Tourette
Syndrome Symptoms
Symptoms
are the subjective evidence of disease or physical disturbance
observed by the patient that indicates the presence of a disorder.
The
general symptoms of Tourette Syndrome can be divided into motor,
vocal, and behavioral manifestations. Though the behavioral manifestations
are not essentially listed in the DSM as diagnostic criteria,
there are those that believe behaviors like ADHD and OCD are common
enough to be considered a co-morbid
condition to Tourette Syndrome. The DSM does make note of this.
About
11-20% of persons coming to clinics have no other disorder, or
could be referred to as "TS-Only." They tend not to
have other problem behaviours. The others meet, on average, criteria
for 2 additional disorders, most often ADHD and/or obsessive-compulsive
disorder OCD.
Tourette
Syndrome symptoms can be experienced as mild, moderate, or severe.
The severity is measured by the symptoms’ frequency, complexity
and the degree to which they cause impairment or disruption of
the patient's ongoing activities and daily life.
Tourette
Syndrome symptoms also have various other scales that symptoms
can be rated by to help in the evaluation and effectiveness of
clinical research. Some of these scales are:
Tourette
Syndrome Global Scale (TSGS)
Clinical Global Impressions Scale (CGIS)
Yale Global Tic Severity Scale (YGTSS)
The Tourette Disorder Scale (TODS)
Yale Global Tic Severity Scale (YGTSS)
These
developed scales for tic disorders that use objective criteria
may evaluate severity for clinical clarification, however, what
may be experienced by the patient may feel completely different.
What may be experienced as mild to moderate Tourette Sympotms
by one person may feel sever to another and vice versa.
There
may be tremendous variability over short and long periods of time
in symptomatology, frequency and severity. Tics typically occur
in "bouts" with many tics over a short interval of time.
In
addition to the moment-to-moment or short-term changes in symptom
intensity, many patients have oscillations in severity over the
course of weeks and months. The waxing and waning of severity
may be triggered by changes in the patient's life; for example,
around holidays, children may develop exacerbations that take
weeks to subside. Other patients report that their symptoms show
seasonal fluctuation. However, there are no rigorous data on whether
life events, stresses or seasons do, in fact, influence the onset
or offset of a period of exacerbation. Once a patient enters a
phase of waxing symptomatology, a process seems to be triggered
that will run its course for weeks or months.
In
its most severe forms, patients may have uncountable motor and
vocal tics during all their waking hours with outburst of full
body movements, shouting or self-mutilation. At times the tics
seem organized in orchestrated patterns that are characteristic
of that individual. Despite this, many patients with severe tics
manage to achieve adequate social adjustment in adult life, although
usually with considerable emotional pain. More than the severity
of motor and vocal tics, the factors that appear to be of importance
with regard to social adaptation include the seriousness of attention
problems, obsessive-compulsive symptoms, the degree of family
acceptance and support, intelligence and ego strength.
Understanding
the symptoms is what will help clinicians and patients reach goals
for the treatment of Tourette Syndrome. The goal of treatment
should not be to completely eliminate all the tics and symptoms,
but to relieve tic-related discomfort or embarrassment and to
achieve a control of the Tourette symptoms that allows the patient
to function as normally as possible. Read more about Tourette
Syndrome treatment here...
Now
lets look at the official symptoms of Tourette Syndrome and some
of the unofficial related Tourette symptoms. Some of the
symptoms experienced by patients, official or not, don’t
always simply fall into the tics category, or comorbid and associated
conditions. Nonetheless, these symptoms can sometimes cross over
into various other neurological disorders and conditions and are
worth discussion among “Touretters”.
Official
Symptoms of Tourette Syndrome
A
simple diagnosis of Tourette Syndrome would only require you to
have these basic qualifications as symptoms of Tourette Syndrome:
involuntary body movements and vocal outbursts (Tics)
for at least 12 months. That's it! If you have Tourette
Syndrome Only aka "TS-Only" officially all you will
have are tics. You can view the complete official diagnostic
criteria for Tourette's Disorder (DSM) here.
Common
Official Tourette Syndrome Symptoms
• Tics
(list) are rapid movements or
sounds that are repeated over and over for no reason. Tics are
brief, intermittent, repetitive, nonrhythmic, unpredictable, purposeless,
stereotyped movements (motor tics) or sounds (phonic or vocal
tics). Although Tourette Syndorme tics are often described
as "rapid" or "sudden," not all are; some
tics are "held" or "tonic" movements involving
freezing in a position for a few seconds. A person with a tic
can't control the movement or sounds. Read more about Tourette
Syndrome Tics...
Rare
Official Tourette Syndrome Symptoms
•
Coprolalia (complex
vocal tic - outburst of obscenities and curse words) and
other coprophenomena.
Self-destructive
Behaviors in Tourette Syndrome Symptoms
•
Head banging (motor tic)
• Eye poking (motor tic)
• Lip biting (motor tic)
Commonly
Associated Conditions in Tourette Syndrome
The most frequent
associated conditions are:
•
Obsessions and compulsions i.e. Obsessive-compulsive disorder
(OCD)
• Inattention i.e. Attention-deficit-hyperactivity disorder
(ADHD)
• Learning disabilities
• Behavioral problems i.e. quick temper, mood swings, over-reaction.
• Impulsiveness i.e. Echolalia (the urge to repeat other's
words), echopraxia(the urge to mimic other's actions), palilalia
(the urge to repeat your own words or thoughts).
Unofficial
Symptoms of Tourette Syndrome
Unofficial
Tourette Syndrome Symptoms is a term for indexing only on this
site. We are using the term for broadening and understanding the
possible spectrum of symptoms and common patterns that those with
Tourette Syndrome may experience.
The
use of the term "Unofficial Tourette Syndrome Symptoms"
does not suggest that these unofficial symptoms should be considered
as an “official symptom” of Tourette Syndrome and
included in the diagnostic criteria. We also do not suggest that
all people with Tourette Syndrome will deal with these common
patterns in their diagnosis.
I've
always found that the absolute best way to learn more about
Tourette Syndrome is to talk to other Touretters. They tend
to know or reveal things about the condition that no-one knows
yet (at least not publicly).
Talking
to other Touretters I discovered that Tourette syndrome appears
to be more than just tics. There are other "symptoms"
of Tourette Syndrome which seem to be reasonably familiar within
the Tourette population.
Caroline
Jacobs
Assistant Editor
The
following symptoms are alphabetically listed without consideration
of severity, frequency, importance, or anything else implied.
•
Heat Sensitivity - With this
possible symptom, the person with Tourette Syndorme is always
warm and has an unusual sensitivity to heat. In hot weather,
the person boils, in cold weather they wear much less heavy clothing
than would be expected.
Thermal
sensitivity in Tourette syndrome
In
a preliminary report at the Child Study Center, Yale School of
Nursing; the effects of heat on tic symptoms were studied in a
sample of 78 adults with Tourette syndrome. Of the 78, 24% or
19 reported increased tics upon exposure to heat. Tic symptoms
in a subgroup of patients with Tourette syndrome may be sensitive
to heat.
•
Light Sensitivity
- Heightened sensitivity to light (especially flickering light)
with irregular dilation and contraction of the pupils and/or with
irregular binocular functions
•
Polydipsia - \Pol`y*dip"si*a\
Excessive water drinking. Excessive and constant thirst
usually associated with disease i.e. diabetes.
Drinking
lots of water is usually healthy. However, the urge to drink excessively
beyond a certain limit may reflect an underlying problem, either
physical or emotional.
People
with Tourette Syndrome and Polydipsia drink about 15 bottles of
water a day from those we have experienced. Toilet trips are very
frequent. It is possible that altered serotonin levels in Tourette
Syndrome is to blame. Serotonin levels affect vasopressin (vay-soe-PRESS-in)
levels a naturally produced hormone in the body. Vasopressin controls
the amount we drink, and is necessary to maintain good health.
Lack of vasopressin causes your body to lose too much water.
•
Sleeping Difficulties - Many of those that we
experience with Tourette Syndrome seem to either one; sleep long
and too much, or not very much at all. They may even fight sleep
until exhaustion takes over and they don’t have a choice.
I rarely have met any in-between. This could be a result of medications,
depression, anxiety, and many other reasons worth researching.
Sleep
Disorders SD
•
Tactile Hypersensitivity - 5 out of the 13 patients
with Tourette Syndrome mentioned they had this symptom. Some of
them couldn't stand the feel of hair on their skin. Clothing tags
are a nuisance. They cannot wear synthetic material or wool.
Pure cotton undergarments seem to be the only acceptable alternative
and a couple of women go bra-less because they are too uncomfortable
otherwise. There seems a higher than normal level of allergies
to things like detergents and cheap metal jewelry. Even the thought
of touching chalk makes some of them squirm. Often a person with
this symptom will feel suddenly itchy all over, for no discernable
reason. This itchiness can be triggered by watching seeing a biting
insect, seeing someone else scratch, and even talking about scratching
or itches.
Other
tactile offenders could be: stiff tags, stiff fibers (e.g., jeans),
seams in socks, waistbands and belts, jewelry, hairbands, synthetic
fibers.
•
Residual Consequences - may include: Low Self-Esteem;
Frustration; Depression; Social Withdrawal - in the 1800's a 90
year old woman, the Marquise de Dampierre, had withdrawn from
social contact for 70 years, due to this disorder - Impaired Relationships;
Anger; Oversensitivity; Discouragement; Feelings of being crazy,
bad, stupid, rejected, unloved, hopeless. Impaired ability to
understand or appropriately respond to others; Self-Injurious
Behaviours and Eating and Sleeping Disorders.
• Associated
Conditions -Terms - Other Disorders
Tourette
Syndrome "Plus",
Anxiety
Disorders ADAA,
Obsessive-Compulsive Disorder OCFoundation,
Depression Disorders DD &
NAFDI,
Attention Deficit Hyperactivity Disorder ADHD,
Pediatric Autoimmune Neuropsychiatric Disorders Associated with
Streptococcal Infections PANDAS,
Sensory Integrative Dysfunction SID,
Rage Attacks - Storms RASD,
Dysinhibition Syndrome DS,
Oppositional Defiant Disorder ODD,
Learning Disorders and Disabilities LDD.
, Neurological Disorders NINDS,
continue to More...
Caroline
Jacobs
Paul Marshall
Tourette
syndrome and human behavior, HopePress - David E. Comings M.D.
www.hopepress.com
MedlinePlus
- Definitions
NCBI
- Serotonin, vasopressin, thirst.
NCBI
- Thermal sensitivity in Tourette syndrome
TSA
- Tourette Syndrome Association Symptomology
Tourette
syndrome: minimizing confusion - Roger D. Freeman, M.D
www.tourette-confusion.blogspot.com
