What are anxiety tics?

Are tics caused by anxiety?

Yes, some tics are caused by anxiety. For example, if you feel stressed, your body might react with a fight-or-flight response to perceived danger. Your heart rate will increase, as will your respiration. Your brain will also release neurotransmitters to your muscles to prepare for fight or flight.

The issue is that not all stress requires a fight-or-flight response. For example, if you’re under pressure at work, all those neurotransmitters heading to your muscles aren’t needed to help you flee or fight. Instead, the influx of messages to your muscles might manifest as physical tics, like muscle spasms or twitching.

Additionally, some people have anxiety disorders and tics together. For example, some children with attention deficit hyperactivity disorder (ADHD) also have tics, while some people with obsessive-compulsive disorder (OCD) do as well.^[2]

Other causes of tics include taking illicit drugs (e.g., amphetamines), having a neurological disorder (e.g Huntington's disease), and sleep deprivation. Genetic factors might also be involved.

So, can anxiety cause tics? The short answer is yes. But while anxiety and stress can play a role in the development of tics, the most common reason for tics is having a tic disorder. This family of disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is explained in more detail below.

Examples of anxiety tics

What are anxiety tics? Simply put, anxiety tics are physical or vocal responses to extreme stress or anxiety. By and large, physical tics (motor tics) manifest in the head and neck, particularly the eyes, mouth, neck, and shoulders.^[3] Common anxiety tics examples include:

• Head jerking
• Rapid eye blinking
• Wrinkling the nose
• Tongue movement
• Grimacing
• Shoulder shrugging

Other anxiety tics symptoms include hopping or squatting. In some cases, patients might experience complex tics in which there is a combination of two or more types of tics. However, this is less common amongst anxiety tics and is more typical of someone with a tic disorder.^[3]

Anxiety tics examples also include vocal tics. Just like motor tics, vocal tics can be simple or complex:^[2][3]

• Hissing or grunting
• Barking
• Snorting or sniffing
• Throat clearing
• Repeating words or phrases (called palilalia)
• Repeating what other people say (called echolalia)
• Using socially inappropriate language (called coprolalia)

Again, simple vocal tics are more often associated with anxiety, whereas complex tics are typically only seen in someone with a tic disorder.

Anxiety tics vs Tourette's disorder - What's the difference?

As discussed earlier, anxiety tics might manifest as a way for the body to deal with increased stress and anxiety. Typically, anxiety tics are short-lived and simple.

On the other hand, Tourette’s disorder is a neurological disorder in which tics are a response to a premonitory urge, like a tingling sensation. Expressing a tic relieves such sensations.

It’s believed that Tourette’s disorder is results from a combination of genetics, chemical imbalances in the brain, and environmental factors. There are various risk factors for Tourette’s, too, including head injury, low birth weight, and carbon monoxide poisoning.^[4]

Not only are the causes of anxiety tics and Tourette’s disorder different, but so are their complexities. Anxiety tics are typically quite simple, and there are no DSM-5 criteria for diagnosing them. However, the DSM-5 requires that tics be present for at least a year before diagnosing Tourette’s disorder. Likewise, both motor and vocal tics must occur, though not necessarily simultaneously.^[5]

Furthermore, anyone can have anxiety tics at any point in their life, but Tourette’s disorder must emerge during the teenage years, before the patient’s 18th birthday. In most cases, children with Tourette’s do not have tics once they enter adulthood.

Are tics caused by any other mental health conditions?

As mentioned earlier, tics may co-occur with certain mental health conditions. Tic disorders are an obvious candidate, given that tics are a hallmark feature.

There are three tic disorders in the DSM-5: Tourette syndrome (as discussed earlier), chronic motor or vocal tic disorder, and provisional tic disorder.

Chronic motor or vocal tic disorder involves having one or more motor tics or one or more vocal tics. People with this disorder do not have both. Additionally, a diagnosis requires that a person has tics nearly every day (or for extended periods) over the course of a year. The tics must start before age 18, and they cannot be better explained by another condition, such as Tourette’s or a medical condition, or by taking medication or other drugs.^[6]

Provisional tic disorder is slightly different because the symptoms present for no more than one year. Otherwise, the diagnostic criteria for this type of tic disorder are the same as above.

As discussed previously, people with ADHD or OCD might also have tics. It’s important to note that ADHD and OCD do not cause tics. Instead, people with these conditions often have a co-occurring tic disorder. For example, 52 percent of people with Tourette’s syndrome also have ADHD.^[7]

While having tics and other mental health conditions can complicate daily functioning, the nature of the tics doesn’t change. That is, someone with a tic disorder may have the same tics with the same frequency as someone with a tic disorder and a co-occurring condition, like ADHD or OCD.

How to manage tics

The good news is that most anxiety tics disappear with time and are not severe. If you fall into this category, you can use any number of self-help techniques to manage your tic symptoms:^[8][9]

• Get enough sleep. A lack of sleep can exacerbate tics and make your anxiety worse.
• Use relaxation techniques when you feel stressed out. Deep breathing, meditation, and mindfulness training are all excellent options.
• Avoid anxiety-inducing activities to the extent possible. This will help you be calm and lessen the chance of tics occurring.
• Be open and honest about the situation. If the people in your life understand what’s going on, they will be better equipped to support you. Moreover, explaining to others that you have tics makes you less likely to have anxiety when tics occur.
• Learn more about tics. The more you know about tics, the better prepared you will be to deal with them effectively.
• Get exercise and find other ways to be active. Play games, sports, paint, play a musical instrument - the options are endless. Engaging in activities like these can help reduce stress and anxiety and might lessen the frequency of tics, too.
• Join a support group. If you’re struggling with tics, a support group can provide information and assistance.

Remember that the best self-help technique for others might not work for you. Moreover, you might find that combining these techniques is ideal for helping you manage your tics. Try these and other tips to find what works best for you.

When to seek professional help

In some cases, tics become severe enough to negatively impact daily functioning, like the ability to perform at work. Likewise, tics might interfere with your ability to function in social situations or at school. If this is the case, it’s time to get professional help.

If your tics are anxiety related, your doctor or mental health provider might prescribe anti-anxiety medications. The medications listed below are among the most common for treating anxiety:^[10]

• Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that help regulate mood and minimize anxiety symptoms. Common options include fluoxetine, citalopram, and paroxetine.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another antidepressant often prescribed for anxiety. Examples include venlafaxine and duloxetine.
• Benzodiazepines, like clonazepam, lorazepam, and alprazolam, are sedatives that reduce symptoms of anxiety. Benzodiazepines have significant side effects and are only effective for short-term use. This being the case, SSRIs and SNRIs are usually the first choices for treating anxiety and tics.
• Buspirone is a long-term anti-anxiety medication that effectively manages anxiety symptoms when other options are ineffective.

Tics are often treated with antipsychotic medications. This class of drugs acts on the neurotransmitters responsible for body movements and helps minimize tics. Common examples include aripiprazole, pimozide, and risperidone.^[8]

Therapy is also an option for treating anxiety and tics. Cognitive-behavioral therapy (CBT) is the most common treatment for anxiety. CBT teaches you to recognize how your thoughts and behaviors are related to your anxiety and seeks to change these thoughts and behaviors to bring about more positive outcomes.

One of the most effective therapies for tics is Habit Reversal Therapy (HRT). This type of therapy teaches you about tics, makes you more aware of them and when they occur, and identifies the urges and triggers for tics. Then, you learn a new way to respond to urges and triggers. For example, if you feel the urge to grimace, you might learn to smile instead until the tic passes.^[8]

Other therapies for tics include Exposure and Response Prevention (ERP), which teaches you how to suppress the urge to tic until the urge goes away. Comprehensive Behavioral Intervention for Tics (CBiT) is another option that focuses on teaching you a variety of behavioral responses that reduce tics.^[8]

These are just a few options at your doctor or mental health provider’s disposal to help you manage your tics. In each case, it takes time for these interventions to show results, so patience is necessary. With time, though, you can see improved functioning with medication, therapy, or both.