Tourette’s Syndrome

The essential features of Tourette's Disorder are multiple motor tics and one or more vocal tics.

Symptoms include:

• Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. (A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.)

• The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.

• The onset is before age 18 years.

• The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).

Associated Features

The most common associated symptoms of Tourette's Disorder are obsessions and compulsions. Hyperactivity, distractibility, and impulsivity are also relatively common. Social discomfort, shame, self-consciousness, and demoralization and sadness frequently occur. A high percentage of children, adolescents, and adults with Tourette's Disorder do not seek medical attention for their tics. At the other end of the spectrum, there are individuals with Tourette's Disorder who are burdened by intrusive, recurrent, forceful, and socially stigmatizing motor and vocal tics.

Social, academic, and occupational functioning may be impaired because of rejection by others or anxiety about having tics in social situations. Chronic tic symptoms can cause considerable distress and can lead to social isolation and personality changes.

Course

The age at onset of Tourette's Disorder may be as early as age 2 years, is usually during childhood or early adolescence, and is by definition before age 18 years. The duration of the disorder may be lifelong, though periods of remission lasting from weeks to years may occur. In most cases, the severity, frequency, disruptiveness, and variability of the symptoms diminish during adolescence and adulthood.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.





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