What Is Tourette’s Syndrome?

Tourette’s syndrome (TS) is a neurodevelopmental condition characterised by repetitive, involuntary movements and vocalisations known as tics. To receive a diagnosis of Tourette’s syndrome, a person must have had both motor tics (involving movement) and vocal tics (involving sound or speech) for more than a year, with symptoms beginning before the age of 18.

Motor tics can be simple – such as eye blinking, shoulder shrugging, or head jerking – or complex, involving sequences of coordinated movements. Vocal tics range from simple sounds like throat clearing, sniffing, or grunting to more complex vocalisations such as repeating words or phrases. A small minority of people with Tourette’s – estimates vary but are generally between 10 and 15 per cent – experience coprolalia, the involuntary utterance of socially inappropriate or offensive words. This is the symptom most associated with the condition in popular media, but it is neither universal nor the most significant aspect of Tourette’s for most people who live with it.

Tics tend to wax and wane over time. They may be influenced by stress, fatigue, excitement, and illness, and many people with Tourette’s report a premonitory urge – a building physical sensation that precedes a tic, similar to the urge to sneeze – that is relieved when the tic occurs. Tics are technically involuntary, but many people can suppress them temporarily, often at significant effort and with subsequent rebound.

Prevalence and Onset

Tourette’s syndrome is more common than many people realise. Tourette’s Action, the UK’s leading Tourette’s charity, estimates that approximately one in every 100 school-age children in the UK has Tourette’s syndrome, with many more experiencing tic disorders that do not meet the full diagnostic criteria. The condition is significantly more common in males than females, with a ratio of approximately 3:1 to 4:1, though the reasons for this are not fully understood.

Symptoms typically begin in childhood, most often between the ages of 5 and 7, and often reach their peak severity in early adolescence. For many – though not all – individuals, tic severity decreases through late adolescence and into adulthood. However, even when tics become less physically prominent, the psychological and social effects of having grown up with the condition may persist and be the primary concern in adult therapy.

Co-occurring Conditions

Tourette’s syndrome rarely presents in isolation. Research consistently shows that the majority of people with Tourette’s also have one or more co-occurring conditions, which can often cause greater daily difficulty than the tics themselves. The most common include:

• Attention deficit hyperactivity disorder (ADHD): present in an estimated 50 to 85 per cent of people with Tourette’s, and often a significant source of academic, occupational, and social difficulty
• Obsessive compulsive disorder (OCD): present in approximately 30 to 50 per cent of cases, and closely related neurologically to tic disorders
• Anxiety disorders: common and often linked to the stress of managing tics in social situations, anticipating reactions, and suppressing symptoms
• Depression: particularly in adolescence and adulthood, when awareness of social difference becomes more acute
• Autism spectrum conditions: increasingly recognised as a frequent co-occurrence, adding further complexity to assessment and support
• Sleep difficulties: tics can disrupt sleep, and sleep deprivation in turn can worsen tics and emotional regulation

For counsellors, understanding this pattern of co-occurrence is important. A client presenting with anxiety, low self-esteem, or social withdrawal may have Tourette’s syndrome as part of their history even if it is not the presenting concern, and vice versa.

Social and Psychological Impact

The social consequences of Tourette’s can be substantial. Many people with the condition describe experiences of bullying, exclusion, and misunderstanding throughout their school years. Being laughed at, mimicked, or excluded because of tics that cannot be controlled causes real psychological harm. Even in adulthood, tics that are visible or audible in public can attract unwanted attention, stares, or hostile reactions.

Many people with Tourette’s describe suppressing their tics in social situations – at work, in shops, in conversations – and then experiencing a rebound of tics in private when the effort of suppression can be released. This constant management of how one presents to the world is exhausting and can contribute to social anxiety, avoidance behaviour, and low self-worth.

The emotional labour of constantly managing and explaining the condition to others – employers, teachers, new acquaintances – is a recurring theme. Many people with Tourette’s report not disclosing the condition for fear of judgement or misunderstanding, which can itself create stress and isolation.

Stigma and Misconceptions

Much of the public misunderstanding of Tourette’s syndrome stems from media portrayals that emphasise coprolalia for dramatic or comedic effect. The reality is that most people with Tourette’s do not swear uncontrollably, and reducing the condition to this stereotype is both inaccurate and harmful. It can make people reluctant to disclose their diagnosis, lead others to doubt them when their tics do not fit the stereotype, and contribute to a climate in which the condition is not taken seriously.

Other misconceptions include the belief that Tourette’s can be controlled with effort or willpower (tics are neurological, not volitional), that it is a condition only of children (many adults continue to be affected), and that it is associated with aggression or antisocial behaviour (there is no evidence for this).

Counsellors who are well-informed about Tourette’s are better placed to challenge these misconceptions – both in their own practice and when working with clients who have internalised stigmatising beliefs about themselves.

How Counselling Can Help

While counselling does not directly treat tic disorders, it can play a meaningful role in supporting the wellbeing of people with Tourette’s syndrome.

Cognitive behavioural therapy (CBT) has been adapted for use with Tourette’s in the form of Comprehensive Behavioural Intervention for Tics (CBIT), a NICE-recommended psychological intervention. CBIT combines habit reversal training (learning to substitute a less visible competing response for a tic) with psychoeducation and functional assessment. This is a specialised intervention that requires specific training, but counsellors can work alongside those offering CBIT by addressing the emotional and psychological dimensions of living with the condition.

Psychoeducation is often a valuable early step – helping clients (and families) understand what Tourette’s is, how tics work, and why they fluctuate. This can reduce self-blame and anxiety, and equip people to explain the condition to others more confidently.

Person-centred work focused on self-acceptance, identity, and self-compassion can be particularly meaningful for adults who have spent years managing and concealing their tics. Many clients benefit from being able to speak openly about their experience without editing themselves or anticipating negative reactions.

Supporting families is also an important aspect of practice with younger clients or adults whose families are closely involved. Parents may experience significant anxiety, guilt, or grief around their child’s diagnosis and may benefit from their own therapeutic or psychoeducational support.

Neurodiversity-Affirming Practice

A growing movement within counselling and psychology emphasises the importance of neurodiversity-affirming practice – an approach that recognises neurological differences such as autism, ADHD, dyslexia, and tic disorders as natural variations in human neurology rather than deficits to be corrected. For clients with Tourette’s syndrome, this perspective can be profoundly validating.

Neurodiversity-affirming practice does not mean ignoring the genuine difficulties that Tourette’s can create. It means holding both truths at once: that the condition brings real challenges, and that the person is not broken or lesser as a result of their neurology. This requires counsellors to examine their own assumptions about normality, productivity, and social conformity, and to be genuinely curious about the client’s own experience of and relationship with their condition.