THE nervous tics they are sudden, rapid and repetitive movements or sounds that often appear in childhood, but can also occur in adulthood.
Although many people experience tics at least once in their lives, these movements often tend to cause concern because they are interpreted as signs of psychological distress or neurological diseases. In reality, in most cases these are benign and transitory phenomena. However, they deserve attention and must be addressed with clarity of information.
Nervous tics: what they are and how they can impact daily life
A tic can be perceived by those who implement it as ainvoluntary actiondifficult to control: it can be simple, like a wink or a cough, or more complex and detailed.
In children, tics tend to occur in situations of stress or tirednesswhile in adults they can re-emerge in moments of strong emotional tension.
When tics become more persistent, invasive and complex to manage, we can talk about Tourette syndrome (TS), a condition characterized by a combination of motor and vocal tics.
The internal sensations that precede tics, such as a sort of urgency or tension to be released, help to better understand the mechanisms that regulate our automatic behaviors. The appearance of tics over time seems to follow a “wave” or even fractal pattern, explaining why symptoms can increase or decrease in a cyclical manner (Leckman, 2023).
In general, the natural evolution of tics shows a significant decline during adolescence but Tourette syndrome can be associated with social, emotional or academic difficulties, especially if it is accompanied by disorders such as ADHD or obsessive-compulsive disorder, which can influence long-term outcomes, significantly impacting the quality of life.
Nervous tics: types and causes
The debate on nervous tics is made complex by the fact that their definition is very blurry.
They fall under the same name apparently very different behavioral manifestations and, for each of these conditions, the causes are not yet clear.
As regards their classification, with a slight approximation, we can say that there are two main categories of tics: motor and vocal. THE motor tics involve body movements, such as blinking, grimacing, shaking the head, twitching the shoulders; the vocal tics involve the involuntary emission of sounds (coughs, grunts) or the repetition of words or syllables.
We can then divide both categories into simple tics (rapid, isolated movements or sounds) e complex tics (articulated and coordinated sequences).
The exact causes are not yet fully known, but a possibleinteraction between biological, psychological and environmental factors.
On the genetic level, a meta-analysis conducted on 4,819 subjects with Tourette Syndrome and 9,488 controls identified a significant locus in the FLT3 gene on chromosome 13. The study estimated that genetic variants in evolutionarily conserved regions would explain approximately 92.4% of the estimated heritability for the syndrome. Furthermore, polygenic risk scores for Tourette Syndrome predict not only the presence of the condition, but also the maximum severity of tics and the likelihood of a family history of tics. However, this finding was not replicated in a larger cohort (Yu et al., 2019).
From a neurobiological point of view, a study conducted by Wang and collaborators (2011) in Tourette patients found increased activity in the motor pathways (sensorimotor areas, putamen, globus pallidus, substantia nigra) and, in the most severe cases, reduced activity especially in the caudate nuclei (in the deep part of the brain linked to movement and habits) and in the anterior cingulate cortex, i.e. the upper and internal part of the cerebral cortex, linked to emotions, attention and cognitive control.
However, these aspects must not be isolated from psychological and environmental factors: stress, anxiety, lack of sleep or emotionally intense events can favor the onset or accentuation of tics. In this sense, it is important to consider that, although tics are commonly believed to be of neurobiological origin, the frequency of tics can be influenced by antecedent environmental events and social consequences. Goldman and DeLeon (2020) reviewed 13 experimental studies that sought to identify factors that maintain tics. Researchers have seen that, in many people with Tourette syndrome, tics tend to maintain themselves, a bit as if they “fed” themselves. However, this is not always the case: in certain cases, studying why a tic occurs can help find more effective strategies to reduce it.
Symptoms and recognition of nervous tics
Tics are generally very recognizable. Essentially these are repetitive, non-purposeful and difficult to inhibit actions. Often the person reports an “internal drive” to make that gesture or sound, which fades only after performing it.
Tics tend to vary over time: they can get worse in certain periods and reduce in others, with a fluctuating trend.
Not all tics require specialist intervention. However, it is advisable to consult a doctor or psychologist when:
- tics persist beyond a year
- they get progressively worse
- interfere with daily, social or school activities
- are associated with other disorders (anxiety, difficulty concentrating, mood disorders)
Nervous tics: diagnosis, treatment options and management
The diagnosis of tic disorder can be made through the clinical interviewldirect observation and gathering information (including from family members or teachers, in the case of children). Neurological tests may sometimes be required to rule out other conditions because it is critical to distinguish tics from other movement disorders or from stereotyped behaviors associated with neuropsychiatric conditions.
Obviously treatment varies based on severity of symptoms, the frequency of tics and the type of discomfort shown by the patient. A first step is psychoeducation, which allows the person and family to be informed. This step can be critical in preventing the risk of developing stigmatizing beliefs and behaviors.
Behaviorally, Habit Reversal Training (HRT) has been identified as a well-established psychological treatment, while exposure response prevention (ERP) is often considered effective. In general, cognitive-behavioral therapy (CBT) is considered effective: a meta-analysis that included 12 clinical studies with 536 patients showed that CBT significantly reduces the overall severity of tics, with a greater impact on motor tics than vocal tics (Shou et al., 2021).
Furthermore, psychotherapeutic interventions can be useful when concomitant anxiety or stress is present.
Pharmacotherapy is indicated especially in the most serious or disabling cases and must always be taken under strict specialist supervision.
Finally, even daily strategies such as improvement of sleep hygienethe stress reduction and practicing relaxing activities can help reduce the intensity of tics.
Empathy and support in managing tics
Tics do not tell us who we are, they are not a limit or a defect: they are just a nuance of the way in which the body and mind communicate. No one should feel defined by an involuntary movement or sound. What is needed is a kind look, sincere listening and deep understanding.
Supporting those who live with tics means offering space, calm and acceptance — because only in the light of awareness and empathy can one learn to live with oneself without fear, transforming what weighs into something of one’s own, lived with dignity and mastery.
