Last Updated on March 14, 2023 by Mike Robinson

Nervous tics are movements or repetitive, rapid, rhythmic, and spasmodic non-vocalizations that occur in children and adults. Tics reproduce gestures of daily life such as blinking, coughing, and winking and can occur in children and adults. They manifest involuntarily and are perceived as irresistible, although temporary relief is possible. They are also isolated, unexpected, and frequent.

The definition of tics provided by the Diagnostic Manual of Mental Illnesses is slightly different. It defines the tic as a sudden, rapid, and recurrent motor movement, not a rhythmic and stereotyped one.

They can appear as isolated clinical signs or be part of more serious psychomotor disorders, of which the most well-known is Tourette Syndrome.

They were described for the first time in 200 AD by Arateus of Cappadocia. And it was not until the 19th century that Gilles de la Tourette told the clinical picture presented by patients with both motor and phonological tics.

Psychological Factors of Nervous Tics

It is important to mention the psychological complexity and its relation to and link with the psychological factors to locate the tics.

We understand psychology as reflecting human performance in interaction with affective and cognitive experiences. That is, there is a link between external aspects (movements, gestures, postures, etc.) and the person’s internal characteristics (psychological factors).

In our daily lives, when we meet people, we form an impression of them based on their gestures, postures, and behavior in general.

Based on this impression, we presuppose other characteristics associated with that person concerning his personality.

In the beginning, I mentioned the link between the psychological and the psychopathological, which manifests when people suffer from a psychopathological disorder.

Concerning the relationship that may occur in some people between motor and psychopathology, motor activity is evaluated by how it shows in people’s attitudes, gestures, mimicry, and movements, both isolated and combined, voluntary or involuntary.

In addition, it depends on two fundamental dimensions: the expressivity transmitted by symbols and the change of position. And structurality (structural nerve determination of movement, for example, stiffness).

Biological Aspects of Nervous Tics

Some brain structures and circuits involved in controlling psychomotor functions are the same as those involved in modulating cognitive and emotional aspects.

The basal ganglia and their circuits have been the most studied, considering that they have a modulating function for motor functions and perform cognitive and affective processes.

• Circuit with projections from the paralympic cortex to the accumbens Nucleus -> relationship with affective and motivational functions
• Circuit from the orbitofrontal cortex to the modulation of operations related to the environmental context and mediates the inhibition of responses.
• Projections from the dorsolateral prefrontal cortex to the Caudate Nucleus mediate work memory and other executive functions.

Other findings have found interconnections between the limbic system (involved in the emotional) and the extrapyramidal system (involved in the motor). And also, the involvement of the cerebellum as a modulator of cognitive and affective functions that extend beyond the modulation of motor activity

This is evident in the following clinical findings between motor manifestations and comorbid cognitive or emotional alterations:

• Parkinson’s patients usually have associated depression, (According to studies, this occurs in between 20 and 90% of cases.)
• Patients diagnosed with Huntington’s disease who present psychotic comorbid symptoms.
• Patients with cerebrovascular accidents have depressive symptoms (25–30%) and concomitant manic episodes.
• People with depression who present alterations in movement as psychomotor slowing
• People with schizophrenia present stereotypies or catatonia.

Prevalence of Nervous Tics

Studies carried out in the general population in pediatrics affirm that tics are the most frequent movement disorder. Between 4 and 23% of children have tics before puberty.

On the other hand, Zohar et al. (1998) indicate that between 1–13% of boys and 1–11% of girls show “frequent tics, jerks, mannerisms, or spasmodic habits.

These children have the highest prevalence rates between 7 and 11 years of age, reaching up to 5%; the probability of suffering from a tic disorder is higher than in adults.

They also affect men more than women, in a 4:1 ratio.

Clinical course

The onset of tics usually occurs in childhood, around seven years old, and over ten years; people with tics develop the ability to be aware of premonitory impulses that precede tic production. It is the perception of a sensation in a particular area of the body where the tic will occur, for example, an itch or tingling. And a relief after the streak of tics.

This tic sensation makes the subjects think that they are habitual and occur in response to unpleasant sensory stimuli.

Nervous tics are usually short-lived, rarely lasting more than a second, and many occur in spells, with intervals between very brief tics (Peterson and Leckman, 1998). They can occur isolated or together following an organization.

Typically, the tics disappear, and this occurs about the age of onset and duration of symptoms; the younger the subjects and the longer lasting the symptoms, the greater the chance that they will not go away.

The recurrent appearance of tics in adulthood is infrequent; when they occur, they tend to be persistent infantile tics, are more symptomatic, and are a secondary expression of some other disorder or other events such as drug abuse or physical diseases such as pharyngitis.

Classification of Tics

There are several raised classifications of tics, both motor and vowel.

On the one hand, we can refer to the nature dimension; on the other, to the complexity of the tics. And finally, to the organic or psychological dimension of these

We talk about primary and secondary tics within the nature dimension of tics.

Within the primary tics, we speak of hereditary and those that occur sporadically during a stage of the person’s life, which may coincide with a more stressful or anxious one.

The secondary tics arise from a disease such as Wilson’s or Huntington’s. Following the drugs, such as tricyclic antidepressants, anticholinergics, antiepileptic drugs, and psychostimulants. As a result of a stroke or a traumatic brain injury.

Concerning complexity, we find simple and complex tics, although we must bear in mind that the difference could be more apparent.

Simple tics

Within this subgroup, we can refer to phonic tics (guttural noises, hisses, clearings, coughs, etc.) and clonic motor tics (those that occur repetitively, involuntarily, abruptly, and explosively); tonics (those that appear suddenly after a period has passed); and dystonics (those characterized as contractures or sprains).

• Clone: winks, blinks, snorts, and inspires.
• Tonic: to turn the head, lift the shoulders, and close the eyelids for a few seconds.
• Dystonic: extension of the neck; contractures in the face.

Complex tics

Where we find sequenced movements, which can encompass different parts of the body, and obsessions are not involved in them as in compulsions. Examples of complex tics include facial gestures such as touching your nose and clearing your throat, gestures related to grooming such as washing hands, flapping, jumping, brushing something like a wall, and repeating words or phrases out of context.

In extreme cases of motor tics, we find copropraxia (obscene movements) or self-injurious movements. Concerning phonological tics, in more severe cases, we speak of coprolalia (use of socially unacceptable words, often vulgar), palilalia (repetition of the sounds or words), and echolalia (repetition of the sound, comment, or phrase just stated).

Psychological tics

The psychological tics are exacerbated when significant emotional stress occurs, dims with distraction, and disappears during sleep. The person can play them voluntarily and inhibit them, which implies increased anxiety and discomfort for the subject. They are not modified, and the etiology is not organic.

On the other hand, Shapiro, in 1978, proposed a classification of the tics based on the etiology of these in terms of their age beginning, duration, and course.

He posed the existence of transient tics of childhood or simple acute tics; simple chronic tics; Huntington’s disease; multiple tics of childhood or adolescence; and multiple chronic tics ( Gilles de la Tourette syndrome ).

Diagnostic classification in CIE and DSM

The manuals of diagnostic classifications of psychological disorders raise the category of tics in the following sections:

• In the ICD (International Classification of Mental Illnesses), tic disorders are classified as behavioral disorders and emotions of habitual onset in childhood and adolescence.
• In the DSM-IV, tic disorders are in the category of motor skills disorders, usually getting a diagnosis for the first time in childhood and adolescence.
• The DSM-5, for its part, classifies them as motor disorders within neurodevelopmental disorders. They appear together with the disorder of the development of coordination and the disorder of stereotyped movements.

Diagnostic Criteria for Tic Disorders (DSM-5)

Criterion A: Multiple motor tics and one or more vocal tics have been present at some point during the illness, although not necessarily simultaneously.

Criterion B. Tics may appear intermittently in frequency but persist for more than a year after the appearance of the first tic.

Criterion C.: Begins before age 18.

Criterion D: You can’t attribute the disorder to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, post-viral encephalitis).

Persistent motor or vocal tic disorder (chronic)

Criterion A: Single or multiple motor or vocal tics have been present during the illness, but not both simultaneously.

Criterion B. Tics may appear intermittently in frequency but persist for more than a year after the appearance of the first tic.

Criterion C.: Begins before age 18.

Criterion D: The disorder is not associated with the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, post-viral encephalitis).

Criteria E:  Did not meet the criteria for Tourette’s disorder.

Specify if:

Only with motor tics.

Only with vocal tics.

A chronic motor or vocal tic disorder is present in some children with developmental difficulties and children with ADHD. Sometimes, symptoms can occur due to high stress or fatigue in the subject.

Transient tic disorder

Criterion A. Single or multiple motor or vowel tics

Criterion B. The tics have been present for less than a year since the first tic appeared.

Criterion C.: Begins before age 18.

Criterion D:  You can’t associate the disorder with the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, post-viral encephalitis).

Criteria E: The criteria for Tourette disorder or persistent (chronic) motor or vocal tic disorder did not occur. 

Transient tic disorder is the most common form between 4 and 5 years of age and usually takes the form of winks, grimaces, or neck shakes; that is, they are limited to the eyes, face, neck, or limbs. superiors

Treatment of tics

Although we currently have effective techniques for reducing tics and nervous habits, it is convenient to make clear that tics don’t clear up on their own. Also, there is no ideal anti-tic treatment.

The criterion of improvement in these people is governed more by the decrease in the percentage of these behaviors than by their complete disappearance. When a low frequency occurs, the interference in the person’s daily life is minimal.

There are different psychological and pharmacological treatments for tics and nervous habits.

Among the pharmacological treatments, the most commonly used are antipsychotics.

Historically, classical antipsychotics will help, but now atypical antipsychotics tend to be used because they have a broader action involving more neurotransmitters and fewer side effects (especially extrapyramidal).

Regarding psychological treatments, those that come from behavioral therapy predominate. But depending on the response to treatment and other factors (comorbidity with other disorders, specific situations of the patient, etc.), it may be necessary to use other different behavioral techniques, psychosocial treatments, or combination treatments when the symptoms are severe and do not remit with the specific behavioral techniques.

The most widely used behavioral technique is the inversion of habit, which is not limited to a specific method but rather represents a complex intervention program. The most important components are:

• Training in increasing awareness of the occurrence of tics
• Practice a competitive response contingent on its appearance, such as relaxation, tensing muscles opposed to those that activate the tic, or perform a response incompatible with such maladaptive behavior.

These components have shown efficacy both together and separately and as 

a single technique.