Tourette Syndrome: A Misunderstood Disorder

Tourette Syndrome (TS) is one of the most misunderstood neurological disorders. My first exposure to TS was, when I was quite young, seeing a man on the popular television show “L.A. Law” insult Vanna White. The media has continually portrayed people with TS as foul-mouthed comic relief. This is not the case. Tourette Syndrome is a very common and complicated disorder that effects children with it greatly.
In 1885, a young French neurologist, Gilles de la Tourette, described a condition characterized by muscle tics, vocal noises and uncontrollable swearing. He described nine of his own patients and reviewed previous literature referring to others with the same symptoms (Kushner, 1998). Tourette’s article laid out a detailed classification of symptoms and prognosis based on his research. He also stated that the tic disease began in early childhood, was progressive and had a “cumulative destructive effect on the nervous system” (Kushner, 1998, p. 2). He believed that the cause of the disease was some sort of hereditary insanity. De la Tourette made these assertions even though he had no real data to back himself up. His notions about the course of the illness and its underlying cause proved, under the light of time, to be false. However, the disease came to bear his name because of his clear identification of his correct identification and classification of its symptoms.
Tourette Syndrome is a common, hereditary neurological disorder. The DSM-IIIR says that the “essential features of this disorder are multiple motor and one or more vocal tics.” (American Psychiatric Association [APA], 1987) Motor tics are compulsive movements of the body, usually the head. For example a person with TS might compulsively blink their eyes, shrug their shoulder or make some sort of facial grimace. Vocal tics are not the much publicized swearing, but rather a loud throat clearing, barking or some other noise. The typical person with TS portrayed by the media compulsively swears or uses socially unacceptable words or phrases. This is called coprolalia; the involuntary utterance of swear or other social taboo (like racial epithets) words. Though this is the most famous symptom of TS, less than a third of those afflicted with TS actually show it. In order to be classified as having TS, the intensity of these symptoms must change over weeks and months (APA, 1987). The age of onset is between two and fifteen years, the median age being seven (APA, 1987). The symptoms must appear before the age of 18 (In DSM IIIR the age of onset is 21, but was changed in DSM IV. It will most likely be changed back to 21, due to public pressure (“The Fact About” 1998) and last for over a year (APA, 1987). Males are also three to four times more likely to suffer from TS than females.
The types of tics are many and varied. There are over 60 recognizable motor tics associated with TS. A motor tic is simply a sudden jerky contraction of a muscle. They range from the mild (and most common) rapid eyeblinking, to the more dangerous tongue biting or rapid head snapping (Comings, 1990). Some motor tics can be especially dangerous to children because they have a harder time controlling their tics. It is very easy for a child to severely bite his tongue, or bang his head against something. Vocal tics are much less dangerous.
Many children suffer from a variety of tic disorders less severe than Tourette Syndrome. Transient tic disorders occurs in about 15% of children and they last for a few weeks to several months (Bruun, Cohen, & Leckman, 1984). Chronic tic disorders last longer (several years) and are consistent. That is, the child will have the same tic over the course of the disorder (Bruun et al, 1984). A third tic disorder is chronic multiple tics, which is the same as chronic tic disorder except that it includes more than one tic (Bruun et al, 1984). TS is much more severe than these are. It includes multiform tics, which vary in intensity and in substance. It is also much harder to deal with because of the associated problems.
There are a number of other disorders that go along with Tourette Syndrome. The most common of these are attention deficit hyperactivity disorder