The fourth revision of the DSM (DSM-IV) in 1994 added a diagnostic requirement for "marked distress or significant impairment in social, occupational, or other important areas of functioning", which led to an outcry from TS experts and researchers, who noted that many people were not even aware they had TS, nor were they distressed by their tics; clinicians and researchers resorted to using the older criteria in research and practice. In 2000, the American Psychiatric Association revised its diagnostic criteria in the fourth text revision of the DSM (DSM-IV-TR) to remove the impairment requirement, recognizing that clinicians often see people who have Tourettes without distress or impairment. Society and culture
Not everyone with Tourettes wants treatment or a cure, especially if that means they may lose something else in the process. The researchers Leckman and Cohen believe that there may be latent advantages associated with an individuals genetic vulnerability to developing Tourette syndrome that may have adaptive value, such as heightened awareness and increased attention to detail and surroundings.Accomplished musicians, athletes, public speakers and professionals from all walks of life are found among people with Tourettes.
The athlete Tim Howard, described by the Chicago Tribune as the "rarest of creatures—an American soccer hero", and by the Tourette Syndrome Association as the "most notable individual with Tourette Syndrome around the world", says that his neurological makeup gave him an enhanced perception and an acute focus that contributed to his success on the field.Samuel Johnson is a historical figure who likely had Tourette syndrome, as evidenced by the writings of his friend James Boswell. Johnson wrote A Dictionary of the English Language in 1747, and was a prolific writer, poet, and critic. There is little support for speculation that Mozart had Tourettes: the potentially coprolalic aspect of vocal tics is not transferred to writing, so Mozarts scatological writings are not relevant; the composers available medical history is not thorough; the side effects of other conditions may be misinterpreted; and "the evidence of motor tics in Mozarts life is doubtful".Likely portrayals of TS or tic disorders in fiction predating Gilles de la Tourettes work are "Mr. Pancks" in Charles Dickenss Little Dorrit and "Nikolai Levin" in Leo Tolstoys Anna Karenina. The entertainment industry has been criticized for depicting those with Tourette syndrome as social misfits whose only tic is coprolalia, which has furthered the publics misunderstanding and stigmatization of those with Tourettes. The coprolalic symptoms of Tourettes are also fodder for radio and television talk shows in the US and for the British media.