Children may be less aware of it than are adults, but their awareness tends to increase with maturity; by the age of ten, most children recognize the premonitory urge.Premonitory urges which precede the tic make suppression of the impending tic possible. Because of the urges that precede them, tics are described as semi-voluntary or "unvoluntary", rather than specifically involuntary; they may be experienced as a voluntary, suppressible response to the unwanted premonitory urge. The ability to suppress tics varies among individuals, and may be more developed in adults than children. People with tics are sometimes able to suppress them for limited periods of time, but doing so often results in tension or mental exhaustion. People with Tourettes may seek a secluded spot to release the suppressed urge, or there may be a marked increase in tics after a period of suppression at school or work. Children may suppress tics while in the doctors office, so they may need to be observed when not aware of being watched.Complex tics related to speech include coprolalia, echolalia and palilalia. Coprolalia is the spontaneous utterance of socially objectionable or taboo words or phrases. Although it is the most publicized symptom of Tourettes, only about 10% of people with Tourettes exhibit it, and it is not required for a diagnosis. Echolalia (repeating the words of others) and palilalia (repeating ones own words) occur in a minority of cases.
At the end of the eleventh century, with the collapse of Byzantine power after the Battle of Manzikert, Bitlis fell under the control of Togan Arslan, a subject of the Shah Arman (Also called Ahlatshah) dynasty based in Akhlat after brief Dilmachoglu rule. It was also ruled by Ayyubid (1207–1231), Khwarezm Shahs (shortly rule in 1230), Sultanate of Rûm (1231–1243) and Ilkhanate (1243–1335). Emirate
Bitlis was a Kurdish emirate from the 13th to the 19th century. Though often subordinate to a succession of larger powers that ruled the Van region, it always maintained a measure of independence. In the 14th century its emirs, the Kurdish Rusaki family, were vassals of the Karakoyunlu and the emirates territory also consisted of several smaller emirates: Ahlat, Mush, and Hinis. The emir of Bitlis submitted to Timur in 1394, but later helped the re-establishment of Karakoyunlu control in the region. After the collapse of the Karakoyunlu state, the Bitlis emirate disintegrated. However, in the 1470s it took the Aq Qoyunlu (White Sheep Turkomans) three successive sieges to capture Bitlis and in 1494/95 the Ruzaki recaptured the town. Armenians formed a large part of the citys population. A number of monasteries were permitted to be built by the Kurdish emirs and during the fifteenth century, Biltis flourished as a center for Armenian manuscript production. Bitlis was forced to accept a Persian governor during the invasion of the Safavid Shah Ismail, but sided with the Ottoman forces as they approached the region. Its emir, Sheref, later changed his allegiance to the Persians.