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Ask Dr. Ticcy: Do my tics mean that I have TS?

Dr. Ticcy is a pseudonym for the Tourette Syndrome Foundation of Canada National Office, which draws on information from experts across Canada and beyond to answer questions from the TS community. Please send your questions to tsfc@tourette.ca with the salutation “Dear Dr. Ticcy.”

Dear Dr. Ticcy,

My younger brother saw a doctor about his tics because they were bothering him. He was diagnosed with TS. When I found out, I started reading about TS because I wanted to learn more about the condition. Then I started noticing that that my dad, my older brother and I all do or say things that fit the definition of a tic.

Is it possible that we (my dad, older brother, younger brother and I) all have TS? I’m wondering if everyone in my family has TS, but my brother’s tics are the worst so he is the only who saw a doctor and got diagnosed?

Thanks!

TS or Not?

Dear TS or Not,

Thank you for your great questions!

First and foremost, remember that the only way to know if you or anyone has TS is to see a clinician (that means a doctor who works in a hospital, clinic or some other healthcare setting where they provide care to patients).

Second, learning as much as you can about TS and tics, just like you are doing, is a positive step. Here is some additional information that might interest you.

According to the guide used by doctors for diagnosing conditions like TS (called the Diagnostic Statistical Manual of Mental Disorders or DSM), there is more than one kind of tic disorder. TS is the most severe type. Milder tic disorders include Persistent Motor Tic Disorder, Persistent Vocal Tic Disorder, and Provisional Tic Disorder.

The DSM-5 (the current fifth edition) states that to have Tourette Syndrome, a person must have:

  • Multiple motor and one or more vocal tics at some point (though not necessarily at the same time);
  • Tics over the course of a time period of more than one year (the tics can wax and wane during this time, the year plus time period begins after the first tic appears);
  • Tics that occur before age 18; and
  • Tics that aren’t caused by the psychological effects of a substance (e.g. Cocaine) or another medical condition (Huntington’s).

To have a different type of tic disorder, a person must meet different DSM-5 criteria.

To have Persistent Motor or Persistent Vocal Tic Disorder, you can’t meet the criteria listed above for TS. This means you can’t have TS and this condition, only one or the other. To have this particular tic disorder, you must have either single or multiple motor or vocal tics, not both types.

Notice having TS means having both multiple motor and one or more vocal tics whereas having Persistent Motor or Persistent Vocal Tic Disorder means having only one type of tic. Like TS, tics may wax and wane in frequency but must persist for more than a year since the first tic appears. Additionally, and also like TS, the onset of tics must happen before age 18 and symptoms must not be caused by a substance or another medical condition.

To have this Provisional Tic Disorder, you must have tics (single or multiple motor and/or vocal) but these tics are present for less than one year after they first appear. Like TS and Persistent Motor or Vocal Tic Disorder, tic symptoms must happen before age 18 and can’t be caused by the psychological effects of a substance or by another medical condition. To be diagnosed with Provisional Tic Disorder, you can’t at any point meet the criteria for TS or Persistent Motor/Persistent Vocal Tic Disorder.

Please note that there are people with TS who do not take part in treatment (whether prescription drug or behavioural therapy, etc.). Others with TS do take medication and/or do behavioural or other types of therapy to help manage their symptoms. Many people with TS report that there associated conditions (e.g. OCD, ADHD, mood disorders) affect their daily living more than their tics. That said, tics can be disruptive to daily life for some people.

Remember that the diagnosis of a tic disorder whether it is TS or milder case, as well as treatment and symptom management, all must be done under the supervision of a professional clinician (e.g. neurologist or psychiatrist).

Don’t know where to start find the specialist near you? Ask your family doctor or primary care physician, or call the Tourette Syndrome Foundation of Canada at 1-800-361-3120.

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