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Question 65: I just saw the documentary about you tonight on TVO, and was deeply moved. My husband's....insistence that he has "some Tourette's probably" got me thinking. He suffered as a child and teenager from social inadequacy, and claims (now that he saw the show) that he often has impulses to "yell out loud" or "smash his fist on something--without anger" but he has always repressed them and succeeds. I, of course, am suspicious, and suspect he has completely controllable "tics"--his eye twitches when stressed, but not much more is obvious to me, and he claims that he "lets go with the tic, controllably" to relieve tension. Aren't these urges hard to control, if it is truly Tourette's? But more importantly, as a sometime student of neurophysiology, I wonder if there is such a thing as "partial Tourette's", like the theory that there may be partial schizophrenia, for example. G.G. ON, Canada.

Good morning G.:

To respond to your first question, yes these urges ARE hard to suppress............but they CAN be: particularly someone who has been doing it for years can get quite good at it (over time you build up that "muscle" that is your brain). As you describe, stress compromises this ability. As he describes, one can "choose" to let go off suppression (as I
do regularly now).

Suppressing a tic is analogous to not scratching a mosquito bite -- it is stressful, particularly the longer you hold off, and can be distracting and distressful but it CAN be done with at least partial success for periods of time. Sometimes it is simply just not worth the cost though -- for example many children find that they can pay better attention in school, and get better grades, if they do not choose to fight this battle.

 

Regarding your second question, certainly TS, like many disorders, falls on a spectrum from the occasional 'nervous habit' to a "chronic tic" (one or two enduring movements or noises) to a "transient tic disorder" (a number of short-lived movements and noises) to TS (a number of movements PLUS one or more noises that endure intermittently for longer than a year). The exact genetics are not yet known for TS, but the most current theories that fit the available facts the best suggest more than one gene is implicated in an "additive" type model similar to that found in schizophrenia. As an aside, both schizophrenia and TS involve dopamine systems in the brain; I wrote a paper once suggesting that schizophrenia may be the ultimate extreme on a "disinhibition" spectrum (on which TS would also fall). This paper can be found on my website at www.lifesatwitch.com/sx.html or downloaded from www.lifesatwitch.com/research.html

It is entirely possible that your husband falls somewhere on this spectrum. As with any disorder, of course, diagnosis has as much to do with degree of distress and impairment of the symptoms as it does with actual symptom severity though. There are scales used by clinicians (in particular, the Yale Global Tic Severity Scale) that can gauge such things.

I hope this helps! Take good care, and enjoy your summer G.
Dr. Dunc.

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