The three main types of tic disorder

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Everyone with Tourette syndrome has tics, but not everyone with tics has Tourette syndrome.

Those diagnosed with Tourette have both motor and vocal tics. These tics last longer than a year.

Other tic disorders classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have subtle differences, so let’s explore them.

The types of Tic Disorders

The DSM-5 classifies three main types of tic disorder:

  • Provisional Tic Disorder
  • Persistent (Chronic) Tic Disorder
  • Tourette’s Disorder

The tic disorders basically describe their nature in their name, apart from Tourette.

This is because Tourette syndrome is named after the neurologist that published studies of tics in 1885, Georges Gilles de la Tourette.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is published by the American Psychiatrics Association and the most up to date publication.

The DSM classification is used to diagnose various mental disorders. It will help us understand what each of these tic disorders consists of and what makes them unique.

What makes tics Tourette syndrome

For tics to be classed as Tourette:

  • Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently
  • The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset

For Tourette to be diagnosed, both motor and vocal tics need to be present in an individual.

Motor tics are the movement based tics. Vocal tics are sounds, words and/or phrases.

They also need to have lasted at least one year.

What makes tics Persistent (Chronic) Tic Disorder

  • Single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal
  • The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset
  • Criteria have never been met for Tourette’s disorder

Persistent (Chronic) Tic Disorder is similar to Tourette, but an individual does not experience motor (movement) and vocal (sound) tics in the year that is needed to diagnose for the tics.

Instead, they have either motor tics or vocal tics. These can be simple or complex.

These have to be present for more than a year after the tics started and the person must have not been diagnosed with Tourette previously.

What makes tics Provisional Tic Disorder

  • Single or multiple motor and/or vocal tics
  • The tics have been present for less than 1 year since first tic onset
  • Criteria have never been met for Tourette’s disorder or persistent (chronic) motor or vocal tic disorder

Provisional Tic Disorder can be diagnosed if tics have lasted less than one year.

These can be simple or complex, and be both motor and vocal tics.

Provisional basically means temporary– and this diagnosis can change if the tics last longer than the year needed to diagnose Persistent Tic Disorder or Tourette.

Current disqualifying factors

The DSM-5 also states that these tic disorders can be diagnosed only if:

  • Onset is before age 18 years
  • The disturbance is not attributable to the physiological effects of a substance or another medical condition

This is interesting, because more and more people have recently been experiencing a sudden onset of tics, even in adulthood.

Whether the age criteria remains the same will have to be seen.

Numerous conditions, medications and drugs can cause tics, or tic-like symptoms different to that of tic disorders. This is why certain conditions or substances can rule out a diagnosis.

Three main tic disorders summary

Tourette is the most severe, with both motor and vocal tics present for more than a year.

This is followed by Persistent (Chronic) Tic Disorder. This can be as frequent and severe as Tourette, but with only motor or vocal tics. Not both.

Provisional tic disorder can be the same severity of both Tourette and Persistent Tic Disorder, but needs to pass that one year mark before it can be diagnosed as anything other than Provisional.


Sources:

American Psychiatric Association. Desk Reference to the Diagnostic Criteria : from DSM-5 by American Psychiatric Association.

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