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the FAQs about
Tourette Syndrome

1.1 - Impulses

Tourette Syndrome is sometimes referred to as an "impulsive disorder" and as a "disorder of disinhibition". One can therefore say that on the one hand TS means being constantly assailed by various strange impulses, and on the other hand being unable or less able to suppress them.

a) Tics

In order to diagnose the Tourette Syndrome tics have to present in one or another form for more than one year.

Tics can be described as sudden urges to make virtually any movement or sound. These can include:
*eyeblinking
*squinting
*lip smacking
*neck jerking
*shoulder shrugging
*arm flailing
*nail biting
*foot stomping
*barking
*coughing
*hissing
*humming
*stuttering
*sudden changes of voice tone, tempo or volume
*short often meaningless phrases
*swearing
The swearing is often perceived to be the most distressing or dramatic aspect of TS and has received the special medical term of coprolalia (Latin: fces lips). More on that later.

There are a few characteristics of tics that clearly set them apart from other phenomena such as habits:

* Tics are seemingly random

Habits are set ways of performing actions which only come into play while you are already performing them. You might have a special way of stirring your coffee but you do it, after all, only while stirring your coffee. Unless you make an effort to unlearn them, habits stay part of you for life.

By contrast, the urge to tic can crop up at almost any time of day, seemingly unrelated to anything else you are doing at that stage. Also, tics might suddenly, after months or years of frustrated attempts to "stop doing them," systematically disappear - to be replaced by other tics.

The extent to which tics are perceived to be random differs from individual to individual. Many researchers seem to think that they are totally random and meaningless "nerve twitches," while many people who actually have TS report that there seems to be some sort of frustratingly hidden pattern or meaning to them that they can't put their finger on.

* Tics are strong urges which call for expression

Some Touretters can consciously or unconsciously suppress their tics for anything from minutes to hours. However, the longer tics are suppressed, the more a sort of inner tension and agitation builds up which must sooner or later be vented as tics.

One way to check whether an action is a tic or not is to apply the "try to suppress it" test. If suppressing it leads to agitation, eventually doing the act or another similar act, or a feeling of "why should I suppress it anymore - I want to do it anyway," it is most likely a tic.

* Premonitions and awareness of impending tics

Some Touretters report that they are conscious of the urge to tic before they actually do so. In that case the urge can express itself as fleetingly remembering that you have this tic and want to make it, a sudden idea or image of frustration which you seem to want to express in the tic, or as the feeling that the tics is building up in you like a sneeze.

Some Touretters aware of the urge to tic as physical, unpleasant sensations which they seek to expel through the tics.

In my experience the urge often appears so quickly that the thought is not quite verbalised by the time you do the tic. In other words, you are vague and fleetingly aware that there is some sort of thought flashing into you head, then it emerges as a tic, and more or less simultaneously the words that "go with the thought" appear in your head.

Also, in almost these cases, you have to make a lightning-fast decision not to tic if you want to catch it before it gets out.

* Tics seem to serve no purpose

Whereas other normal urges such as scratching itches and coughing serve some purpose, tics outwardly seem to serve none. For example, the difference between normal swearing and coprolalia is that a Touretter is often not even angry or agitated at anything when he/she swears and the swearing often emerges totally out of context.

The pent-up urges that seek their outlet in tics are never completely expelled and eventually keep reappearing.

To sum up: with normal actions you decide to do something, like get up and leave. After the decision, and only if you decide to act on it, you actually do it.

With tics it is almost the reverse: there is no premeditated will to do them and only if you decide to suppress the tic (and are able to suppress the tic) do you end up not doing the action - for a while.

If you want to imagine what tics are like: imagine being aware of the urge to sneeze without any physical sensation in your nose preceding it. Now replace "sneezing" with any other sudden act you can think of.

Or imagine the urge to close your eyes because a fly is flying straight towards them, but without there actually being any fly. Now imagine that as you resist the urge to close you eyes, the "imaginary" fly is frozen in front of your eyeballs, forever nerve-wrackingly homing in on them until you eventually have to close you eyes or jerk away your face.

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b) Echolalia, echopraxia, palilalia, and other repetitions

Related to tics are other urges: When my friends and I are driving somewhere, I often find myself repeating outside words I read out loud. The conversation sometimes goes something like:

"Laundromat."
"What?"
"Oh, nothing."

"Armed robbers shot."
"Huh?"
"I was only speaking to myself..."
"Oh."

I once walked past a block of flats that I thought were called "Ultimatum". As I read their name to be "Ad libitum" the sense of confusion was so strong as to be almost physical and I found myself repeating: "Ad libi-Ad libi-Ad libi-Ad libitum -- Enough, thank you!"

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c) Coprolalia, or swearing

This is generally the best known and dramatic aspects of TS. When TS grabbed the attention of the media in past, it was mostly due to this more sensational aspect of the syndrome. Eye-catching captions such as "Cursing Disease" or "The Foulmouth Syndrome" were used. Sadly, this is often the only aspect of TS that is commonly known (and made fun of.)

The truth is that swearing is not a universal symptom of TS. Coprolalia occurs in about 8 to 30 percent of cases, and even then it often seems to last only for a phase in life.

Coprolalia can be one of the most distressing yet fascinating aspects of TS. Many of those who exhibit coprolalia live in environments where swearing is not allowed or condoned. Many don't condone swearing themselves. Coprolalia can also cause social problems, causing the false impression that one is swearing at other people.

It is also for this reason that Touretters have often been falsely thought to be somehow morally deficient, and that TS was considered a psychological disorder.

The question remains: how can a biological condition often surface as a proneness to utter certain obscene words? I can propose two explanations:

  1. Whether you consider swearing reprehensible, or swear yourself, swearwords often carry a strong emotional value - that is their purpose, after all. Although the specific forms of the swearwords are determined culturally and not biologically, it is possible that, as one grows up and learns their meaning, they are "stored" in association with certain specific emotional systems in the brain.

  2. There are favourite swearwords and less favourite swearwords. It seems as if the more common swearwords have certain sound qualities that give them a sharp "edge," such as plosive consonants and alliteration, etc. These same aspects make them ideal for ticcing. In fact, other vocal tics also often seem to carry a certain rhythmical quality.

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