CBIT Therapy for Tics and Tourette Syndrome

Tics are rapid, purposeless, unvoluntary, unrhythmic, repetitive, frequent, unwanted, and discrete muscle movements. Sometimes they are referred to as jolts or twitches. Tics are classified as simple or complex motor or vocal tics. Motor tics include blinking, neck rotation, torso twisting, jumping, toe flexing, and countless other movements. Vocal tics include numerous vocalizations including coughing, making a hum or grunt sound, and saying a word or phrase. 

Please consult with a neurologists specializing in tics if you are experiencing distress related to sudden and involuntary movements or vocalizations. It is important to have a comprehensive evaluation and proper diagnosis to proceed with effective care. Some patients with tics benefit from medication, while others respond better to behavioral intervention. The most research-backed and effective treatment is Comprehensive Behavioral Intervention for Tics (CBIT). CBIT Therapy is a form of Habit Reversal Training that focuses on the management of tics by briefly and painlessly inhibiting muscles involved with unwanted and repetitive movements and sounds.

Common tic disorders and their diagnostic criteria are described below:

Provisional Tic Disorder

• Patient has one or more motor or vocal tics.
• Tics are present for less than one year.
• Tics start before age 18.
• The tics are not due to a medication, other drugs, or a medical condition that can cause tics (for example, Huntington disease or postviral encephalitis).
• The patient has not been diagnosed with another tic disorder.

Persistent Tic Disorder

• The patient has one or more motor tics or vocal tics, but not both.
• The tics occur many times a day nearly every day or on and off throughout a period of more than a year.
• The tics start before age 18.
• The tics are not due to a medication, other drugs, or a medical condition that can cause tics.
• The patient has not been diagnosed with another tic disorder.

Tourette Syndrome (Tourette Disorder, Tourette's, TS)

• The patient has two or more motor tics and at least one vocal tic.
• The tics have been present for at least one year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on for at least one year.
• The tics begin before age 18.
• The tics are not due to a medication, other drugs, or a medical condition that can cause tics.

Functional Tic-Like Behavior (FTLB)

Functional tics are sudden, involuntary, and non-rhythmic movements or sounds caused by a Functional Neurological Disorder (FND)

• They start rapidly and increase in severity over a short period of time 
• They are often associated with anxiety and depression 
• They are more common in females and teenagers 
• Functional Tic-Like Behavior is often thought to be an outward display of emotional distress.

TikTok Tics  (FTLB  Mass Sociogenic Illness)

• TikTok Tics is a serious disorder in which patients think they have Tourette Syndrome but do not. This belief comes from having behaviors similar to those demonstrated by influencers who falsely claim to have Tourette's on platforms such as TikTok and YouTube. Common behaviors include shouting out words, whistling, losing their balance, flicking wrists, yelling words heard on the videos and acting in disruptive ways. The tic-like behavior is much different in appearance than other tic disorders in the speed in which it occurs and the frequency, number, and intensity.
• Patients with TikTok Tics tend to be female or non-binary youth with a past history of anxiety, depression, and Autism, and feelings of isolation. TikTok Tics is primarily treated as a mental health condition with physical symptoms.
• Attention placed on the tic-like behaviors tends to increase their intensity and frequency.
• Patients with TikTok Tics often seek out others with the same condition to compare symptoms and form a sense of belonging.
• Learn more about TikTok Tics from a research paper recently published with specialists from Boston Children's Hospital at  http://dx.doi.org/10.1002/brb3.3451 

It should be noted that tics related to Tourette Syndrome first occur in early childhood and then tend to last off and on for an extended time. Tics also start very gradually, with only one new tic emerging at a time. There is no sudden onset of multiple tics as there tends to be with functional tics / TikTok Tics. 

Many people with Tourette Syndrome have co-occuring concerns including anxiety, depression, Autism, OCD, ADHD, gender dysphoria, dysgraphia, rigidity, and difficulty with executive functioning tasks. There also is some correlation with  Body-Focused Repetitive Behaviors (BFRB) such as excessive nail biting, hair pulling (Trichotillomania) or skin picking, and Functional Neurological Disorder (FND) such as tic-like behaviors. 

To learn more about Tourette Syndrome and other tic disorders, please visit the Tourette Association of America website.