Tics vs. Tourette Syndrome: What’s the difference?

Twitching. Excessive blinking. Persistent throat clearing. These can all be considered tics, or sudden, repetitive movements or sounds that your body makes involuntarily.

You may have heard tics referred to as “Tourette’s,” but technically the two terms are not interchangeable. Tourette Syndrome (TS) is a specific tic disorder diagnosis, and while tics are a defining feature of TS, they also appear in other tic disorders and related conditions, like Tourettic obsessive-compulsive disorder (OCD). 

TS and other tic disorders are not rare; nor do they occur only in kids. As many as 1 in 5 school-aged children experience tics. Sometimes it’s transient, while other times it persists into adolescence and adulthood. That said, more research is needed to determine exactly how many adults have TS and other tic disorders.

Read on to learn more about the different types of tics and tic disorders, as well as how to best manage them.

What are tics?

A tic is an involuntary vocalization or movement. These repetitive behaviors are classified as either motor tics, which involve sudden bodily movements, or vocal tics that range from subtle vocalizations like throat-clearing to blurting out full sentences. Here are some common examples of both:

Motor tics

• Blinking: Quick fluttering of the eyelids or eye jerks
• Tongue movements: Sticking out or rolling the tongue
• Head movements: Twitches or jerks of the head and neck
• Squatting and hopping: Moving up and down with the legs or bending the knees repeatedly
• Tapping: Repeatedly tapping any surface or body part
• Shoulder shrugs: Moving the shoulders up and down
• Copropraxia: Obscene gestures, like flipping the middle finger

Vocal tics

• Grunting, hissing, or humming: Unintentional sounds made with the vocal cords 
• Sniffing: Sniffling when there’s no sign of nasal congestion
• Snorting: Short breaths through the nose
• Coughing or throat clearing: Persistent coughing or clearing of the through when it’s not “necessary”
• Coprolalia: Involuntary cursing or use of other derogatory language

Tics are further categorized as simple or complex. Simple tics are brief, basic movements or verbalizations only involving a few parts of the body, like blinking or sniffing. Complex tics are elaborate sequences made up of a combination of simple tics, like shaking one’s head while repeating a particular phrase. Tics that arise due to anxiety are referred to as nervous tics. 

I display tics. Does that mean I have Tourette syndrome?

Not necessarily. Tics can be symptomatic of three main tic disorders:

1. Tourette syndrome (TS) is the most well-known tic disorder. To meet the criteria for a TS diagnosis, you must exhibit multiple motor tics and at least one vocal tic that lasts for over a year. Tic severity, frequency, and complexity is a wide spectrum. Research shows that boys are three to four times more likely to have TS compared to girls.

2. Provisional tic disorder, a.k.a transient tic disorder, where a person experiences motor and/or vocal tics for under one year. With provisional tic disorder, tics usually go away on their own within a few months. It’s the most common tic disorder, impacting about 10 percent of young children.

3. Persistent (chronic) tic disorder is a condition where someone experiences either vocal or motor tics (but not both) for over one year.

The diagnostic criteria for all three of these disorders also requires that:

• Tics started before age 18 (it’s uncommon for tics to begin in adulthood, but it does happen).
• Symptoms are not caused by medicine or other drugs.
• Tics do not come from another medical condition, like Huntington disease which causes uncontrollable movements.

Tic disorders have a significant co-occurrence with attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). It’s been reported that an estimated 60 to 80 percent of TS patients also have ADHD.

I heard that tics can appear “out of nowhere”—just by watching others who experience them. True?

You may have read news stories about the mysterious uptick of sudden-onset tic-like symptoms in teen girls during Covid pandemic. Doctors eventually discovered that these tics were showing up because the girls were watching a ton of videos on YouTube and TikTok where they observed people with TS and other tic disorders exhibiting tics. 

Interestingly, experts determined that in many cases the behaviors were related to a condition called functional neurological disorder (FND), which is usually driven by psychological stressors. This is different from the kind of tics that people with TS experience. The majority of those who developed these sudden-onset functional tics recovered after they stopped watching these types of videos and receiving additional treatment. 

Experts now consider this “outbreak” an example of “mass sociogenic illness”—that’s a fancy term for when multiple people who are somehow socially connected to each other develop the same rapid onset of otherwise medically unexplainable symptoms. It’s important to emphasize that sociogenic illness is very rare.

How are tics different from stims or compulsions?

Stims, tics, and compulsions can look pretty similar to the untrained eye. All three are repetitive behaviors that are seemingly involuntary. They all have a coping or self-regulatory function and can show up in a wide variety of ways. But there are key differences that are important to know about.

Stims

Stims or “self-stimulatory behaviors” are behaviors that virtually everybody engages in. Neurotypical people can often be seen drumming their fingers on a desktop when they’re feeling impatient or twirling their hair when they’re bored, for example. That said, stimming sometimes looks a tad different in those who are neurodivergent. These individuals, including those identified as autistic, may engage in stimming to help manage their emotions or cope with overwhelming sensations. Stims can include:

• Rocking back and forth
• Hand flapping
• Repeating words or phrases
• Humming
• Excessive blinking

Tics

As mentioned earlier, tics are involuntary and sudden movements or vocalizations such as twitching, blinking, shrugging of shoulders, or grunting. Tics are generally described as a release of built-up bodily tension, where people sometimes experience a strong, uncomfortable and distressing sensation beforehand that is relieved by performing the tic.

“Most people with tics originally don’t think that they can even stop them,” says Dr. Patrick McGrath, PhD, chief clinical officer at NOCD. “But you can actually train people to be able to monitor the buildup of tension that they have,” Dr. McGrath explains.

Compulsions

Compulsions, most commonly associated with OCD, are repetitive behaviors or mental acts that people with the condition feel driven to do. While compulsions are deliberate actions designed to neutralize anxiety brought on by obsessions or prevent something bad from happening, tics are largely involuntary and lack any real goal other than the intention to relieve inner tension or discomfort. “Unlike compulsions, tics are not done with the express intent to prevent something bad from happening,” says  Dr. Nicholas Farrell, a therapist at NOCD with extensive experience in Tourette’s syndrome and other tic disorders. “They’re done with the intent to escape an uncomfortable sensation.” What’s more, the actual behaviors that constitute compulsions can be more far-reaching than tics.

Some common compulsions include:

• Repeatedly checking things, like doors or the stove
• Excessive cleaning
• Repeating acts (e.g. walking back and forth through a doorway multiple times)
• Repeating special words or phrases in a specific way
• Organizing things symmetrically or making sure objects are placed “just right”
• Hoarding 
• Counting, as well as identifying numbers as “good’ vs. “bad” (“I must take an even amount of steps, otherwise something bad will happen.”)

What is Tourettic OCD?

While tics and compulsions are quite different, OCD and TS have a lot of overlap. Up to 60% of TS patients also report OCD symptoms, according to the International OCD Foundation. Tourettic OCD is a mix of symptoms from both conditions. 

The tics that show up in Tourettic OCD essentially function as compulsions, since they are brought on by obsessions. But unlike in “standard” OCD, Tourettic OCD obsessions trigger physical discomfort instead of emotional distress. People with Tourettic OCD perform “tic-compulsion combinations” to diffuse the feeling of bodily discomfort.

For example, someone with Tourettic OCD may get an obsessive thought about harming themselves and then rapidly shake their head. “It feels like they have to do that in order to get the thought out of their head,”  Dr. McGrath explains. “It could look like a tic in some ways, but it’s purposely being done in response to an obsession.”

How to get help for tics and compulsions

The recommended mode of treatment for all tic disorders is habit-reversal training (HRT)—a therapy that helps people stop or reduce the frequency of an unwanted behavior by replacing it with another. 

In HRT, people are taught to identify when tension buildup is occurring and become aware of any patterns that precede tics. After developing this awareness, they can then work on replacing the tics with what are called “competing behaviors.” For instance, they may learn to take a deep breath every time they get the urge to do a coughing tic.

Some research has found exposure and response prevention therapy (ERP), an evidence-based treatment that was actually designed to treat OCD, can be as effective as HRT in treating tic disorders. A therapist who specializes in ERP guides a patient as they build up a tolerance to the urge that comes before a tic. Take head-shaking, for example: “I’m just going to have you not shake your head and allow the thought to be there and not do something to try to shake it out or make it go away,” Dr. McGrath says.

While ERP and HRT can both be helpful for tics, if you have actual Tourettic OCD, ERP is the recommended form of treatment. It’s a treatment that has decades of clinical research to back up its effectiveness for all types of OCD, including Tourettic OCD.

ERP allows you to consciously confront your obsessions and develop the ability to resist compulsions. With practice, and the right therapist supporting you, your tics and/or compulsions will become less frequent and take up less of your precious time.