Symptoms of TS

The key features of Tourette syndrome (TS) are tics; both repeated movements and sounds that are involuntary. Most people with TS will experience co-occurring conditions also such as obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD) and anxiety.

Tics

Tics usually start in childhood around the age of six to seven years and tic symptoms often fluctuate in severity and frequency.  Although the nature of tics is that they come and go, such patterns are also influenced by environmental factors including stress, excitement and relaxation.

Tics can occur in nearly any part of the body and in any muscle; some individuals report of ‘internal tics’ such as deep abdominal muscle tension and ‘stomach tics’ 

The biggest misconception around TS is that everybody with the condition swears. Coprolalia is the clinical term for tics that produce socially unacceptable words; and only approximately 15-20% of people with TS have this symptom.  Please read our factsheet sheet on the right hand side for more details about social taboos and for more information about coprolalia in our resources section.

Tics can be divided into Simple and Complex categories.  Below is an example of common motor and vocal tics:

Pain

Physical and vocal tics can lead to pain and discomfort for some people.  For further information, read our factsheet about pain in the right side column. You can also listen to a podcast made in 2019 with BBC 5Live Investigates, exploring this often over looked area, with interviews from adults with TS; Dr Seonaid Anderson; specialist neurologists in the field of TS, and looking at the role of physiotherapy as a potential support service. Download the podcast

Premonitory urge

Many individuals experience a physical sensation – a premonitory feeling/urge – that precedes a tic.  It has been compared to other physical sensations such as the need to itch or sneeze, or a burning, electrical feeling inside.  Supressing a tic can increase the premonitory urge, and once a tic has been performed the premonitory urge often reduces.  For some people multiple attempts of a tic are necessary until it ‘feels right’ and the premonitory urge diminishes.

Can tics be controlled?

Although tics are involuntary, many people are able to suppress their tics for a short time. A helpful way of understanding this is to compare it to blinking. For a short period of time it is possible to keep your eyes wide open and avoid blinking – and with practice you will get better at doing it for longer – but eventually you will have to blink as the urge is too strong to control. Suppressing tics works in the same way. It can take a great measure of concentration – especially to begin with – to resist the urge to tic, but with practice a certain level of control can be applied. Some people will be able to suppress their tics more easily than others.

It is quite common for children with TS to suppress their tics at school, yet families will notice a marked increase in their child’s tics once they get home. This is likely to be a result in the change of environment. School is very structured and has reinforcers that may make a child want to control their tics. In comparison home life is more relaxed and therefore helps children to feel at ease with expressing their tics.

Tic Attacks

The term ‘tic attack’ is often used to describe bouts of severe, continuous, non-suppressible and disabling tics which can last from a few minutes to several hours. They often include whole body writhing movements, muscle tensing and shaking. Tic attacks can create a lot of anxiety for the individual experiencing them and their families.

You can read more about tic attacks and how to cope with them in our factsheet (see right hand column for download).

Co-occurring features and conditions

Up to 85 percent of people with TS have more than just tics. Co-occurring symptoms may include obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), anger/rages and anxiety.  When a person presents with tics and co-occurring symptoms this is clinically referred to as ‘mixed neurodevelopment symptoms’.  Such additional symptoms may cause more problems than tics as they can be less visible.

You can read in more detail about co-occurring conditions here