Tic disorders aren’t well understood, but they’re beginning to gain more recognition, in large part because more people — including celebrities like Billie Eilish — are speaking openly about what it’s really like to live with a tic disorder. One of the most common misconceptions about tics, which the CDC defines as “sudden twitches, movements, or sounds that people do repeatedly,” is that they are voluntary, attention-seeking behaviors — and this simply isn’t true. In reality, people have no control over their tics, whether they are physical or verbal.
About a half million children in the United States have a tic disorder, estimates the Tourette Association of America. Some tics are temporary and pass on their own over time, but others experience tics into their teens and adulthood. New research shows that persistent tic disorders (including Tourette syndrome) may affect about 1.4 million people in the US.
Tics can be motor (physical, such as blinking or shrugging, or more elaborate movements like hopping or bending) or vocal (such as grunting, throat clearing, or full words or phrases), the National Institute of Neurological Disorders and Stroke states. “Symptoms of tics include blinking, jerking or banging one’s head, clicking fingers, coughing or sniffling, or repeating a sound or phrase,” Julian Lagoy, MD, a psychiatrist with Mindpath Health, says.
The type and duration of tics influence the potential diagnosis. The American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5) includes three tic disorders:
- Tourette syndrome (TS). TS has a few different characteristics that warrant a diagnosis: the presence of two or more motor tics, one vocal tic, tics for at least a year, tics that appeared before age 18, and symptoms that are not caused by other drugs or medical conditions.
- Persistent motor or vocal tic disorder. People with this condition must have one or more motor tics or vocal tics (not both); frequent, nearly daily tics occurring for over a year; have symptoms not caused by other drugs or medical conditions; have tics appearing before age 18; and cannot be diagnosed with TS.
- Provisional tic disorder. People with this disorder must have one or more motor or vocal tics present for no more than 12 consecutive months, have symptoms not caused by other drugs of medical conditions and appearing before age 18, and cannot be diagnosed with either TS or persistent motor or vocal tic disorder.
In addition to these three clinical disorders, it’s also possible to develop tic-like behaviors that do not meet the criteria for a diagnosis. In fact, the Tourette Association of America reports that since the COVID-19 pandemic, there’s been an increase in sudden onset, tic-like behaviors among young people.
Causes of Tics
“It is unknown what exactly causes tics to develop and occur,” Dr. Lagoy says, noting that several different factors may be associated with tic disorders. Underlying conditions, genes, and other environmental factors can all play a role in someone’s experience or diagnosis. “However,” Dr. Lagoy adds, “the severity and occurrence of tics is increased due to stress and sleep deprivation.”
Additionally, there are several other conditions associated with the tic disorder spectrum — specifically Tourette syndrome. The CDC reports that 83 percent of children with TS also have at least one other disorder, including anxiety, OCD, ADHD, learning disabilities, autism, depression, and developmental delays.
For older adults and teens, the National Health Service does note that tics and other symptoms “usually improve after several years and sometimes go away completely,” though there is currently no cure for Tourette syndrome.
Most Effective Tic Treatments
A tic disorder can only be diagnosed by a healthcare provider or specialist — Dr. Lagoy recommends seeing a neurologist and psychiatrist if you are experiencing tic-like symptoms.
Treatment depends on the individual’s need but usually involves one or a combination of the following, per the National Institute of Neurological Disorders and Stroke: medication (including dopamine blockers, stimulants, or alpha-adrenergic agonists), behavioral therapy (like Cognitive Behavioral Intervention for Tics, for example), or psychotherapy.