Tourette’s syndrome is a neuropsychiatric disorder that manifests itself in so-called tics. Tics are spontaneous movements, sounds, or utterances of words that occur without the intention of the affected person. The movements often occur repeatedly in the same way but are not rhythmic and can occur individually or in series. Tourette’s usually begins in childhood, more rarely in adolescence. Younger children in particular often go through a phase with tics that disappear on their own after a few months. If complex vocal and multiple motor tics occur in combination, one speaks of Tourette’s syndrome (APA, 2013).
The causes of Tourette’s syndrome have only been rudimentarily researched to date. It is assumed that it is largely genetically predisposed (Pauls, 2003). The development of Tourette syndrome is attributed to a disorder in the neurotransmitter metabolism of the brain. In particular, the neurotransmitter dopamine is the focus of research. Studies have shown that the number of dopamine receptors in the brains of patients with Tourette syndrome is increased (TGD, 2021). However, a disturbed serotonin, norepinephrine, glutamine, and opioid metabolism and the interactions between these substances also seem to play a role (TGD, 2021). The disorders manifest themselves primarily in the so-called basal ganglia. They regulate which impulses a person translates into actions and which do not. In order to develop this, additional triggers in the environment must be present. These include, for example, negative factors during pregnancy and birth, such as smoking and psychosocial stress during pregnancy, prematurity, and oxygen deprivation at birth (TGD, 2021).
The psychological suffering of those affected is high in some cases due to the prominent, uncontrollable symptoms – especially in Tourette’s syndrome. The complexity of some tic disorders sometimes causes great astonishment and also anger or rejection among those around them (family members, friends, teachers; Hoekstra, Steenhuis, Kallenberg, & Minderaa, 2004; Khalifa & Von Knorring, 2006). Many non-affected persons cannot imagine that these actions and vocalizations are involuntary and disease-related. Some people feel also provoked by the tics; especially if it involves coprolalia/copropraxia. Coprolalia is a complex vocal tic in which affected individuals express obscenities in single words or sometimes entire sentences. Copropraxia is the same but for motor tics in which, for example, the middle finger is often shown. Therefore, justified fear due to the tics and also feelings of shame are very common in children and adolescents with chronic tic disorders or Tourette syndrome (Freeman et al., 2009; Kobierska, Sitek, Gocyła, & Janik, 2014). On the other hand, many affected individuals are well integrated socially, as long as the symptomatology is not too pronounced (Freeman et al., 2009).
Often, the affected children do not even notice their tics at first. It is usually the parents or educators who become aware of these behavioral characteristics. They often feel disturbed, worry, and consider whether parenting mistakes were behind it, even if the children’s development is going well (Khalifa & Von Knorring, 2006). For most of those affected, the symptoms improve after puberty or even disappear completely. Others have tics throughout their lives. Boys are affected four times as often as girls (Leckman et al., 1998). It is estimated that about one percent of people develop Tourette syndrome (Robertson, 2008).
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Freeman, R. D., Zinner, S. H., Müller‐Vahl, K. R., Fast, D. K., Burd, L. J., Kano, Y., … Stern, J. S. (2009). Coprophenomena in Tourette syndrome. Developmental Medicine & Child Neurology, 51(3), 218–227. doi: 10.1111/j.1469-8749.2008.03135.x
- Hoekstra, P. J., Steenhuis, M. P., Kallenberg, C. G., & Minderaa, R. B. (2004). Association of small life events with self reports of tic severity in pediatric and adult tic disorder patients: a prospective longitudinal study. The Journal of clinical psychiatry, 65(3), 426.
- Khalifa, N., & Von Knorring, A. L. (2006). Psychopathology in a Swedish population of school children with tic disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 45(11), 1346-1353.
- Kobierska, M., Sitek, M., Gocyła, K., & Janik, P. (2014). Coprolalia and copropraxia in patients with Gilles de la Tourette syndrome. Neurologia I Neurochirurgia Polska, 48(1), 1–7. doi: 10.1016/j.pjnns.2013.03.001
- Leckman, J. F., Zhang, H., Vitale, A., Lahnin, F., Lynch, K., Bondi, C., … Peterson, B. S. (1998). Course of tic severity in Tourette syndrome: the first two decades. Pediatrics, 102(1 Pt 1), 14–19. doi: 10.1542/peds.102.1.14
- Pauls, D. L. (2003). An update on the genetics of Gilles de la Tourette syndrome. Journal of Psychosomatic Research, 55(1), 7–12. doi: 10.1016/S0022-3999(02)00586-X
- Robertson, M. M. (2008). The prevalence and epidemiology of Gilles de la Tourette syndrome: Part 1: The epidemiological and prevalence studies. Journal of Psychosomatic Research, 65(5), 461–472. doi: 10.1016/j.jpsychores.2008.03.006
- Tourette Gesellschaft Deutschland [TGD] (2021). Ursachen & Symptome. Retrieved February 2, 2021, from https://tourette-gesellschaft.de/ursachen-symptome/
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- MondoMedia. (2011, March 10). Dick Figures – Role Playas (Ep #9) [Video]. YouTube. https://www.youtube.com/watch?v=9UikCf4HyoY
Author : Alexander Ariu