Characteristics of tics include:

Tics are predictable.

• Tics will occur consistently based on situation or environment.

• With experience one can tell what situations a particular tic will occur in.

Tics are suppressible.

• Tics can be prevented or stifled, usually at the cost of effort or discomfort.

• Sometimes the term 'unvoluntary' is used to describe this (Cavanna et al., 2013).

  • Voluntary action: "... is consciously performed, is flexible, and can be controlled."

  • Involuntary action: "... is automatically performed, is inflexible."

  • Unvoluntary action: "... is perceived as a voluntary response to an uncontrolled and involuntary urge to move."

• Suppressing a tic may also cause tics to be worse when the suppression is ended.

Tics are distractible.

• Tics tend to calm down when one is focused on something else.

Tics are suggestible.

• Tics may be worsened or triggered by seeing or thinking about them.

Tics are nonrhythmic.

• Tics don't occur on a regular, rhythmic beat.

• This is contrasted by similar symptoms of other disorders, such as stereotypies/self-stimulatory behaviors.

Tics are usually preceded by a premonitory [sensory] urge.

• More than 90% of patients experience a premonitory urge before ticcing (Reese et al., 2014).

• Premonitory [sensory] urges are described as a building discomfort in the area where the tic will occur.

  • This discomfort is typically relieved following execution of the tic.

  • The sensation may be described as a building energy (80%), a feeling of "not right" (76.2%), an incompleteness (65.6%), a pressure (58.2%), or an itchiness (40.2%) (Reese et al., 2014).

• Premonitory urges are thought to be critical to the maintenance of tics (Reese et al., 2014).

  • 71% of patients with Tourette syndrome believe their tics would no longer occur if the premonitory urge were eliminated.

  • Two-thirds of patients with tics describe all of their tics as voluntary responses to involuntary [premonitory] urges.

    • Another 25% say this is true of at least some of their tics.

• Premonitory urges may not be noticed by young children, but patients are usually aware of them by late childhood (around age 10).

  • This may have to do with the disorder impairing the "recognition of authorship of the action" (Cavanna te al., 2013).

Tics wax and wane.

• Over time the intensity and frequency of tics will gradually fluctuate.

• Tics may even disappear entirely for months at a time.

Tics may worsen with stress and may improve when sleeping.

Tics only affect voluntary muscle groups.

• Involuntary muscles (eg. the heart) cannot have tics, but heart diseases may occur more commonly with tic disorders (Brander et al., 2019).

Tic disorders are categorized as the following:

Neurodevelopmental disorders.

• Tic disorders are rooted in the brain's structure as it develops.

  • Tics will most often first appear (onset) in the early developmental period (ages 4-6); onset becomes increasingly rare with age.

  • There are no true "cures" for tic disorders because the disorders are built into the brain's structure.

  • Tic disorders are heavily rooted in genetics; heritability ranges from 0.25 to 0.5 (Zilhão et al., 2017; Center for Disease Control and Prevention [CDC], 2022).

    • There is an environmental (epigenetic) factor to the development of tic disorders as well (Pagliaroli et al.,2016).

Disorders of the nervous system.

• Tic disorders affect nervous system, which controls the sensory and motor signals between the brain and body.

Hyperkinetic movement disorders.

• Tic disorders involve involuntary (or 'unvoluntary') movements.

• Other movement disorders include Parkinsonism, choreiform disorders, ataxic disorders, and myoclonic disorders.

Obsessive-compulsive disorder (OCD):

• Experienced by at least 20% of patients with tic disorders (Robakis, 2017).

• Traits of OCD are experienced by 66% of patients with tic disorders (Robakis, 2017).

• Evidence of ADHD or OCD is always seen in the patient or their immediate family (Coffman & Quezada, 2021).

  • ADHD, OCD and tic disorders are commonly referred to as the "Tourette clinical triad" or "Tourette triad."

Tourettic OCD:

• Common Tourettic OCD "impulsions" include:

  • The need to repeat an action or tic until it feels "just right" (and preoccupation or discomfort when this cannot be done).

  • A relatively high need for tactile actions like touching, tapping, or rubbing.

  • Impulsions regarding symmetry, numbers, or exactness.

• Tourettic OCD may be differentiated from traditional OCD in the following ways:

  • It tends to have an earlier onset, appearing first alongside the tic disorder (whereas classic OCD typically onsets in adolescence).

  • It is more common in males than females, like tic disorders (whereas classic OCD is more balanced).

  • Its "Impulsions" are preceded by a physical discomfort akin to the premonitory sensory urge of tics rather than an obsession.

  • It may be associated with a higher percentage of violent or sexual thoughts.

• Tourettic OCD is likely related to, but distinct from, both tic disorders and OCD.

  • It is likely neurologically more closely related to tic disorders than OCD.

  • Tourettic OCD is suggested to lie on a continuüm or spectrum between tic disorders and OCD.

Autism spectrum disorder (ASD):

• Including sensory processing issues.

Anxiety disorders:

• Especially separation anxiety.

Behavioral disorders:

Mood disorders:

• Especially depressive disorders or bipolar disorder.

Misconception: Individuals with tic disorders all have swearing tics.

Reality: Swearing as a tic (coprolalia) is rare.

1. • • They only 10-15% of individuals with tic disorders ever experience coprolalia.

Misconception: People with tic disorders can control their tics if they try.

Reality: While tics can usually be suppressed, suppression is not the same as control.

1. • • Suppressing tics also causes unhealthy exhaustion and stress, and may make the tics worse later.

Misconception: Tourette syndrome is the only tic disorder.

Reality: Tourette Syndrome is one of several tic disorders.

1. • • TS is the most advanced tic disorder, requiring both motor and phonic tics for diagnosis.

     • Chronic motor/phonic tic disorder diagnosis requires only motor or only phonic tics.

     • There are also secondary tics disorders which are tic disorders caused by infections, drugs, or illness.

Misconception: Tics go away in adulthood; only kids can have tic disorders.

Reality: Tics do tend to diminish in adulthood, but only 1/3 of individuals with tic disorders no longer experience any tics in adulthood.

Misconception: When tics disappear they are gone for good.

Reality: Tic disorders wax and wane over time, sometimes disappearing entirely for a time.

1. • • If tics disappear they may or may not be gone for good.

Misconception: Tic disorders are a mental illness.

Reality: Tic disorders are neurodevelopmental disorder, not psychiatrics illnesses.

1. • • That is, they are built into the brain's development, not obtained later in life.