What you may be describing is a tic disorder. In order to determine if a disorder is present, an in-person evaluation with a specialist is necessary. The following information that I am providing is general and is in no way a diagnosis. It’s meant for educational and informational purposes only.
There are three main types of tic disorders: Tourette disorder, persistent (chronic) motor or vocal tic disorder and provisional tic disorder. For this response, I will focus on the most common type which is Tourette disorder, which is also known as Tourette syndrome.
Tourette disorder is considered a neurological disorder characterized by involuntary movements and tics. A tic is a sudden, rapid, recurrent motor movement or vocalization. Tics can vary and involve almost any muscle group or vocalization; however, eye blinking and throat clearing tend to be the most common types. Tics are generally involuntary but many people find that they can voluntarily suppress them for a certain amount of time.
Symptoms of Tourette disorder typically appear in childhood, as early as four years old and often reach their peak between the ages of 10 and 12. Males are more likely to be affected by Tourette disorder than females.
It’s common for Tourette disorder to co-occur with other psychiatric disorders. It is estimated that 90% of individuals with Tourette’s have disorders such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Tourette disorder also co-occurs with depression, sleep disorders and other learning disabilities.
Some people with Tourette disorder engage in self-injurious behavior. This is defined as the deliberate, nonaccidental, repetitive affliction of self-harm to oneself without suicidal intent. Self-injurious behavior is found in approximately 60% of individuals with Tourette’s disorder. Forms of self-injurious behavior can include: compulsive skin picking, lip biting, filing the teeth, headbanging, self-hitting, eye damage, burning due to touching hot objects, self-cutting and, in extreme cases, castration.
Tic symptoms can change across the lifespan. They vary in severity over time. As children get older, they report their tics being associated with an urge or sensation that precedes the tic. This is a feeling of tension that is reduced following the expression of the tic. These urges are experienced by those with Tourette’s as not being completely involuntary in that the urge can be resisted.
Some individuals may also feel the need to perform a tic movement or vocalization in a very specific way or repeat it until they achieve the feeling that the tic has been done “just right.” Among those unfamiliar with Tourette disorder, these urges and the need to do things “just right” can be misinterpreted as symptoms of OCD. Generally speaking, differentiating OCD from Tourette’s disorder can be difficult. Further complicating the matter is that Tourette disorder and OCD commonly co-occur. A specialist may be able to decipher the difference.
You stated that you have not mentioned your symptoms to your therapist due to fear of judgment and embarrassment. By continuing to keep this a secret, you may be doing yourself a major disservice. The possibility exists that you are experiencing a neurological condition. Keeping it a secret delays treatment and may lead to more suffering.
I strongly urge you to report the symptoms to your therapist. Ask to be referred to a neurologist for testing. A specialist will obtain a description of your symptoms, evaluate your family history, and potentially perform neuroimaging and genetic testing.
Treatments for neurodevelopmental disorders such as Tourette’s often include medication and psychotherapy. Medication can help to alleviate some of the symptoms. Therapy can help to reduce stress.
Once you have an evaluation, you’ll know more about whether or not you are affected by Tourette disorder. It’s important to be honest with your therapist about your symptoms. If she doesn’t know what’s wrong, she can’t help you. I would also encourage you to read more about Tourette disorder and related tic conditions. Most importantly, consult a neurologist for testing. Good luck and please take care.
Dr. Kristina Randle