The OCD and Related Disorders Program – Tourette Syndrome (TS) and
Chronic Tic Disorder (CTD)
The Obsessive Compulsive Disorder (OCD) and Related Disorders Program at the Massachusetts General Hospital/Harvard Medical School provides state-of-the-art outpatient care for people with Tourette Syndrome (TS) and Chronic Tic Disorder (CTD). We offer both cognitive-behavioral therapy (i.e., Habit Reversal Therapy [HRT]) and medication treatment. We also provide one-time consultations, evaluations, and follow-up care. Treatment delivered in the context of research studies is usually provided at no cost to our patients.
What is a Tic?
The OCD and Related Disorders Program
Massachusetts General Hospital
Simches Research Building
185 Cambridge Street, Suite 2000
Boston, MA 02114
Maps & directions
A tic is a sudden, rapid, repetitive, involuntary muscle movement (motor tic) or vocalization (vocal tic). "Simple" tics may include eye blinking, neck or shoulder jerking, sniffing, picking, grunting, barking, and chirping. "Complex" tics can include arm flapping, facial grimacing, coprolalia (the involuntary uttering of obscene words or phrases), palilalia (involuntary repetition of one's own words), and echolalia (involuntary repetition of another person's words or phrases). Contrary to many portrayals in the media, coprolalia is rare and occurs in fewer than 10% of people with tic disorders.
Tic disorders are categorized according to age of onset, severity, duration of symptoms, and presence of vocal and/or motor tics. However, distinguishing between one tic disorder and another can be difficult.
Transient Tic Disorders typically begin in childhood and are seen in as many as 5% - 24% of school children. To receive a diagnosis, the individual must experience tics for at least 4 weeks, but not for more than 1 year. Motor tics (e.g., eye blinking, grimacing) are more frequently observed than vocal tics (e.g., throat clearing). As with all tic disorders, transient tics tend to worsen during times of increased stress, excitement, or lack of sleep.
Chronic Motor or Vocal Tic Disorder differs from transient tic disorders in that the tics persist for more than one year. Single or multiple motor or vocal tics (though not both) must be present, and the onset of the illness must occur before the age of 18.
Tourette Syndrome (Gilles de la Tourette Syndrome or TS) is a neurological disorder characterized by multiple motor tics and at least one vocal tic, though both types of tics do not necessarily need to be present at the same time.
The first symptom of TS is usually a simple motor tic (e.g., eye blinking). Subsequently, an individual may develop tics involving other parts of the body, including the neck, shoulders, trunk, and limbs. Sometimes the tics become complicated and complex, involving the entire body, such as with kicking or twirling. TS sufferers often report feeling a "premonitory urge"- a strong and irresistible urge to perform a tic - followed by a momentary feeling of relief once the tic is performed. Other tics can happen without warning.
The symptoms of TS vary from person to person and range from very mild to very severe, although the majority of cases are mild. Symptoms typically wax and wane, with a peak severity between the ages of 10 and 12. Many individuals with tics experience a significant reduction of their tics as they enter adulthood. Associated problems may include impulsivity, attention difficulties (ADHD/ADD), learning disabilities, and obsessive-compulsive behaviors.
How do I know if I have a Tic Disorder?
If you answer yes to several of the following questions, you may have TS or chronic tic disorder. Please note, however, that only a qualified clinician can provide you with a definitive diagnosis.
- Have you ever had (or do you currently have) facial tics, jerking, or any other unusual body movements? (motor tics)
- Have you ever made (or do you currently make) involuntary noises or grunts? Or do you say words involuntarily? (vocal tics)
- Have you found yourself performing these behaviors several times a day?
- When did you first begin having the tic(s)? Was it before the age or 18 and at least a year ago?
- Has there ever been a period of time when you were tic-free for more than 3 months?
For more information about our program please go to our website: www.mghocd.org/tics