Many individuals with mild to moderate tic severity experience no distress or impairment in functioning and may even be unaware of their tics. Individuals with more severe symp- toms generally have more impairment in daily living, but even individuals with moderate or even severe tic disorders may function well. The presence of a co-occurring condition, such as ADHD or 0CD, can have greater impact on functioning. Less commonly, tics dis- rupt functioning in daily activities and result in social isolation, interpersonal conflict, peer victimization, inability to work or to go to school, and lower quality of life. The indi- vidual also may experience substantial psychological distress. Rare complications of Tou- rette’s disorder include physical injury, such as eye injury (from hitting oneself in the face), and orthopedic and neurological injury (e.g., disc disease related to forceful head and neck movements).
movement disorder. Motor stereotypies are defined as involuntary rhythmic, repetitive, purpose and stop with distraction. Examples include repetitive hand waving/rotating, arm ﬂapping, and finger wiggling. Motor stereotypies can be differentiated from tics based on the former's earlier age at onset (younger than 3 years), prolonged duration (seconds to minutes), constant repetitive fixed form and location, exacerbation when engrossed in ac- tivities, lack of a premonitory urge, and cessation with distraction (e.g., name called or touched). Chorea represents rapid, random, continual, abrupt, irregular, unpredictable, nonstereotyped actions that are usually bilateral and affect all parts of the body (i.e., face, trunk, and limbs). The timing, direction, and distribution of movements vary from mo- ment to moment, and movements usually worsen during attempted voluntary action. Dys- tonia is the simultaneous sustained contracture of both agonist and antagonist muscles, resulting in a distorted posture or movement of parts of the body. Dystonic postures are of- ten triggered by attempts at voluntary movements and are not seen during sleep.
Substance-induced and paroxysmal dyskinesias. Paroxysmal dyskinesias usually oc- cur as dystonic or choreoathetoid movements that are precipitated by voluntary move- ment or exertion and less commonly arise from normal background activity.
Myoclonus. Myoclonus is characterized by a sudden unidirectional movement that is often nonrhythmic. It may be worsened by movement and occur during sleep. Myoclonus is differentiated from tics by its rapidity, lack of suppressibility, and absence of a premon- itory urge.
Obsessive-compulsive and related disorders. Differentiating obsessive-compulsive behaviors from tics may be difficult. Clues favoring an obsessive-compulsive behavior in- clude a cognitive-based drive (e.g., fear of contamination) and the need to perform the ac- tion in a particular fashion a certain number of times, equally on both sides of the body, or until a ”just right" feeling is achieved. Impulse-control problems and other repetitive be- haviors, including persistent hair pulling, skin picking, and nail biting, appear more goal directed and complex than tics.
Many medical and psychiatric conditions have been described as co—occurring with tic disor— ders, with ADHD and obsessive-compulsive and related disorders being particularly com- mon. The obsessive-compulsive symptoms observed in tic disorder tend to be characterized by more aggressive symmetry and order symptoms and poorer response to pharmacotherapy with selective serotonin reuptake inhibitors. Children with ADHD may demonstrate disrup— tive behavior, social immaturity, and learning difficulties that may interfere with academic progress and interpersonal relationships and lead to greater impairment than that caused by a tic disorder. Individuals with tic disorders can also have other movement disorders and other mental disorders, such as depressive, bipolar, or substance use disorders.
307.20 (F95.8)