. Provisional Tic Disorder

This disorder commonly appears during youth and affects up to 20% of school-age children. It is characterized by one or more motor or vocal tics that must have been present for at least a month but less than a year to diagnose.

Unlike other tic disorders, provisional tic disorder does not require both motor and vocal tics for diagnosis. These tics are usually temporary and tend to resolve on their own without needing significant medical intervention. However, if symptoms persist or worsen, seeking a healthcare provider’s advice is recommended for proper evaluation and management.

2. Persistent Motor or Vocal Tic Disorder

With this disorder, a child might have one or more long-lasting tics. Unlike provisional tics, chronic tics last more than a year. They may be either motor or vocal, and symptoms often begin before age 18. At least 1 in 100 children suffer from this chronic disorder. All persistent tic disorders are further divided into either motor or vocal, unlike Tourette’s which requires both.

3. Tourette Syndrome

This is another type of tic disorder in which the patient has both motor and vocal tics. The symptoms of Tourette syndrome usually begin in children between the ages of 5 and 10.

The severity of the child’s condition may change over time. Some children may have periods with fewer tics, followed by increased tic activity. In some cases, patients with Tourette syndrome may experience improvement as they get older, while in others, the condition may worsen with age.

What Causes Tics Disorders?

Healthcare providers and researchers still do not know the exact cause of tic disorders. However, recent studies have identified specific gene mutations that may contribute to this condition. 

• Tic disorders are also associated with brain chemistry, particularly the neurotransmitters – glutamate, serotonin, and dopamine.
• Imbalances in these chemicals can disrupt normal brain signaling, which eventually triggers tics. Dopamine dysregulation is especially associated with tic severity, while serotonin influences mood and impulse control, affecting tic behaviors.
• Tics can also result from various diagnoses, including head injuries, stroke, infections, poisoning, surgery, or other injuries.
• Certain tics can be associated with more serious medical disorders, such as Creutzfeldt-Jakob disease or Huntington’s disease.

Risk factors for certain tic disorders include genetics, as they often run in families. Men are more likely to be affected by different types of tic disorders than women.

What are the Symptoms of Tic Disorders?

Motor tic symptoms occur quickly and repeatedly without any pattern or rhythm. These tics may affect any body part but often involve the face, head, or neck.

• Simple motor tics involve a single muscle group and include blinking, grimacing, shoulder shrugging, head jerking, nose twitching, or darting eyes.
• Complex motor tics involve more than one muscle group and include touching or smelling objects, repeatedly mimicking someone’s movements, stepping in a specific manner, hopping, or making socially unacceptable gestures. 
• Complex motor tics can also include behaviors like copropraxia. These are involuntary, socially inappropriate gestures like obscene hand movements. Another common symptom is echolalia, which is the repetition of another person’s words.
• Vocal tics refer to the sounds patients make when they have tics. These include sniffing, grunting, humming, hissing, barking, or throat clearing. 
• Complex vocal tics also involve making animal noises, repeating sounds, yelling, or saying socially inappropriate words. 

Many individuals with tics experience a premonitory urge. This is a physical sensation or tension that builds up before a tic. This may often feel like pressure or an itch needing immediate release. 

Complications Associated with Tic Disorders

Children with tic disorders may often face other health complications, such as anxiety, ADHD, depression, autism spectrum disorder, learning difficulties, or OCD. Some may also experience speech and language difficulties and sleep issues.

Research has found that children with Tourette syndrome or any chronic tic disorder often experience a lower quality of life and decreased self-esteem. People with Tourette syndrome frequently have difficulties with social functioning due to their tics, anxiety, or ADHD.

How to Diagnose Tic Disorders?

Diagnosing tic disorders typically involves a thorough medical evaluation, including a review of the patient’s medical history and symptoms. Healthcare providers rely on specific criteria to make an accurate diagnosis, with the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) being a key tool used by professionals. To diagnose a tic disorder, the provider will first look for the presence of motor tics (involving movement) or vocal tics (involving sounds). 

• The tics must occur repeatedly and be noticeable for at least one year to meet the criteria for a diagnosis of persistent or chronic tic disorder. If tics have been present for less than a year, the diagnosis may be provisional tic disorder.
• Tourette’s syndrome requires the presence of both multiple motor tics and at least one vocal tic, persisting nearly every day for more than a year, with onset before age 18.
• The criteria used to diagnose transient tic disorder include the presence of one or more tics, which may occur for more than 12 months in a row.
• Chronic motor or vocal tic disorders may be diagnosed if the tics have occurred daily for a year or more. People with a chronic tic disorder may occasionally experience either motor or vocal tics. 
• Most children are under 11 at the time of diagnosis. To rule out other causes of tics, a doctor may suggest blood tests, MRI scans, or other imaging techniques.

How to Treat Tics Disorders?

Tic disorders do not have a cure, but a doctor can recommend treatments to manage the symptoms. These treatments may include medications and therapy if the tics cause injury or pain, create stress, or interfere with your daily life.

Medications

Medications can help manage some serious and disturbing tic symptoms. They can also improve your daily experience with the condition. Antipsychotic medications like aripiprazole and risperidone are often prescribed for tics. On the other hand, alpha-agonists like clonidine are also used in less severe cases of tic disorders.

Please note that medications cannot completely eliminate tics. Your doctor may adjust medications and dosages until you find the best one with the fewest side effects.

Behavioral Therapy

You may prefer working with a mental health professional to learn ways to reduce how often you experience tics and how much they affect you. Habit reversal is the most common type of behavioral therapy, which involves awareness training and competing response training. 

• In awareness training, you say the tic out loud as it occurs. A competing response helps you learn how to change your behavior when the tic happens.
• Comprehensive behavioral intervention for tics (CBIT) is another form of behavioral therapy. It is the most recommended form of behavioral intervention for tics, with significant evidence supporting its effectiveness. CBIT often includes education about tics, relaxation techniques, evidence-based approaches to managing tic disorder symptoms, and habit reversal.

Read More: How to Manage Stress – Understanding the Root Causes

Psychotherapy

Psychotherapy, or talk therapy, may help manage mental health problems that often accompany tic disorders, such as ADHD, depression, and anxiety. It typically involves one-on-one or group conversations with a therapist, who helps you identify and change troubling emotions, thoughts, and behaviors related to mental health.

Deep Brain Stimulation (DBS)

This treatment involves placing a small device in the brain to send electrical signals to certain parts of your body. This treatment is still being studied, and research continues globally to determine its safety and effectiveness. It is only recommended for individuals with severe tic disorders.

Tic Disorder: Is There a Remedy?

A person suffering from a tic disorder can usually lead an active life without complications, especially if they are receiving the appropriate treatment. If you are a healthcare provider, it is essential to enroll in certifications that teach you how to treat or manage tic disorders. Ensure that you earn the certificate from a recognized organization so that you can help individuals with tics and other related conditions.