Hello
folks:
I have put these 2 emails together to reply to because they are somewhat
related -- G.W., you ask what are meant by 'environmental factors' that
can magnify symptoms, and J.S., you provide an excellent example of
what some of those environmental factors might be and the impact they
can have. A number of studies have tried to ascertain if there are certain
factors that ALWAYS exacerbate tics and others that ALWAYS attenuate
tics: for example --
Silva,
RR, Munoz, DM, Barickman, J & Friedhoff, AJ. (1995). Environmental
factors and related fluctuation of symptoms in children and adolescents
with Tourette's disorder. Journal of Child Psychiatry, 36(2), 305-312.
In
general, however, it's been found that what DECREASES tics in one person
may INCREASE or NOT IMPACT tics in someone else. My own belief is that
it is stress that increases tics, and since what an individual finds
stressful is largely idiosyncratic, large sample studies would have
difficulty finding conclusive results. In essence, each participant
would be reacting differently in different situations depending upon
whether or not they find those situations stressful and so general results
are impossible to find.
It is also worth mentioning that I define 'stress' in the sense of 'anything
that impacts the resources of the body' (something that 'strains the
system', so to speak). Hence a whole variety of things can be considered
stressful beyond those traditionally thought of (the psychological stress
of studying for an exam, for instance). Being too hot, too cold, hungry,
thirsty, being in a room full of people vs. being alone, etc. are all
physical stressors. Big events (such as J.S.'s move) are stressors even
though they are 'happy' events -- often a birthday or Christmas is one
of the worst times for TS'ers because of the excitement around these
events.
Regarding how to control stress, there is not any TS-specific advice
to give -- everyone has stress in their lives, and everyone reacts to
it (for example, when an individual finds that he or she can sing when
along, but his/her throat constricts as soon as others are in the room).
The only difference between 'normies' and those with TS is that OUR
reactions to stress are more obvious. Think of TS symptoms as the music
and stress as a volume control -- anything you can do to turn that knob
to a lower setting will de-amplify the music.
Some people find herbal supplements or different 'comfort foods' to
help alleviate stress, yes, but there is no rigorous research yet to
demonstrate any reliable and valid results. In other words, we don't
know yet if the different herbs people try will work every time, and
whether it is REALLY the herbs that is making the difference or something
else (maybe the person's BELIEF that the herbs are helping).
Some try meditation (my ex-fiancée); others use chiropractic
(myself). Some go to massage therapy or use hot baths at the end of
a day. Exercise is important, as is eating regular, healthy meals. A
good night's sleep is an all important foundation. Good psychological
health is important too -- talking out problems or emotions with someone,
disclosing your TS to your work environment or classroom, using tools
like a DayTimer to keep life organized, predictable, and to develop
routines, ensuring you have some 'personal time' (a 'haven' is very
important for example -- a place of solitude that is yours alone), and
balancing work with personal pursuits/hobbies all contribute to minimizing
stress.
None of these suggestions (and this is by no means an exhaustive list)
are earth-shatteringly new, and none of these suggestions on their own
are necessarily the ultimate or right answer for each of you. What I
wish to simply convey is that every little bit counts -- each trick
turns that volume control down a little bit more.
There will always be stress in a person's life -- times of transition
(like that of J.S.) are unavoidable...........after a recent change
in credentials/city/job/life myself, J.S., BELIEVE me I can commiserate!
Also, no one should expect others to 'insulate' them from any and all
of life's stressors G.W. -- do not feel guilty if sometimes you have
subjected your son to a stressful situation. By allowing him the dignity
and opportunity to face the real-world you ultimately do him many favours
(such as helping him to learn to increase his tolerance TO stress) and,
through doing so, show a lot of love.
I hope this has helped somewhat -- fingers crossed that you are now
getting your life (and hence your tics) re-settled J.S.!!
cheers,
Dr. Dunc.
