On May 22, 2001, radio talk show personality Laura Schlessinger, better known as Dr. Laura, received a call from a woman who was distressed by her sister’s decision to exclude their nephew from an upcoming family wedding. When the caller mentioned that the boy suffered from Tourette’s disorder (also sometimes called Tourette syndrome), Dr. Laura berated her for even thinking that it might be appropriate to invite a child who would “scream out vulgarities in the middle of the wedding.” As we’ll soon explain, Dr. Laura’s comments embody just one of several common myths regarding Tourette’s.
Tourette’s disorder is the eponymous name for the condition first formally described in 1885 by French neurologist Georges Gilles de la Tourette, who dubbed it maladie des tics (“sickness of tics”). According to the current edition of the American Psychiatric Association’s diagnostic manual, Tourette’s disorder is marked by a history of both motor (movement) tics and phonic (sound) tics.
Motor tics include eye twitching, facial grimacing, tongue protrusion, head turning and shrugging of the shoulders, whereas phonic tics encompass grunting, coughing, throat clearing, yelling inappropriate words and even barking. Some tics are “complex,” meaning they are coordinated series of actions. For example, a Tourette’s patient might continually pick up and smell objects or repeat what someone else just said (echolalia). Often a tic is preceded by a “premonitory urge”—that is, a powerful desire to emit the tic, which some have likened to the feeling we experience immediately before sneezing. Tourette’s patients typically report short-term relief following the tic.
Tourette’s generally emerges at about age six or seven, with motor tics usually appearing before phonic tics. In rare cases, the disorder disappears by adulthood. Data suggest that it may be present in one to three out of 1,000 children; about three to four times as many males as females are affected.
Myths and Realities
As the Dr. Laura incident demonstrates, Tourette’s disorder is the subject of popular misconceptions; we’ll examine the four that are most widespread.
Misconception 1: All Tourette’s patients curse. In a survey of undergraduates by University of San Diego psychologists Annette Taylor and Patricia Kowalski, 65 percent endorsed this view. In fact, coprolalia, the use of curse words, and copropraxia, the use of obscene gestures, occur in only a minority—probably about 10 to 15 percent—of Tourette’s patients. But because these symptoms are so dramatic, they plant themselves firmly in observers’ memories. They also garner the lion’s share of media attention, as in a 2002 Curb Your Enthusiasm episode featuring a chef with Tourette’s disorder, who curses uncontrollably in front of his customers.
Misconception 2: Tourette’s symptoms are voluntary. Because Tourette’s sufferers can often suppress their tics for brief periods, some have concluded mistakenly that patients generate them of their own accord. In fact, they have little or no control over premonitory urges and can inhibit tics only for so long, just as you can only briefly avoid scratching an itch. Moreover, tic suppression typically results in a later “rebound” of tics.
Misconception 3: Tourette’s disorder is caused by underlying psychological conflict. As medical historian Howard Kushner, now at Emory University, noted, the idea that Tourette’s results from deep-seated psychological factors held sway in American psychiatry for much of the 20th century. As recently as the mid-1980s, one of us (Lilienfeld) was told by a psychologist in training that the tics of Tourette’s patients represented symbolic discharges of repressed sexual energies. Today we know that the disorder is substantially heritable. A 1985 study by R. Arlen Price, then at Yale University, and his colleagues found that in identical twins (who share virtually all of their genes) with Tourette’s, both twins had the disorder 53 percent of the time, whereas in fraternal twins (who share half their genes on average) with Tourette’s, both twins had the disorder only 8 percent of the time. Still, stress can increase tic frequency, so genes are unlikely to tell the whole story. Brain-imaging studies of Tourette’s patients reveal abnormalities in areas related to movement, such as the basal ganglia, a collection of structures buried deep in the cerebral hemispheres.
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Add CommentThere individuals [quote"Psychiatrist Arthur K. Shapiro and psychologist Elaine Shapiro of Cornell University conjectured that the troubled girl who formed the basis for the 1971 book and 1973 blockbuster film The Exorcist had Tourette’s disorder. Some observers, they contend, misinterpreted her head jerking, grunting and profane language as hallmarks of demonic possession.[end quote]
Reply | Report Abuse | Link to thisshould be advised that the case upon which Blatty's book was based documented events involving a boy, not a girl; Blatty changed the gender of the participant. I had the transcripts and records of the originaol case for research and seriously doubt that Tourette's could be the explanation for everything that happened.
Questions: 1) Does the severity of Tourette’s form a continuum; do some people have worse cases than others? Or is it a yes/no situation?
Reply | Report Abuse | Link to this2) Is Tourette's progressive, changing from a mild case to a severe case over time?
Bill,
Reply | Report Abuse | Link to thisI can only use my brother as an example to your #2 question. In his case, he dramatically improved over time. However, he does not have a severe case of it. As a child, he displayed the facial grimacing, shoulder shrugging, picking items up to smell them as well as other "movement" tics. He never exhibited phonic tics. As he matured, he learned to tone down or stop the movements altogether. The change especially seemed to be linked to when he realized he "acted differently" and "wanted to be like everyone else". He is now a functional 31 year old and most people would never know he has the disorder. Only in times of stress, do some of the tics return, particularly the facial grimaces.
Yes, Bill, a continuum is a good way to describe Tourette Syndrome. My daughter has mild symptoms, yet we know other teens and adults with much more life-altering tics. As far as progression, tic severity does change over time, with periods of "waxing and waning." However, to meet the clinical definition of Tourette, there must be no tic-free period lasting longer than 12 months before age 18. Periods of rapid change, such as puberty, and periods of great stress both bring out many tics, including new ones, whereas slower growth periods and more peaceful times will bring a time of fewer tics, or less severe ones. The national organization has a terrific website at www.tsa-usa.org. Thank you for being one who tries to get the facts.
Reply | Report Abuse | Link to thisI'm always amazed at the arrogance of the medical profession; telling us that (Misconception 3) it's a psychologial condition (like homosexuality once was) and can be cured with $$ talk treatment, as well as treating thyroids with radium etc, etc. The list goes on.
Reply | Report Abuse | Link to thisPeterT
My mother tried to kill me, when I was two years old, for the crime of being left-handed, and I have had a facial tic, ever since. Whether that's Tourette's, or not, seems to depend on the definition. I certainly suffered some brain damage, since my left eye is weaker than my right and get the feeling the facial tics are a result of some area, within, that suffered some damage. I have been studying nutrients, lately, and have been taking tyrosine (5g/d), which allows me to better deal with stress. It's no magic bullet; it's more like Alexander's cavalry laying waste to the Persian right flank. Lysine seems to fill in some of the gaps, and arginine has to be taken to take care of an apparent Lys-Arg balance. Surprisingly, echinacea seems to help with the stress that is a catalyst for the tics; although the tics do remain at an idle, even when stress is at a minimum.
Reply | Report Abuse | Link to thisThe tics associated with Tourette's are problematic, but from experience what is much worse are the comorbid diagnoses. These include, but are not limited to ADHD, social cognitive impairments, OCD, and other learning disabilities. In addition, I find that those suffer from TS into adulthood are differentiated from their peers by delayed age-appropriate decision making skills and maturity.
Reply | Report Abuse | Link to thisMy 28 year old son has moderate TS, along with high-functioning autism spectrum disorder. He is slowly exhibiting more TS and less autism over time. What I don't know is why ticcing comes and goes during the day and seemingly has no trigger or brake.
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