Causes of repetitive tics and habit patterns are not always known or discernable. It is likely there is no single cause, but rather a combination.

Genetics, as well as environmental factors, likely play a role in developing these complex disorders, especially Tourette Syndrome. 

Family history of Tourette Syndrome or other tic disorders might increase the risk of developing the condition. 

Chemicals in the brain that transmit nerve impulses (neurotransmitters), including dopamine and serotonin, might play a role.

Habits that start for one particular reason end up becoming repetitive and stress-reducing and may eventually lose connection to the original reason, resulting in the unwanted behavior

Tourette Syndrome: Involves sudden, brief or intermittent movements and sounds, neither wanted nor easily controlled. The most severe tic disorder, symptoms can interfere with daily functioning and quality of life.

Other tic disorders and twitches: Less severe spasm-like movements of particular muscles can occur anywhere in the body, often affecting the eyelids or face.

Body-focused, repetitive behavior (BFRB) disorders include “self-grooming” behaviors—such as hair pulling or skin picking that can damage the body—and can also be disruptive nervous habits, such as thumb sucking, body rocking, stuttering or tapping fingers.

Nervous habit disorders: Children showing repetitive patterns of movement that become a means of discharging tension but interfere with their physical, emotional or social functioning.

Diagnosis and Assessment

Untreated problems can be damaging, while effective treatment can result in significant reductions in symptoms, contribute to living a more fulfilling and satisfied life and better functioning at home, school or work. After completing treatment, clients report feeling happier, more in control and being a better family member and friend.

The first step toward recovery is diagnosis, based on an assessment from both a primary care provider and a mental health professional. The assessment also helps determine risk factors that may have played a role in developing tic and habit disorders, such as:

Family history. Tic and habit disorders are significantly more likely to occur in people who have parents with tic and habit disorders.

Other mental health disorders. People with such disorders often have a history of an anxiety, depression, autism spectrum disorder (ASD) or obsessive-compulsive disorder (OCD).

Stress. Stressful life events—moving, going to college, a new job, or family/relationship issues—may increase risk of tic and habit disorder.

Based on signs and symptoms, diagnoses generally involve:

Physical exam. A medical doctor performs an examination and orders lab tests to rule out other medical causes for tic and habit issues.

Psychological evaluation. A mental health professional asks about thoughts, feelings and behaviors—and possibly requests completion of a psychological self-assessment questionnaire.

Other studies. Additional tests may be done to check for complications related to the disorder.

Treatment

People with tic and habit disorders are often seen by pediatricians, psychologists or psychiatrists for evaluation and treatment. But many do not need treatment when symptoms are not troublesome. Tics and habits often lessen or become controlled after the teen years. In more severe cases, however, early intervention treatment can lessen the severity and help individuals live a fuller, more productive life.

Evidence indicates these disorders—motor and vocal tic disorders, self-destructive oral habits, trichotillomania (hair pulling), onychophagia (nail biting) and thumb sucking—can be effectively treated with behavioral and/or pharmacological approaches.

Main behavior therapy treatments for tic and habit disorders:

Habit reversal therapy (HRT)—with comprehensive applied behavioral analysis (CBIT) is a manualized treatment for children and adults, lasting 8-16 sessions. Added components, such as progressive muscle relaxation and breathing techniques, help lower clients’ overall distress.

Exposure and response prevention (ERP) for tic disorders

HRT and stimulus control strategies for BFRBs

HRT and acceptance-based behavioral therapy (ABBT) for habit disorders

Primary Treatments for Tic Disorder & Tourette Syndrome

Behavioral therapy interventions, including habit-reversal training (HRT), medication or a combination of these can help people monitor tics, identify premonitory urges, learn to voluntarily move in a way incompatible with the tic and reduce tic frequency. 

For parents of children with Tourette Syndrome:

• • Be your child’s advocate at school by educating teachers, school staff and others with whom your child interacts. Use educational resources that reduce your child’s stress, such as tutoring, untimed testing and smaller classes.
  • Nurture your child’s self-esteem by supporting personal interests and friendships.
  • Join a support group to help you cope. 

Treatments for Body-Focused, Repetitive Behaviors (BFRBs)

Individuals, especially children, need clinical attention if they experience psychosocial impairment, physical damage or emotional distress. BFRBs are treated with combinations of: 

• • Cognitive behavioral therapies (CBT) 
  • Behavioral therapies
  • Other behavioral therapy techniques—such as acceptance-based behavioral therapy and dialectical behavior therapy (DBT)—are particularly effective in facilitating acceptance of negative feelings that give rise to habit behaviors and improving emotion regulation.

Psychotherapy

Talk therapy can help in coping with habit and tic disorders, as well as with accompanying problems, such as attention-deficit/hyperactivity disorder (ADHD), obsessions, depression or anxiety.

Medications

A range of medications, including but not limited to antidepressants, are typically used to reduce tic and habit frequency and enhance a person’s daily life. This usually does not result in the complete remission of tic symptoms.

CONNECT TO CARE

REFERENCES

Association of Behavioral Cognitive Therapy (ABCT)

Mayo Clinic

Webmd

National Institute of Mental Health (NIMH)

Tourette Association of America

PubMed, National Library of Medicine

Research Gate

Anxiety.org