Patient perception of tics and other movement disorders

To determine the subjective perception patients have of abnormal movements, 170 patients with various hyperkinesias were interviewed with questions directed at the "voluntary" or intentional versus "involuntary" aspects of their symptoms. One hundred and two of 110 patients with non-tic disorders thought that the abnormal movements were entirely involuntary. Forty-one of 60 tic disorder patients stated that all their motor and phonic tics were intentionally produced. Fifteen others had both voluntary and involuntary components, usually with the former predominating. A "voluntary" response could be used to predict the correct diagnostic category (tic versus non-tic) in 8 of 9 patients for whom the referral category was incorrect. These results suggest that a large proportion of the motor and phonic symptoms experienced by tic patients are irresistibly but purposefully executed, more akin to compulsions than to the other "involuntary" hyperkinesias with which they are commonly discussed.