What are Functional Tics?
13th September 2024
Functional tics are sudden, involuntary movements or vocalisations that resemble tics seen in conditions like Tourette’s syndrome but have have distinctly different psychological and neurological underpinnings.
Unlike neurodevelopmental tics, functional tics often emerge due to psychological stress, trauma, or significant life transitions. These tics can vary widely in presentation, but may include jerky movements, repetitive sounds, or facial expressions that vary in intensity. They may also fluctuate depending on an individual's emotional state.
Functional tics often have a rapid onset, compared to the gradual presentation seen in Tourette's. Functional tics are also more variable and may show variability in how they present or the circumstances in which they are exhibited. For example, someone could experience a tic in their hand in some contexts and then in their face in others. Since functional tics are so influenced by emotional states, they are considered to have a more psychological than neurodevelopmental foundation. Possible causes are thought to include psychological stressors, trauma, or disruptions in how the brain processes motor control and emotion. Neuroimaging studies have shown that functional tics may be associated with abnormal activation in brain circuits involved in motor function and emotional regulation (Demartini et al., 2021).
How are they diagnosed and treated?
Diagnosis of Functional Tic Disorder (FND) typically involves clinical observation and history-taking by an experienced clinician who is able to rule out the possibility of other tic disorders. A clinician will usually consider factors such as the first onset and course of the tics, as life stressors and co-occuring psychological difficulties. For parents or caregivers of young people experiencing these symptoms, it’s essential to seek support from a healthcare professional familiar with functional neurological disorders. It is also important to validate the individual's experience of tics and their symptoms.
Treatment often involves a multidisciplinary approach, including CBT to identify and manage triggers and negative thought patterns, and mindfulness-based interventions helping to manage stress. Sometimes, physical therapy or occupational therapy might be useful to manage the physical aspects of tics, especially if they are painful or put strain on the body.
For adults with FND, workplace accomodations may be helpful for managing symptoms. This could include quiet work environments, flexible working hours, and providing breaks throughout the working day. The Equality Act provides guidance for seeking these types of adjustments.
References
Demartini, B., Ricciardi, L., & Edwards, M. J. (2021). Functional tics: A systematic review. Parkinsonism & Related Disorders, 89, 175-180.
