Explosive outbursts in Tourette syndrome and chronic tic disorders

Explosive outbursts, often referred to as "rage attacks," affect a significant number of individuals with Tourette syndrome (TS) and chronic tic disorders (CTDs), and are associated with increased disorder-related morbidity and psychosocial impairment. Tic severity, psychiatric comorbidity, psychosocial and other factors appear relevant. This chapter provides an overview of the phenomenology, possible neurobiologic and environmental underpinnings, and evaluation and treatment of explosive outbursts in TS. Existing literature on explosive outbursts, rage attacks, impulsive anger and aggression, and episodic dyscontrol in TS/CTD was reviewed and summarized. Explosive outbursts are common transdiagnostic symptoms and occur with increased frequency in individuals with TS/CTD. The etiology of these symptoms in TS/CTD is still unknown, appears multifactorial, and may reflect factors that are intrinsic to tic disorders, associated with their common neuropsychiatric comorbidities, and/or extrinsic influences. At present, evidence-based treatments for explosive outbursts in TS/CTD are limited. There remains an urgent need to advance the investigation of these disabling symptoms in TS/CTD. Use of consistent terminology and standardized assessment tools for studying and treating explosive outbursts in TS and CTDs are much needed.