Dr. Pamela Simms
Licensed Psychologist 

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Tourette syndrome

 

Tourette syndrome (TS) is a neurological disorder that presents with vocal and motor tics occurring throughout a period of more than one year. A tic is a sudden, rapid, recurrent, stereotyped motor movement or vocalization. It is common for tics to wax and wane, and for the tics to change in appearance and sound. For example, an eye blinking tic may reduce or “disappear” only to be followed by a shoulder shrug motor tic or a throat clearing vocal tic.

 

Common Motor Tics

  • Eye-blinking
  • Shoulder shrug
  • Tapping fingers or feet
  • Wrinkling the nose
  • Facial grimace
  • Rolling the head
  • Flipping or twirling hair
  • Twisting the torso
  • Straightening clothes

Common Vocal Tics

  • Throat-clearing
  • Humming
  • Sniffing
  • Tongue-clicking
  • Shrieks
  • Grunting
  • Whistling
  • Repetition of one’s own words
  • Repetition of other’s words
  • Burps or belches

Treatment
The main goal of treatment is to minimize the tics as much as possible. As stress is know to exacerbate tics, one of the first treatment goals after psychoeducation is identifying stressors in the individuals’ life and reducing these stressors as much as possible, with the expectation that the tic severity will also reduce. Furthermore, it is common for the individual to experience a co-morbid anxiety disorder such as generalized anxiety, social anxiety and/or Obsessive Compulsive Disorder. In this case, tics can often be treated indirectly by treating the anxiety first. When anxiety reduces, tics may reduce alongside.

 

While tic and anxiety reduction are important goals of treatment, Dr. Simms also prioritizes fostering a healthy self-esteem of the individual with TS, as tics frequently draw attention and can be embarrassing for the individual with TS, which potentially impacts their self-esteem. Self-acceptance and acceptance of TS is an important factor in preserving the spirit of the individual. Tics will come and go, but the self-esteem and spirit of the individual remains throughout life and must be nurtured.

 

In addition to reducing co-morbid anxiety, Habit Reversal Training (HRT) is taught to reduce tics. This treatment uses awareness training to identify any “premonitory urges” (physical sensations that occur prior to the vocal or motor tic). With awareness, the individual is then able to engage in a competing response that counteracts the specific tic. For example, a person with an eye-poking tic may chose to sit on their hands or clasp their hands together firmly on their lap to prevent their fingers from poking their eyes. Dr. Simms commonly recommends this approach for self-harming tics or when the person wants to temporarily resist the tic in order to reduce the embarrassment that the tic may create. It is important to note that long-term or frequent resistance to vocal and motor tics is not recommended because it commonly creates internal stress that may lead to increased irritability, anxiety, and/or a strong “release” of tics shortly after the individual stops resisting the tics.

  

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