Should I get help for functional tics? What experts say

It can be confusing and distressing to notice yourself making movements that you feel you can’t control. You might blink your eyes repeatedly, shrug your shoulders, or a little sound may escape your lips that you didn’t consciously try to make. These may all be symptoms of tics, which can cause anxiety and embarrassment, especially if they happen around family, friends, or colleagues. 

So what are tics, exactly? Well, the Centers for Disease Control and Prevention (CDC) define them as sudden twitches, movements, or sounds that are done repeatedly. One tic disorder you may be familiar with is Tourette Syndrome, which is a nervous system condition. But there are also functional tics, which are in a completely different category, according to Taylor Newendorp, M.A., LCPC, Network Clinical Training Director at NOCD. Interestingly, the prevalence of these types of tics exploded during the COVID-19 pandemic, making clinicians ask: What is going on? 

What is a functional tic?

A functional tic is considered a movement disorder that can sometimes happen as a result of psychosocial stressors, according to a 2022 study published in Psychology Research and Behavior Management. (A psychosocial stressor could be anything from going through a divorce, to weathering a natural disaster, to working in a stressful environment.) The exact reason you may develop a functional tic isn’t entirely understood, though there may be differences in brain signals that make you more vulnerable to developing them. 

Here are some some characteristics of functional tics:

• They affect more females than males
• Tics often come on in adolescence or young adulthood. (Tourette Syndrome, however, tends to start in childhood.)
• Often, there’s no family history of tics
• You may have complex tics that involve movements in several parts of your body, and feel involuntary
• Tics can be associated with non-epileptic seizures

“People who have tics describe having what’s called a premonitory urge—which is the time before a tic occurs. It’s often a second or less. But there’s an internal pressure to perform the behavior,” says Newendorp. “Almost as soon as that urge occurs, the behavior follows. That’s why a person has a hard time stopping themselves.” 

With functional tics, there is evidence that people may have less of these premonitory sensations, or they may be different in nature from other tic disorders—so it’s just something to note if you experience tic-like behaviors.

Examples of tic behaviors

Although some tics can involve larger movements, many of these actions are small. “More often than not, tic behaviors are subtle and not really too noticeable to other people. Over time, people find clever and creative ways to mask their ticks,” says Newendorp.

Some examples of common tics include:

• Excessive swallowing
• Head twitching
• Jumping, kicking, hopping or spinning, per the National Library of Medicine
• Lip smacking
• Nose twitching
• Vocalizing short sounds, such as grunting, sniffing, or throat-clearing
• Shoulder shrugging

Although tics can be subtle, many people who perform them say that they cause a lot of distress in their lives. They may be frustrating, annoying, or embarrassing. The fact that it feels like these behaviors are automatic—or out of your control—can also trigger anxiety, says Newendorp. 

If you’re worried that you have a functional tic or have experienced tic-like behaviors that have seemingly popped out of nowhere, the good news is that there is some really good treatment available to you!

Causes of functional tics

During the COVID-19 pandemic—particularly in the early days of quarantine—experts worldwide noticed a disturbing uptick in tic-like disorders, according to the Tourette Association of America. It was mostly seen in teenagers who didn’t have a history of tics, and their behaviors appeared to be similar to ones that appeared in TikTok videos. The Association notes that exposure to these tic-like symptoms, coupled with stress, isolation, and anxiety from the pandemic, could be connected to developing tics in certain young people who are prone to them.

So while it may seem like watching videos of these behaviors might make you “catch” a tic, that’s not how the disorder works. You have to be susceptible to them in the first place, says Newendorp. Tics are a neuropsychological issue that you’re either born with or have a genetic propensity to develop later on. In a 2023 study of 166 people experiencing functional tics, 86% were female, and the average age of patients was 23 years old. Patients also reported that their tics became severe very fast—in as little as a week or up to a month. And tics tended to co-occur with other conditions. Anxiety was diagnosed in 70% of the group with functional ticks, and one-quarter of participants had autism spectrum disorder. 

There are other disorders that are connected to tics, as well. One is obsessive-compulsive disorder, or OCD. This is a mental health condition that affects about 1 in 40 people worldwide. With OCD, you experience repetitive and intrusive thoughts, images, urges, or feelings, called obsessions. Due to the distress these obsessions cause, you perform compulsions, which are mental or physical behaviors that are done in an attempt to decrease your anxiety, or prevent “bad things” from happening. Research shows that about 30% of people who have OCD will also develop a tic disorder in their lifetime, and 20% of those with a tic disorder may develop OCD, says Newendorp. 

Treatment for functional tics

The most effective treatment for any type of tic is habit reversal training, or HRT. “This is the most evidence-backed form of therapy to monitor and manage tics,” Newendorp says. 

HRT teaches you to be aware of your habits, including when and why they occur, and then use individualized strategies to resist the urge to perform them. With practice and commitment, this can retrain your brain away from tic behaviors.

This is also an important therapy in the treatment of OCD-related disorders like hair pulling and skin picking behaviors. “Tics can feel involuntary, but a person can absolutely learn how to interrupt those automatic behaviors so they don’t cause ongoing stress or embarrassment,” he adds.

These are the three main components of HRT, and how it can be used to manage tics:

Education

The initial step of HRT is to learn more about your condition, why your tics occur, and how they’re connected to your triggers. It’s also important to develop a treatment plan with your therapist and/or a medical professional. For example, medications can be used to treat anxiety and depression—if one or both of them occur with your tic disorder, although drug therapy won’t effectively treat functional tics themselves.

Tracking

It can be challenging to catch yourself before performing a tic, since it happens so suddenly. But the promising news is that it is possible. “The idea is to increase your awareness of certain times, situations, or locations throughout the day where you’re more prone to engaging in tics,” says Newendorp. “While the pattern of tics is different depending on the individual, you’ll start to see your own pattern emerge, which can be a lightbulb moment.” 

For example, you might notice that you have more tics first thing in the morning—or late in the day, when you’re tired and run down. Stress is another common trigger. “It holds true for a lot of disorders that when you’re overtired, over-stressed, sick, or not in the best physical health, symptoms are more likely to show up,” says Newendorp. 

Once you know when they happen, or what scenarios are most likely to trigger tic behaviors, you can start taking action to counteract them. Your therapist can help you monitor these urges and, in time, show you how to resist the urge to perform them—reducing the frequency of tics, or even eliminating them. 

Acting

The ultimate goal of HRT is to learn a competing response for the behavior that you’re trying to stop. This helps you resist the urge to engage in a tic. Newendorp uses this example: If your tic is to make a little sound out of your mouth, when you feel the urge to do that, you could quickly take a sip of water and hold it in your mouth with your lips closed to prevent you from making that sound. Or, if your tic is eye blinking, then your response might be to sit and deliberately keep your eyes open. “The approach does require some creativity between the therapist and client, but once you come up with the competing response, you would practice it as much as possible, particularly during the times of the day when tics are most likely to occur,” he explains. 

Also worth noting: If you have OCD and a tic disorder, another treatment to consider is exposure and response prevention (ERP). It was developed specifically to treat OCD, and is clinically proven to be highly effective in the majority of people. 

Here’s how it works: A trained therapist who specializes in OCD will take the time to understand your symptoms and create a custom ERP therapy plan specifically for you. Then, you’ll work together to rank your fears or triggers based on how stressful they seem. To begin with, your therapist will typically prompt you to face a fear that brings on only a mild amount of distress. Instead of responding with a compulsion, you’ll learn to tolerate the discomfort. By making this conscious choice and seeing that nothing bad occurs, or realizing that you handled the discomfort better than you thought you could, your brain gets the message that there was nothing to fear in the first place.

Want to begin your ERP therapist search? We encourage you to browse the NOCD Therapist Directory. Every NOCD therapist is not only specialized in ERP but trained to deliver treatment online. Choose your therapist and we do the rest, including helping with scheduling and payment. Of course, if NOCD Therapists aren’t the right fit, you can also explore the International OCD Foundation Therapist Directory.