Editing Tic (section)

== Characteristics ==

Tics are described as ''semi-voluntary'' or ''unvoluntary'',<!-- Please do NOT CHANGE "UNVOLUNTARY" to "INVOLUNTARY"; it is not a typo, it is the correct term, please read the text and the references. --><ref name="TSADef">{{cite journal |last=The Tourette Syndrome Classification Study Group |date=Oct 1993 |title=Definitions and classification of tic disorders |url=https://jamanetwork.com/journals/jamaneurology/fullarticle/592549 |journal=Arch Neurol |volume=50 |issue=10 |pages=1013–16 |doi=10.1001/archneur.1993.00540100012008 |pmid=8215958|url-access=subscription }}</ref> because they are not strictly ''involuntary''—they may be experienced as a ''voluntary'' response to a [[premonitory urge]] (a [[sensory phenomena|sensory phenomenon]] that is an inner sensation of mounting tension). A unique aspect of tics, relative to other movement disorders, is that they are suppressible yet irresistible;<ref name=Dure>{{cite journal | author = Dure LS, DeWolfe J | year = 2006 | title = Treatment of tics | journal = Adv Neurol | volume = 99 | pages = 191–96 | pmid = 16536366 }}</ref> they are experienced as an irresistible urge that must eventually be expressed.<ref name=TSADef/>

Tics may increase as a result of [[Stress (medicine)|stress]], fatigue, boredom, or high-energy emotions, which can include negative emotions, such as [[anxiety]], as well as positive emotions, such as excitement or anticipation.<ref name=":0">{{Cite journal |last1=Iverson |first1=Ann M. |last2=Black |first2=Kevin J. |date=2022-10-08 |title=Why Tic Severity Changes from Then to Now and from Here to There |journal=Journal of Clinical Medicine |language=en |volume=11 |issue=19 |pages=5930 |doi=10.3390/jcm11195930 |issn=2077-0383 |pmc=9570874 |pmid=36233797 |doi-access=free }}</ref> Relaxation may result in a tic increase (for instance, watching television or using a computer), while concentration on an absorbing activity often leads to a decrease in tics.<ref name=":0" /><ref>National Institutes of Health (NIH). [https://web.archive.org/web/20050323092424/http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm Tourette Syndrome Fact Sheet.] Retrieved on March 23, 2005.</ref><ref>Packer, L. [http://www.tourettesyndrome.net/tourette_primer4.htm Tourette Syndrome "Plus"]{{dead link|date=December 2015}}. Retrieved on February 12, 2006.</ref> Neurologist and writer [[Oliver Sacks]] described a physician with severe [[Tourette syndrome]] (Canadian Mort Doran, M.D., a pilot and surgeon in real life, although a [[pseudonym]] was used in the book), whose tics remitted almost completely while he was performing surgery.<ref>Doran, Morton L. The Tourette Syndrome Association, Inc., Connecticut Chapter 1998 Educators' Conference; 1998 Nov 6; Danbury, CT.</ref><ref>Sacks O. ''[[An Anthropologist on Mars]]''. Knopf, New York, 1995.</ref>

Immediately preceding tic onset, most individuals are aware of an urge<ref>{{cite journal | author = Cohen AJ, Leckman JF | date = Sep 1992 | title = Sensory phenomena associated with Gilles de la Tourette's syndrome | journal = J Clin Psychiatry | volume = 53 | issue = 9| pages = 319–23 | pmid = 1517194 }}</ref> that is similar to the need to yawn, sneeze, blink, or scratch an itch. Individuals describe the need to tic as a buildup of tension<ref>{{cite journal | author = Bliss J | date = Dec 1980 | title = Sensory experiences of Gilles de la Tourette syndrome | journal = Arch Gen Psychiatry | volume = 37 | issue = 12| pages = 1343–47 | pmid = 6934713 | doi = 10.1001/archpsyc.1980.01780250029002 }}</ref> that they consciously choose to release, as if they "had to do it".<ref>{{cite journal | author = Kwak C, Dat Vuong K, Jankovic J | date = Dec 2003 | title = Premonitory sensory phenomenon in Tourette's syndrome | journal = Mov Disord | volume = 18 | issue = 12| pages = 1530–33 | pmid = 14673893 | doi = 10.1002/mds.10618 | s2cid = 8152205 }}</ref> Examples of this premonitory urge are the feeling of having something in one's throat or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye. Some people with tics may not be aware of the premonitory urge. Children may be less aware of the premonitory urge associated with tics than are adults, but their awareness tends to increase with maturity.<ref name=TSADef/>

Complex tics are rarely seen in the absence of simple tics. Tics "may be challenging to differentiate from compulsions",<ref>Scamvougeras, Anton. [http://ww1.cpa-apc.org:8080/publications/archives/bulletin/2002/february/specialfeaturescamvougeras.asp "Challenging Phenomenology in Tourette Syndrome and Obsessive–Compulsive Disorder: The Benefits of Reductionism".] Canadian Psychiatric Association (February 2002). Retrieved on June 5, 2007.</ref> as in the case of [[klazomania]] (compulsive shouting).