Therapy When You Have Tourette's

What Tourette's is

Tourette's syndrome involves both motor tics and vocal tics, present for more than a year. A tic is a sudden repeated movement or sound. Most people describe a building sensation beforehand, often called a premonitory urge, which the tic relieves.

Tics can be held in for a while. Doing so takes considerable effort and the pressure usually builds until it comes out later. Many adults describe getting through a working day and then ticcing heavily the moment they are alone.

Tics tend to worsen with stress, tiredness and being watched. That combination is unhelpful, because being watched is the situation in which most people most want them to stop.

The swearing thing

Coprolalia is the involuntary swearing that dominates every portrayal of Tourette's on television. An international study of 597 people found that it had occurred at some point for about one in five. The figure was 19.3 per cent of males and 14.6 per cent of females.

So most people with Tourette's have never experienced it. They are still met with the assumption that they do. That misunderstanding is not a minor irritation.

It shapes how strangers react, how employers respond and how long people wait before telling anybody.

Source: Freeman et al. 2009

How common it is, stated properly

You will often see the figure of 1 in 100 for Tourette's. It needs explaining rather than repeating.

The best available meta-analysis puts prevalence at around 0.52 per cent in children. The confidence interval runs from 0.32 to 0.85 per cent. Estimates for adults are much lower.

One meta-analysis puts adult prevalence at roughly 118 cases per million.

The reason is that tics commonly reduce substantially in adulthood for many people. So on a page written for adults, quoting the school-age figure would overstate things considerably. Rarer does not mean less real, and it does often mean harder to find someone who knows the condition.

Sources: Scharf et al. 2015, Levine et al. 2019

What therapy is and is not for

Reducing tics is a clinical matter, and specific behavioural treatments for tics exist. We are not a clinical service and we do not provide them.

What therapy is very good at is everything that grows around a visible, misunderstood, stigmatised condition.

• Anticipatory anxiety about being seen, and the shrinking of life that follows it
• Exhaustion from suppressing tics all day in order to be taken seriously
• Anger, which is entirely reasonable and still needs somewhere to go
• Work and study, and the adjustments you are entitled to ask for
• The loneliness of explaining the same thing to every new person

What often comes with it

OCD and ADHD both occur alongside Tourette's frequently enough that many people are dealing with more than one thing.

That has a practical consequence. A repeated action driven by a premonitory urge is not a compulsion driven by dread. Treating one as the other does not work.

Find a professional who can tell the difference. Say at the outset if you think both are present.

Our OCD page covers that distinction in more detail.

Finding the right person

You are looking for someone unbothered. Not someone performing being unbothered.

Practical things to ask before booking. Have they worked with tic disorders before? Are they comfortable if you tic throughout the session, without commenting on it?

Are they willing to work by video, which many people find easier because they control the environment?

Somebody may have to visibly compose themselves the first time you tic. Better to know that in the first five minutes than the fifth session.

Where else to get help

Tourettes Action is the UK charity for Tourette's syndrome. They provide information, support and advocacy, and they campaign specifically against the stereotypes described above. Their awareness campaign runs each June.

If things are difficult today, our crisis page lists free confidential helplines you can contact now.