What are tics?
Tics are rapid, repeated movements or vocalizations. They start suddenly and serve no recognizable purpose. Although they are often repeated, they do not follow a clear rhythm. Tics can be motor and expressed in body movements or vocal and expressed through sounds, words or exclamations. Tics can be simple and performed jerkily and quickly, or complex and appear cumbersome or deliberate. Tics can occur individually, with short or long pauses, but also in series. Typically, tics are preceded by a premonitory feeling that announces or even provokes the tic and subsides - at least temporarily - after the tic. Most people affected can suppress their tics voluntarily for a short time.
Motor tics
Motor tics result from muscle movements. Simple motor tics only affect a few muscle groups in one part of the body. They are most common in the face and head. Complex motor tics either result from the involvement of different muscle groups or look as if they fulfill a purpose. Special forms of complex motor tics include copropraxia (showing obscene gestures), echopraxia (non-purposeful imitation of observed movements of other people) and (rare) palipraxia (repeating one's own movements). Here is a table with the most common motor tics.
| Simple motor tics | Complex motor tics |
|---|---|
Blinking, squinting, rolling, widening eyes (without eyebrow movements) | Seemingly intentional movements, |
| raising eyebrows | Gestures on the face, head, hand, arms, torso, feet, legs |
| wrinkling nose, contorting | plucking at clothing |
| Puffing out cheeks | Hopping, jumping |
| Open mouth, pucker | Clapping, tapping |
| lip movements | Turn in a circle |
| Stick out tongue | bending, flexing torso movements |
| jaw movements | Extending arm movements |
| frowning | stamping |
| grimacing | dystonic tics |
| chattering teeth | Writing tics |
| Head shaking, throwing, twisting, twitching, nodding | Tic-like compulsive actions |
| Shoulder twitching, arm / hand movements | Echopraxia |
| Abdominal movements | Copropraxia |
| Trunk movements | Palipraxia |
| Leg/foot movements | (autoaggressive actions) |
Vowel tics
Vocal tics are caused by movements of the vocal and respiratory apparatus. Simple vocal tics such as clearing the throat, sniffing, coughing and blowing the nose occur most frequently; loud exclamations and screams are rare. In children in particular, mild simple vocal tics are often misinterpreted and mistakenly associated with other illnesses (such as respiratory diseases). Complex vocal tics such as coprolalia (exclaiming obscene words), echolalia (repeating sentences, words, syllables or sounds that are not used for Communications) and palilalia (involuntary repetition of self-pronounced words) are much rarer - and usually occur in severe Tourette syndrome with several comorbidities. Here is a table with the most common vocal tics.
| Simple vocal tics | Complex vocal tics |
|---|---|
| Coughing | Echolalia |
| Sniffing, snorting | Coprolalia |
| Coughing, coughing | Palilalia |
| Pulling up nose | Speech blockage |
| snorting | Atypical speech turns |
| noisy inhalation or exhalation | Exclaiming fragments of speech |
| squeaking, squealing, grunting | Calling out other socially inappropriate words (non-obscene complex socially inappropriate behavior, NOSI) |
| Whistling, humming | |
| uttering cries | |
| Shouting out syllables (hm, eh, ah, ha) | |
| Emitting animal or other sounds | |
| Spitting |
What tic disorders are there?
Transient tic disorder is associated with motor and/or vocal tics that last less than a year. It is a common disorder of childhood and is usually only associated with mild simple motor tics. This diagnosis can only be made reliably in retrospect.
The following chronic tic disorders are characterized by the fact that the tics are present over a period of at least one year and have an onset in childhood and adolescence.
- Tourette's syndrome is characterized by several motor tics and at least one vocal tic.
- Chronic motor tic disorder differs from Tourette's syndrome only in the absence of vocal tics. In most cases, however, the motor tics are also less pronounced and the frequency and severity of psychiatric comorbidities is lower.
- Chronic vocal tic disorder is characterized by the persistent occurrence of exclusively vocal tics. This diagnosis is extremely rare and should only be made after very careful differential diagnostic clarification.
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