Tourette’s syndrome (TS) is a neurological disorder that usually starts in childhood. It includes sudden, rapid, repetitive, non-rhythmic movements or vocalisations known as ‘tics’.
TS is a much misunderstood condition in society, where symptoms of TS manifesting in the form of repeated swearing or generally inappropriate comments, affect only a small percentage of people with the disorder.
For two thirds of children with TS, tics get better in the course of adolescence, and disappear completely or reduce very substantially to the point of not being at all bothersome by early adult life. However, it's estimated that there are currently over 300,000 children and adults living with TS in the UK. Tics in TS tend to fluctuate in frequency and severity, with their peak being at around the age of 10 to 12 years. TS frequently co-exists with other conditions like attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), or other neurodevelopmental and mental health issues.
While there's no cure for TS, mental health treatment can help you to manage your symptoms and improve your overall quality of life. If your tics are particularly severe to the extent that they're causing you significant frustration, stress or physical pain, Priory’s nationwide network of highly experienced specialists can help to alleviate your symptoms.
TS is a neurological disorder that's characterised by repetitive involuntary movements and vocalisations known as tics. You would usually observe symptoms of tics in your child, with boys thought to be affected up to three or four times more than girls.
The tics that are associated with TS can include simple movements, usually concentrated within certain groups of muscles such as the face and shoulders. Some of the most common tics include repeated eye blinking, shoulder jerking and grimacing, while simple vocal tics may involve throat clearing or sniffing.
Alternatively, you or your child may experience more complex tics, which tend to combine the more simple involuntary movements and vocalisations together. For example, repetitive eye blinking could coincide with shrugging shoulders and facial movements, while more complex vocal tics could involve words or phrases. Although it only applies to around 10% to 15% of people with TS, complex tics can involve involuntary swearing or repeating the words or phrases of others. TS may also be associated with forms of self-harm such as physically punching yourself.
Whether you or your child’s TS symptoms are diagnosed as mild or severe, these symptoms can vary in type, frequency and severity as time goes by. For example, symptoms of TS can initially start in the head and shoulder area, before moving elsewhere on the body. Simple tics and involuntary movements will generally happen before you notice any vocal tics or more complex patterns of movement.
Due to the cause of TS involving problems in brain communication and functioning, it's possible that a diagnosis of TS can include associated behavioural problems and mental health conditions at the same time. These can include hyperactivity and problems with attention as part of ADHD, or the intrusive thoughts and worries that are characteristic of OCD. This is why you or your child may need a comprehensive treatment plan that also aims to treat other conditions that may be present.
Treatment available at Priory hospitals and wellbeing centres can help to alleviate some of the most debilitating symptoms of TS. Behavioural therapy sessions can help you or your child to learn coping mechanisms and alternative voluntary movements to reduce the urge to repeat a tic a certain number of times before the desire goes away. Many tics can be worse if you or your child are feeling particularly anxious or excited. Therapy sessions are designed to help you to observe and understand these triggers to help you manage your condition.
The precise cause of TS is still unknown, although it's believed to develop from a problem in the part of your brain that regulates body movements.
Due to the complexity of many instances of TS, there are likely to be a combination of genetic and environmental factors that influence the brain’s ability to correctly transfer information required for movement. Therefore, chemicals such as dopamine and serotonin, which play a part in sending these messages, may also be involved.
Further risk factors for developing TS include:
Priory understands that living with TS can be very difficult and can even stop you living the life you want. That’s why we offer flexible outpatient therapy programmes delivered by specialist therapists, that help to improve symptoms of Tourette’s and work towards improving your quality of life.
While tics aren’t unduly harmful to you or your child’s health, motor tics involving sudden, jerky movements can feel painful. The frequency and severity of these tics can vary from day-to-day, with symptoms feeling worse on some days, and improved on others. Tics may be triggered when you or your child are feeling particularly stressed, anxious or tired, or even during periods when you or your child are particularly relaxed.
If you or your child have tics, then it's likely that you'll feel an internal urge to relieve a tic before it happens. This is referred to as a ‘premonitory sensation’, and is similar to the anticipation felt before having to sneeze. The only way to relieve the urge is to complete the motor or vocal tic, or repeat the tic a specific number of times.
These premonitory sensations may include:
It's believed that some people with TS can control their tics, particularly when they're especially unwanted, such as during social situations, a work meeting or school classroom, although this takes a great deal of practice and concentration.
Even if you're able to control when tics occur, it can be very tiring each time you suppress the urge. This can lead to an increase in tics subsequently as your body’s way of compensating.
You may notice that tics occur less in certain situations, like when you're reading, playing sports, or are taking part in any activity that needs more concentration during your day.
While there's currently no cure for TS, most children and adults with tics won't need medication or specific treatment to relieve symptoms. If your tics are frequent and severe, to the extent that they're affecting your day-to-day life or are causing you to experience social and emotional problems, then Priory’s therapeutic treatment programmes for TS can help.
Behavioural therapy and psychotherapy sessions will be provided by specially trained therapists or psychologists who are highly experienced at treating people with tics and other symptoms of TS. These methods can help to reduce the frequency and severity of your tics through controlling urges to tic and increasing your awareness of triggering situations.
Some of the behavioural therapy and psychotherapy techniques used at Priory include:
CBIT includes habit reversal training, which involves understanding the feelings and emotions that lead to you experiencing tics. After this, you'll work with your therapist to determine other ways that you can reduce the urge to tic.
This may also involve learning how to voluntarily move before you believe a tic is about to occur, which can ultimately reduce symptoms by not allowing your body to fall into a pattern of involuntary movement.
Psychotherapy may also be used to help you learn coping mechanisms for not only dealing with symptoms of TS, but also any associated social and emotional problems that can develop as a result of the condition.
This can include turning a negative outlook into a more positive one, focusing on proactive methods of improving your relationship with the condition, and working towards making you feel more hopeful about living with TS, both now and in the future.
If you've been diagnosed with TS, and the tics and associated symptoms of the condition are negatively impacting on your wellbeing, then medication can help to reduce the frequency and severity of your tics. While there's no one medication that will guarantee significant relief from symptoms, groups of drugs such as A2 agonists or very small doses of antipsychotic medications can prove to be effective.
Certain medications can also be useful when treating related neurodevelopmental or mental health disorders that can occur if you have TS. These include stimulant medication for ADHD and selective serotonin reuptake inhibitors (SSRIs) for OCD, anxiety and depression.
