Motor and Vocal Tics: Causes, Symptoms, and Treatment

Tourette syndrome (TS) is a neurodevelopmental condition on the spectrum of Tic Disorders which affects the brain, spinal cord, and nerves. It is characterized by sudden, uncontrollable movements and/or sounds called tics. Diagnosis requires motor and vocal tics present for at least 1 year.

Other Tic Disorders

A spectrum of neurodevelopmental conditions which include:

• Chronic Motor or Vocal Tic Disorder (CMVTD): the presence of motor OR vocal tics (not both) for more than 1 year.
• Provisional Tic Disorder (PTD): Tics occurring for less than 1 year.
• Not Otherwise Specified: for tics that have an atypical onset after age 18, or do not meet criteria for another specific tic disorder.

Trichotillomania (TTM)

Trichotillomania (TTM) is an impulse control disorder where hair pulling is the trademark symptom. Common areas on the body where hair is pulled include the scalp, eyelashes, eyebrows, and the pubic area. Pulling may be automatic (without thought) or a focused response to a trigger.

TTM patients can experience medical complications of their pulling behaviors which include skin irritations at the pulling site, dental problems from biting or chewing hair, infections, and repetitive-use hand injuries. Some may develop GI complications if they ingest their chewed hair.

Symptoms of Tic Disorders

Symptoms normally occur before the age of 18. Most people with TS experience their worst tic symptoms in their early teen years with symptoms dissipating in young adulthood. Symptoms of tic disorders are typically worse during times of excitement or anxiety, and occur less frequently when the person is absorbed in activities, concentrating, emotionally pleased, or sleeping.

Types of Tics

• Simple Motor Tics: Sudden, brief, repetitive movements of a small amount of muscles such as blinking, grimacing, shrugging, or jerking of head or shoulders.
• Simple Vocal Tics: Can include repetitive throat-clearing, sniffing, snorting, grunting or barking sounds.
• Complex Motor Tics: Involve distinct, coordinated patterns of movements that involve large muscle groups. Can be a coordinated series of simple motor tics and include movements such as hopping, jumping, bending, and twisting.
• Complex Vocal Tics: Include words or phrases.

Premonitory sensations: a sensory phenomenon which occurs in 90% of adults with tic disorders where an urge, impulse, tension, pressure, or tingle occurs before a motor or vocal tic, usually sensed in specific locations in the body (shoulder, hands, throat).

Understanding Tics: A Comprehensive Guide to Motor and Vocal Tics

Causes and Prevalence

Researchers believe tourette’s to be hereditary, though other factors may be involved. The cause of TTM is probably multiple genes and environmental risk factors.

Prevalence of TS in adults appears to be around .05%, though more study is needed on the prevalence of TS in adults. 3.4% of adults are thought to have Trichotillomania. TTM affects primarily females, whereas males are affected 3-4 times more than females by tic disorders.

Treatment Options

Tic and hair pulling symptoms can decrease self-esteem and interfere with family life, social acceptance or job functioning. They're chronic conditions, and symptoms vary, changing over time.

Behavioral Therapy

Behavioral therapy teaches a person to become aware of their behavior and helps them change what they do in a careful and systematic way.

Habit Reversal Training (HRT)

Habit reversal training is a cognitive behavioral therapy technique used for treatment of tic disorders and trichotillomania. It includes:

• Self-Monitoring/Awareness: Improves your awareness of pulling, or tic behavior and the urge that precedes the behavior, as well as triggers.
• Stimulus Control: Methods to reduce the likelihood that the behavior will start.
• Competing Response Training: Learning a new response behavior to engage in at the earliest sign of an urge to pull or tic, that prevents you from pulling or ticing at that moment because the behaviors cannot both be done at once.

Comparison of Tic Disorders

Disorder	Symptoms	Duration
Tourette Syndrome (TS)	Motor and vocal tics	More than 1 year
Chronic Motor or Vocal Tic Disorder (CMVTD)	Motor OR vocal tics	More than 1 year
Provisional Tic Disorder (PTD)	Tics	Less than 1 year
Trichotillomania (TTM)	Hair pulling	Chronic condition