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The Truth about Tics

The following statements describe perceptions that some people may have with regard to tics. Enhance your understanding of tics by going through them.

The explanations offered here are based on the cognitive and psychophysiological model of tic disorders developed by Dr. O'Connor.

1. Tics are involuntary reflexes that I have no control over.
Tics are usually considered to be semi-voluntary. People actually have a certain amount of control over their tics; in most cases, they can resist or delay them. Some people are able to control their tics through mental discipline and a calm attitude.

2. Tics are entirely caused by neurological mechanisms.
While there is no proof that neurological deficiencies cause tics, people who have them have more active brains, which translates into an increase in their active reflexes and cerebral chemical activity. However, this hyperactivity can be reversed with pharmacological or behavioural therapy.

3. Whatever triggers my tics is not related to my moods or thoughts.
Tics are situational and seem to occur most often when the affected person is bored or frustrated. Often, one’s thoughts or expectations can cause a tic.

4. Tic disorders are very rare.
In the past, Tourette’s syndrome was considered very rare (0.1% of the population), but today it is estimated that TS occurs in 1% of the population, tic disorders in 8% and habit disorders in 20%.

5. People with tics have psychiatric problems.
Tic disorder is categorized as an impulse control disorder, but there is no proof of a direct link with other psychiatric disorders, such as schizophrenia, depression and anxiety. Sometimes people with tics have other disorders, but this comorbidity is independent of tics. Children, for example, often suffer from hyperactivity.

6. If I have tics, it means I’m not behaving properly.
Although tics are categorized as an impulse control disorder, this doesn’t mean that the person is impulsive in the everyday sense of the word. It is no more than a general diagnostic category that includes habits such as pulling one’s hair or biting one’s nails.

7. People form a negative opinion when they see my tic.
Adults usually get used to someone who has tics. People will accept the tics as a familiar part of the person, particularly if they are in a supportive environment. Of course, if the tic directly disturbs others (e.g., producing loud noises), it may continue to provoke irritation. People with tics tend, nevertheless, to suffer from a negative self-image and are preoccupied by their appearance. Paradoxically, the strategies they employ to hide or disguise a tic may sometimes attract more attention than the tic itself, because the strategies themselves may seem strange.

8. People with tics have less control of themselves than the average person.
Tics seem to be uncontrollable, especially when they appear in a series. However, there is no proof that people with tics have less self-control than other people in other areas of their life. Tics tend to peak in certain very specific situations; the rest of the time, the person is in fact in control.

9. There is no treatment for tics.
Tics occasionally resolve spontaneously, especially among children, but this rarely occurs among adults. On the other hand, the intensity and severity of tics may fluctuate. Cognitive-behavioural therapy and medication have demonstrated a certain degree of efficacy in reducing the problem.

10. People with tics are less intelligent.
There is no proof that people with tics are less intelligent or educated than those with other problems. In fact, most people with tics function well in their daily life and lead a normal existence.
11. Tics are a learned habit.
There is considerable evidence showing that certain tics, while seeming to be reflexes, are actually habits learned or developed during childhood and adolescence. These tics are similar to other habit disorders which are also acquired during childhood, such as hair-pulling, skin-picking or nail-biting.

12. Tics relieve tension.
Muscle tension is a common problem in people with tics, especially in the areas associated with a tic. Producing a tic seems to temporarily relieve this tension, but, unfortunately, the tension-relief cycle ultimately leads to chronic tension.

13. Tics are caused by stress.
Tics are not caused by stress. In fact, directed stress (e.g., sustained concentration) can reduce tics. There is evidence showing that tics form part of a continuum along with complex habits such as hair-pulling, nail-biting and skin-picking. These habits share certain characteristics with tics and may be aggravated when one is in a bad mood, but they are not caused by stress.

14. People with tics are more nervous than others.
People with tics are not more nervous than average, despite the term "nervous tics." There is no proof that people with tics suffer from a greater level of anxiety. Tics are not the same as compulsions or obsessions.

15. People with tics are more aggressive than others.
Tics are sometimes related to frustration because people become frustrated by their tics. Among children with Tourette’s syndrome (a severe tic disorder), this frustration is sometimes associated with fits of rage. There used to be a psychoanalytic myth that tics were a manifestation of suppressed hostility, but this explanation is no longer considered valid or relevant to treatment.

16. Vocal tics (i.e., producing sounds involuntarily) are not the same as muscular tics.
Vocal tics are also produced by tension. Vocal reflexes release tension, just like motor reflexes. Vocal tics are thus similar to muscular tics and are treated in the same way.

17. My tics occur all the time.
Your tics may seem to occur all the time, particularly if you focus all your attention on them. The frequency of tics can vary from a few to several hundred per day, but, in most cases, there is a pattern whereby they are worse at certain times of the day and better at other times.

18. The only way to deal with tics is to resist them, delay them or disguise them.
You may think you are helping yourself by suppressing your tics. However, all you are doing is reinforcing avoidance while building up muscle tension. This tension is what is liable to provoke tics.

19. My tics are a result of cerebral dysfunction.
There is no evidence showing that people who have tics process information differently or that their brains function differently. However, they may have difficulty in planning their actions efficiently due to a desire to do many things at the same time.

20. Relaxing helps me to control my tics.
This is true. One of the primary objectives of our program is to manage overall motor activation, and relaxation is a part of the intervention intended to reduce this activation.

21. If I suppress a tic and resist it, it will just appear later in a different form, because my level of tension has increased.
There is no evidence showing that tics function like a hydraulic pressure system that has to release pressure somehow. If the desire to produce tics persists, this means that the overall level of tension remains high (i.e., the tension has not been released) and the general activation that produces tics thus persists. Learning to control and regulate their high level of activation will allow affected people to naturally eliminate the need to produce tics.

22. My tics are a result of my stressful lifestyle.
Activities in everyday life can increase affected people’s level of tension, especially when they are trying too hard to achieve them.

23. Tics may be caused by expecting them or focusing on them.
There is evidence showing that expecting a tic can increase the likelihood that it will occur. This is explained by the fact that affected people brace themselves for the tic and react prematurely, thereby creating tension.

24. Preventing tics is better than controlling them.
Giving yourself free rein in terms of your actions, thoughts and emotions can reduce tension and hyperactivation, thereby preventing tics. On the other hand, trying to fight or reverse a tic can cause more tension.

25. Medication is the only way to control a tic.
Antipsychotics and muscle relaxants help to reduce the frequency and intensity of tics, but they never eliminate them completely. It is likely that these drugs act on the neurochemical circuits involved in motor activation. Behavioural exercises are a good alternative to pharmacological activation control.

26. Tics cannot be controlled; they can only be delayed.
It is possible for affected people to completely prevent production of tics by managing their overall level of activation. Delaying a tic is not a recommended strategy, because the source of the problem remains, as well as the desire to produce a tic.

27. My tic will get worse over time.
Tics fluctuate over time, but if they are not treated, they will never disappear completely and could in fact get worse or spread to other parts of the body at various times of life.

28. If I eliminate this tic, it will just be replaced by another one in a different place.
Reducing the overall level of activation and tension will prevent the substitution of tics. Replacing one tic with another doesn’t address the cause of the problem.

29. Tics are similar to Parkinson’s disease and Huntington’s chorea.
There is no proof that the cerebral structures affected by neurological disorders are the same as those affected by tic disorders. All of these disorders involve changes in cerebral mechanisms, but in different ways. Tics do not lead to more serious motor or cerebral disorders.

30. A behavioural approach can help me to control my tics.
Cumulative evidence from small-scale studies suggests that a behavioural program can help to control tics. In a recent study, 60% of people with tics obtained positive results after a 12-week program, and these results were maintained even two years later. The behavioural approach is different from other psychoanalytic approaches because it focuses on managing behaviour in the here and now rather than digging into the past.