Tic Disorders and Twitches

Medically Reviewed by Shruthi N, MD on July 08, 2024
Written by Hilary Parker, Frances Gatta
8 min read

Tic disorders are conditions involving your nervous system. They cause you to make repetitive, sudden, rapid sounds or movements, and you may struggle to control yourself when they happen. These disorders affect 1 in 5 children at some point. Tics usually start between ages 4 and 6, and symptoms are most noticeable between 10 and 12 years old.

Tic disorders include Tourette syndrome, persistent or chronic tic disorder, and provisional tic disorder. If you have tics, you're more likely to have other mental health conditions, including depression, bipolar disorder, substance use disorder, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety disorders, and learning disorders.

Sometimes, tics get better over time or go away completely. But they may also be long-lasting.

Three tic disorders are included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR), which health professionals use to help diagnose and treat tic disorders. 

Provisional tic disorder. This disorder most commonly appears in your youth. It affects up to 20% of school-age children. Your doctor might diagnose your child with this tic disorder if they have one or more motor (physical) or vocal tics for at least one month but for less than one year. 

Persistent (chronic) motor or vocal tic disorder. While provisional tics disappear within a year, chronic tics last more than a year. With this disorder, your child might have one or more long-lasting tics. They may be either motor or vocal, but not both. Symptoms begin before age 18. Chronic tics occur in less than 1 in 100 children.

Tourette syndrome. Sometimes, what seems to be a chronic tic may be a sign of Tourette syndrome, the most severe type of tic disorder. If your child has this disorder, they will have both motor tics and vocal tics.

Experts estimate that 1 in 162 children in the U.S. have the condition. Symptoms usually begin when children are between the ages of 5 and 10.

The severity of your child's condition may change over time. They may have periods with fewer tics, followed by periods with more tic activity. Many people with Tourette syndrome find that their condition improves as they get older. But some may find their condition gets worse with age.

What is tic anxiety disorder?

Anxiety often triggers tics or makes them worse. Researchers think it’s because having tics when you’re anxious or stressed could make them harder to control. It might also be that anxiety makes tics happen more often. Sometimes, having anxiety might make you more aware of how other people react to your tics, which can make your symptoms feel more distressing.

The exact cause of tic disorders isn’t understood. But researchers think that genetics and environmental factors play a role. 

Tics often:

  • Run in families (genetic)
  • Are related to behavioral disorders such as ADHD and OCD
  • Happen as a complication of pregnancy and birth-related problems such as smoking during pregnancy and low birth weight.

More research is needed to understand how these factors affect the likelihood of having tics. 

Are men and people assigned male at birth (AMAB) at higher risk for developing tic disorders?

Tic disorders are more common in men and people AMAB. In fact, men are three to four times more likely than women to have tics. 

Motor tic symptoms happen suddenly, quickly, and repeatedly without following a pattern or rhythm. They can involve any body part but often affect your face, head, and neck.

Simple motor tics involve one muscle group and include:

  • Blinking
  • Grimacing (facial expression of pain or dislike)
  • Head jerking
  • Shoulder shrugging
  • Nose twitching
  • Darting eyes

Complex motor tics usually involve more than one muscle group and include:

  • Touching or smelling objects
  • Mimicking someone’s movements repeatedly
  • Hopping
  • Stepping in a specific manner
  • Making socially unacceptable gestures
  • Bending or twisting
  • Doing many simple tics at once, such as blinking and head jerking

Vocal tics are any sounds you make when you’re having tics.

Simple vocal tics are:

  • Sniffing
  • Grunting
  • Humming
  • Hissing
  • Throat clearing
  • Barking

Complex vocal tics include:

  • Repeating words or sounds
  • Making animal noises
  • Yelling
  • Saying socially inappropriate words

Your doctor will make a diagnosis using a standard set of criteria, including:

  • The type of tics you have 
  • How long you've had them
  • How often they happen
  • At what age they started

They may ask you other questions to make a diagnosis or to figure out the cause, such as:

  • If you have a family history of tics
  • If you take any medications or substances that may be causing your symptoms
  • If you have any medical conditions

You won’t have to do any blood, lab, or imaging tests to get diagnosed. But in rare cases, where your doctor wants to confirm other conditions aren’t causing your symptoms, you may do a blood test or imaging tests such as MRI, CT, or electroencephalogram (EEG).

You may get your diagnosis from a primary care provider, pediatrician, or mental health care specialist. Your doctor may refer you to a specialist if you show unusual symptoms.

Tic disorders have no cure, but a doctor can recommend treatments to manage your symptoms, or in some cases suppress them. These may include medications and therapy, especially if the tics cause pain or injury, interfere with daily functioning, or make you stressed. Treatment may also help manage other conditions you have with a tic disorder.

Medications

Medicines can help manage serious and disturbing tic symptoms and symptoms of other related conditions such as ADHD or OCD. They also improve your daily experience with the condition. But they don’t make tics go away completely. Most medicines doctors prescribe for treating tics haven’t been approved by the FDA.

What works for one person may not work for the next. Your doctor may change medications and doses as needed till you find the best one with the most minor side effects.

Medicines your doctor may recommend include:

Oral alpha-adrenergic agonists. Your doctor may prescribe these medicines if you have mild symptoms. They include:

  • Clonidine
  • Guanfacine

Oral antipsychotics. Your doctor may prescribe antipsychotics if you struggle to control your symptoms. These medicines include

  • Haloperidol
  • Olanzapine
  • Pimozide
  • Risperidone

Antiseizure medications. Studies suggest that medicines for treating epilepsy, such as topiramate (Topamax), may help manage symptoms in some people with Tourette syndrome.

Medicines for mental health conditions. Your doctor may recommend medication for mental health conditions you may have with tic disorders, such as antidepressants and ADHD medicines.

Botulinum (Botox) injections. Your doctor may recommend a Botox injection into the muscle involved in the tics to help relieve a simple or vocal tic.

Behavioral therapy

You may work with a mental health professional to learn ways to reduce how often you have tics, how serious they are, and how much they affect you.

The most common type of behavioral therapy is called habit reversal. It involves awareness training and competing response training.

In awareness training, you say the tic out loud as it’s happening. Then, you use a competing response, which helps you learn how to change your behavior when the tic occurs. For example, if your tic involves head rubbing, the competing response teaches you to place your hands on your knees or cross your arms so that you’re unable to rub your head.

Another form of behavioral therapy is the comprehensive behavioral intervention for tics (CBIT). CBIT is a therapy that includes habit reversal, education about tics, relaxation techniques, and other evidence-based approaches to managing tic disorder symptoms.

Your therapist will help you understand more about your symptoms, including the type you’re having, triggers, and new behaviors that may help reduce how often your symptoms happen.

Psychotherapy

Talk therapy or psychotherapy may help manage mental health problems that often show up with tic disorders such as ADHD, depression, and anxiety. It involves having one-on-one or group conversations with a therapist.

Your therapist will help you identify and change disturbing emotions, thoughts, and behaviors tied to your mental health condition.

Deep brain stimulation (DBS)

This is a treatment that involves putting a small device in the brain to send electrical signals to parts of your body involved in movement. This treatment is still being studied, and more research is needed to find out if it's safe and effective. It's only recommended if you have a severe tic disorder that doesn't improve with other treatments.

People with tic disorders usually have no complications and can live an active life, especially when they’re getting the right treatment. But sometimes tic disorders can lead to:

  • Increased risk of mental health problems such as anxiety, mood disorders, learning problems, and sleep problems
  • Thoughts of self-harm in extreme cases
  • Pain, such as headaches
  • Anger-management problems

Sometimes, having a tic disorder can affect your self-esteem and ability to interact with people, date, and make friends. It may also make you more likely to have anxiety, depression, substance use disorder, and other mental health problems.

You can manage these problems and maintain an active and social lifestyle with a tic disorder by:

  • Connecting with and learning from others with tic disorders by joining a support group, for instance. You can find online and in-person support groups on websites such as the Tourette Association of America and Tourettes Action.
  • Participating in activities that help you relax to reduce your stress and anxiety levels, which can trigger tics. Try journaling, taking walks in nature, doing yoga, dancing, and reading.
  • Staying physically healthy by eating a nutritious diet and exercising regularly.
  • Getting plenty of sleep.
  • Seeing a therapist.

Do tic disorders go away on their own?

Tic disorder symptoms often improve as you get older, and they may eventually go away on their own, even without any treatments.

You can help a child with tic disorder manage their symptoms and live confidently.

  • Let their school know about their condition and the help they may need to learn and interact socially, such as having smaller classes and tutoring.
  • Help your child pursue their interests and friendships to build self-esteem and a social life.
  • Find or create a support group for parents with children with tic disorders. You can learn from and share experiences that may benefit your child.
  • Make sure they attend therapy appointments.

No one knows exactly why tic disorders happen, and researchers are still studying how genetic and environmental factors affect your risk of having them. Tic disorders often happen with other mental health conditions, such as depression, anxiety, bipolar disorder, substance use disorder, ADHD, and OCD. Although they may get better with time or go away on their own, your doctor may prescribe treatment if your tic symptoms are distressing and affect your quality of life.