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What is up with my sister's tongue?
July 14, 2014 8:56 AM   Subscribe

I went to see my sister last night and she is doing this strange thing with her tongue -- she keeps sticking it out, seemingly unaware she is doing so. She has a host of medical issues and seems to be caught in an anxiety spiral at the moment about one health issue in particular. Could this tongue thing be a legit side effect of her existing health issues or a manifestation of her anxiety?

Yes, you are not her doctor. This is what she is doing: when talking or eating or just sitting around, she pushes her tongue out all the way out of her mouth and down over her lower lip, over and over and over. The closest thing I can associate it to is the way a person without teeth might thrust his tongue over his gums or how one might react if you got something hairy or sticky on your tongue.

Here are current health issues: diabetes, hypothyroidism, recurrent MRSA infections in the last two years that have been treated with high-dose antibiotics, pretty poor dental health. She is on thyroid medication, and her doctor recently upped her dosage. I think the doctor is trying to treat her thyroid before addressing the diabetes, which is not out of control but is also not managed particularly well either (it was diagnosed in the last few years). She has not had mental issues in the past, other than depression and acting out as a teen (she was adopted as an older child into my family), and a childhood diagnosis of ADD. She does struggle sometimes with anxiety and circular thoughts. She is in her late 30s now.

Here is her current life situation: she adopted several children recently, also just started a full-time job, is in the middle of moving apartments, and while she has a husband who helps as he can, he is also physically disabled and has cognitive limitations (low literacy, can't drive). She also, in my opinion, has some serious focusing issues that make the daily logistical management of her life harder than it has to be. (To head off any comments here about the adopted children: they are well-cared for and loved.)

She is also currently convinced she has Morgellons, or a delusional belief that one has bugs crawling on them. She self-diagnosed this via the Internet and asked me last night to check her skin for bugs. She is convinced she has gone crazy and doesn't want to go to the doctor or for me to help her out. She seems pretty worn down and exhausted to me, and in a defeatist head space.

She has insurance through her new job but has not filled out the enrollment paperwork (see focusing issues above.) I am willing to pay out-of-pocket for her to see her doctor, but she has not accepted my offer yet.

This preoccupation with bugs is not new. It started last summer when a bedbug infestation led to a traumatic event -- the foster kids (now her adopted children) she was caring for were temporarily removed from her home while the bedbug situation was addressed. Ever since, she has been paranoid about bugs and has been telling me for a while that she has bugs crawling on her.

I don't know if she has ever talked about this bug sensation with her doctor, but it seems pretty likely that the sensation could be peripheral neuropathy related to the diabetes, and not delusions.

What is new is this tongue thrusting thing. I asked her about it and she couldn't tell me why she was doing it and didn't seem aware of it until I pointed it out. She said she just figured it was related to the "Morgellons" and that she had just gone nuts, end of story.


I'm wondering if it could be thrush, or if could be anxiety related.

I can help her address my suspicions about the peripheral neuropathy -- I'm pretty sure I can get her to make an appointment with her doctor by applying some sisterly pressure. I can also help talk her through the anxieties I'm sure she is currently dealing with and offer practical help to lighten her load during this stressful time. We are not close, but I love my sister. She has a friggen' heart of gold, but does a piss poor job of taking care of herself.

But I'm really bothered by the tongue thing. I know it may be silly to focus on this one thing when she has many other health issues on her plate, but it made her seem pretty deranged last night. Have you ever seen anyone exhibit this behavior? If so, did it have a medical cause or a psychological one?
posted by megancita to Health & Fitness (13 answers total) 2 users marked this as a favorite
 
Not sure if I'm correctly understanding your description of her behavior -- is she basically licking her lower lip over and over?

It might just be irritated/dry, which becomes a cycle if you keep licking it. Maybe try giving her some chapstick? Or if it's already an ingrained habit that she wants to break, maybe she could coat her lips with something sour (like what nailbiters do to break their habit) in between meals (then wash it off before eating).
posted by Jacqueline at 9:00 AM on July 14


This sounds like tardive dyskinesia. Is she on any anti-psychotics?
posted by rabbitrabbit at 9:02 AM on July 14 [24 favorites]


Combination of Morgellons + compulsive tics reads like she's abusing amphetamines to me, but with the last of meds she's on and thyroidism, who knows.
posted by empath at 9:04 AM on July 14 [4 favorites]


I worked with a man who had this repetitive action as a side-effect from a medication he was taking for the relief of (I think) chronic itching. As rabbitrabbit says, it's also a known side-effect of some anti-psychotics. I've also seen it (bizarrely) in a couple of people who developed it only when they had UTIs, but even the doctors thought that was weird, so I don't think that's a normal cause.

You can also get tic disorders that are not as complex as Tourette's. This would count as a simple motor tic.

She should definitely see a doctor about it, and a neurologist for preference.
posted by kadia_a at 9:06 AM on July 14 [1 favorite]


Combination of Morgellons + compulsive tics reads like she's abusing amphetamines to me

Good point -- even on just my regular prescribed dose of Adderall, I sometimes mindlessly rub the tip of my tongue against the back of my teeth enough to end up with tongue sores. So I can speak from experience that mindless, repetitive tongue movements is definitely a side effect of amphetamine use.
posted by Jacqueline at 9:11 AM on July 14 [1 favorite]


I remember this symptom from my work in mental health, and will second possible tardive dyskinesia.

The wikipedia article mentions a link between diabetes and tardive dyskinesia, especially in women.

I would make sure she sees a doctor soon about it, because it can be a red flag for over-medication, and can be very difficult to reverse.
posted by warm_planet at 9:28 AM on July 14 [1 favorite]


Seconding rabbitrabbit- my mother in law was on antipsychotics and she did exactly this.
posted by ethnomethodologist at 9:28 AM on July 14


The only medication she is on is 75mg of Levothyroxine (Synthroid). She agreed to meet with me tonight for a one-on-one chat.
posted by megancita at 10:15 AM on July 14


Seizure disorder (which may also have influenced the childhood ADD diagnosis and current focus issues), exacerbated by the new thyroid med.
posted by Iris Gambol at 10:22 AM on July 14


Oral tics don't necessarily mean you're "abusing" amphetamines; it can be a normal side effect for therapeutic doses of stimulants.
posted by threeants at 10:30 AM on July 14 [4 favorites]


Anxiety and stress can also bring out symptoms of obsessive-compulsive disorder, even if a person is older and has not been diagnosed with it before. Your mentioning of her "Morgellons" and insect obsessions, plus her "anxiety and circular thoughts" as you called them, made me think of the tongue-thrusting as an OCD symptom. Perhaps she thinks of this as only a habit that she is doing without thinking, but a doctor could ask the right questions to find out if this is merely a habit, or indicative of one of the disorders others have mentioned here (TD also came to mind for me, but then I work in a mental health care setting), or OCD.

You might ask her what happens if she consciously keeps her mouth shut and tries not to stick her tongue out. If it happens automatically after a few minutes as she forgets to monitor herself, it's more likely a habit or TD. If she starts to feel anxious about it, like she HAS to stick her tongue out or bad things will happen (or she might even have a physical feeling or pain or discomfort that won't go away until she gives in to the urge to stick her tongue out), I would suspect OCD.
posted by gillyflower at 10:57 AM on July 14 [2 favorites]


The only medication she is on is 75mg of Levothyroxine (Synthroid).
I've been on levothyroxine (thyroid meds) for two years, and never had anything remotely like this. Neither my endocrinologist nor my pharmacist ever mentioned the possibility, and I don’t see anything about it at Synthroid.com. (Known adverse reactions include headache, hyperactivity, nervousness, anxiety, irritability, emotional lability, and insomnia.)
posted by editorgrrl at 11:22 AM on July 14 [1 favorite]


Combination of Morgellons + compulsive tics reads like she's abusing amphetamines to me

Good point -- even on just my regular prescribed dose of Adderall, I sometimes mindlessly rub the tip of my tongue against the back of my teeth enough to end up with tongue sores. So I can speak from experience that mindless, repetitive tongue movements is definitely a side effect of amphetamine use.


Just another data point that when I went back on adderall for a sleep disorder, I licked and rubbed my lower lip raw with my tongue.
posted by Brainy at 11:56 AM on July 14 [1 favorite]


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