91 Tourette’s Disorder (307.23)
DSM-IV-TR criteria
- A. Both multiple motor tics and one or more vocal tics must be present at the same time, although not necessarily concurrently (A tic is a sudden, rapid, recurrent, non-rhythmic, stereotyped motor movement or vocalization).
- B. The tics must occur many times a day nearly every day(usually in bouts) nearly everyday or intermittently over more than one year, and during this period there must not have been a tic-free period of more than three consecutive months.
- C. The onset is before age 18 years.
- D. The disturbance must not be due to the direct physiological effects of a substance (e.g., stimulants) or general medical condition (e.g., Huntington’s disease or positive encephalitis).
Associated features
- According to the American Psychiatric Association (2000), “associated features of Tourette’s disorder commonly include obsessions and compulsions. These can include clicking of the tongue, squatting, sniffing, hopping, skipping, throat clearing, and stuttering. Other common associated features are hyperactivity, distractibility, and impulsivity.” Rejection by others due to the tics and other disruptions can impair both functioning and acceptance in social, school, and work settings.
- Individuals with Tourette’s may also have an increased anxiety about having tics in social situations, causing them to stray away from going out or being accepted by others. “In severe cases of Tourette’s Disorder, the tics may directly interfere with daily activities, such as reading and writing” (American Psychiatric Association, 2000). Other disorders that are frequently associated with Tourette’s include Obsessive-Compulsive Disorder, Attention-Deficit/Hyperactivity Disorder, and Learning Disorders (American Psychiatric Association, 2000).
- Epidemiology shows the high relevance of Tourette’s Disorder to Obsessive-Compulsive Disorder; around 30% of children diagnosed with OCD also have Tourette’s. On the reverse side, 60% of children with Tourette’s will also generally have some form of OCD (Wagner, 2006, p.65). Furthermore, there are also signs of self-injurous behaviors, sleep disturbances, aggression, anxiety, and depression.
Child vs. adult presentation
- Tourette’s Disorder appears to be more profound among boys than girls during early childhood, but to be more severe in women than men in adulthood.
- In most cases the disorder peaks in severity at 10-12 years of age. In about 25% of patients the disorder does not improve until adolescence. In 10% of patients the disorder is severe and persists through adulthood.
Gender and cultural differences in presentation
- Tourette’s Syndrome occurs in people from all ethnic groups; males are affected about three to four times more often than females. Through different cultures, it appears that associated features vary.
- In clinical settings the disorder is diagnosed approximately 3 to 5 times more often in males than in females, the gender ratio is perhaps low