Telling between a tic and the same thing from a "normal" cause?
August 24, 2013 4:20 PM   Subscribe

Can people who have tic disorders (such as Tourette's) that cause them to do things that everybody does once in a while tell when they're doing that thing because of the "normal" cause and when they're doing it because of the tic?

For example, everybody clears their throat, everybody sniffles, everybody coughs. Are people with tic disorders that make them do these kinds of things much more frequently than most people able to tell the difference between when they're doing it because of their tic and when they're doing it because of whatever reason most people do it?

So, for example, sniffling. Does it feel to them like their nose is running, and so they sniffle? Or does it only feel that way when their nose is actually running, and meanwhile when the tic is the cause it feels like something else (something distinguishable) that also causes them to feel the need to sniffle?

And to be clear, I don't mean "can they tell" in the sense of "can they wipe their nostril with their finger and see if it's wet", for example. Obviously they can do things like that, but I mean more along the lines of does the feeling that is driving them to tic feel like the feeling of a runny nose, or is it two different feelings that both happen to result in sniffling?

Finally, I hope I don't cause any offense by my use of the term "normal" - I don't mean any, and I don't mean any judgment or any other negative connotation. I'm just not really sure how else to succinctly describe causes like "something in my throat" or "nose is running" or so forth that happen every once in a while to everyone.
posted by Flunkie to Health & Fitness (5 answers total) 6 users marked this as a favorite
This reddit AMA thread from a few weeks ago might help you understand. I found it really interesting.
posted by something something at 4:30 PM on August 24, 2013 [1 favorite]

Tics most commonly start between the ages of 7 and 10, so in my experience, at first the kids may not have the kind of self-awareness to pick apart a tic from something like a tickle in the throat or what have you. The other thing is that tics tend to wax and wane, so things like the throat sniffing and clearing can be mistaken for something like allergies for quite a while. Most people who have tics that persist into adolescence or adulthood describe having premonitory urges which is a clear feeling of a tic coming on. Most folks are also able to suppress those urges, like you might suppress a sneeze in a quiet environment, though the suppression takes a lot of effort and only lasts for a while.
posted by goggie at 4:33 PM on August 24, 2013

In "An Anthropologist on Mars" Oliver Sacks talks about several surgeons and GP's who have Tourette's and his descriptions of the nature of the eruptions/tics/compulsions.

One particular surgeon he showcases is able to shut off the syndrome during certain activities, like surgery. Other folks that he mentions along the way and in footnotes have as many distinct manifestations as there are places in the brain to have malfunctions. Thus, I'm betting the answer to your question is undoubtedly "Yes", but I also think you'd have a hard time imagining any presentation that isn't in the literature somewhere. Brains are complicated, whether normal or not. Sometimes, whacky ones behave normally for a second and sometimes, normal ones go haywire briefly. Consciousness lives up there and it isn't always a consistent beast.

He also mentions auditory, visual, olfactory and other hallucinations and how for SOME patients with long term problems, they are aware of them being hallucinations, even though the perceptions are as real as a refrigerate would be to you and me. Hyper-real, in some cases.

I've been on a little Sacks jag recently, and if you are a lay person (as am I), it's fun to read his experiences and observations because it desensitizes and objectifies a lot of behavior we sometimes judge harshly. I wouldn't think a thing in the world bad about you if you had a muscle cramp or a twitch in your eyelid, but say schizophrenia or OCD and all of a sudden people get all judg-ey. Ewwwww.....

His stuff is accessible to normal folks.
posted by FauxScot at 5:09 PM on August 24, 2013

I have intrusive thoughts which really feel like... Well not like anything I can really describe at all. The closest analogy I can think of might be something like sitting next to a stranger having a loud phone conversation. The words aren't ignorable and they prompt thoughts that, while certainly yours, you wouldn't have had otherwise.

I also have some motor tics that vary in visibility and disturbance. Their causes also seem to vary from tic to tic. When stressed I often shrug my shoulders and shake my hands. This isn't because I need to do those specific movements, or am having them done to me, but because my shoulders will absolutely not feel like they're put on right. Imagine a jacket on a hanger that wasn't straight and might fall on the floor. Something like that. The shrugging and shaking just seems to be relatively effective at resetting that feeling. Sometimes I imagine that's what a dog that just have to shake out after having its back scratched must feel like.

Similarily there are times when my girlfriend is convinced I must have restless leg syndrome but really I just know the muscles and tendons and ligaments in my leg aren't tracking right and the right flex or tremour in the right way will correct this cosmic wrong. These sorts of feelings prompt incredibly repetitive (and extremely hard to suppress) physical reactions. While I can see the physical action as a mostly voluntary coping mechanism choosing not to engage in them feels akin to advocating asphyxiation for hay fever sufferers. Choosing _not_to_ is the difficult thing. They happen when provoked regardless of how distracted, tired or disciplined I am. Choosing not to engage in them really does feel (in the moment) as likely as deciding not to breath. It is simply easier to let the lizard brain take care of the details for me.

Other tics including more textbook forms like rocking, hand clenching and facial tics are things that I simply am not aware of and might even miss when they are brought to my attention. Like a stroke patient with side blindness, to a degree, or fighting to see something in a blind spot, These things just don't register consciously at all. A more common like experience might include having your signifant other chastise you for incessantly whistlehumming the same chorus over and over again.

Ok, maybe that one's just me too. Or maybe it's not. We are a weird bunch, humans, every last one of us.
posted by mce at 6:16 PM on August 24, 2013 [1 favorite]

Best answer: My main tics include sniffing, throat-clearing, squinting/blinking, and hand & foot joint shaking & popping. I agree with mce - my urges before a tic involve feeling "wrong," and I have to make it feel right. It's not the same feeling as when I have a cold or allergies and I have to sniff or clear my throat to move actual manifestations of snot.
Sometimes I have to "manual override" my tics because the actual performance of satisfaction becomes burdensome. Like when I'm running - because my mouth is dry from breathing, the sniffing & horking screws up my breathing & swallowing, so I have to tell myself "it's just a sensation - deal," but it's not a full-time solution.
posted by toodleydoodley at 8:16 AM on August 25, 2013

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