Sudden Onset Tic and Tic-Like Presentations in Older Adolescents and Adults

The past 3 years have seen an unprecedented increase in patients with functional tic-like behaviors (FTLB), a previously rare form of functional movement disorder (FMD) that can be mistaken for Tourette syndrome (TS). This article contrasts the patient characteristics, phenomenology, risk factors, and comorbidities of FTLB and TS to define criteria for differential diagnosis. Clinical issues, treatments, theoretical explanations, and future research questions are discussed.

FTLB predominately affect females, with a later onset of movements and vocalizations that are more complex, directional, severe, debilitating, and non-suppressible compared to TS. Psychosocial stressors from the pandemic, exposure to tic-content on social media, and comorbid anxiety and depression are etiological factors. Cognitive behavioral therapies appear to be effective treatment strategies.

Creation of standardized clinical practice guidelines for diagnosis and treatment of this now common FMD are recommended. Etiological explanations fit coherently within a biopsychosocial model of pathology.