Fits, Tantrums, and Rages in TS and Related Disorders

Abstract

Tourette syndrome (TS) is a neuropsychiatric disorder of childhood onset characterized by motor and phonic tics. In the majority of cases, psychiatric comorbidity complicates TS, manifesting with a wide range of affective and behavioral disturbances. Aggressive symptoms are relatively common in TS and have adverse impacts on family functioning and quality of life. The etiology of such symptoms may reflect a complex interplay among neurobiological, genetic, and environment factors. This paper provides an update on aggressive symptoms in TS with focus on explosive outbursts or Brages^and self-injurious behaviors. Recent studies highlight the association between aggression and common psychiatric comorbidities as well as the role of psychosocial influences. Aggressive symptoms in TS appear associated with tic severity and certain psychiatric comorbid disorders including attention deficit hyperactivity disorder (ADHD), obsessivecompulsive disorder (OCD), and mood disorders. Although still limited, pharmacological and non-pharmacological evidence-based treatments are emerging.

Tourette syndrome research highlights 2015

“…Eddy et al found that both male and female TS subjects, compared to controls, reported more distress during emotionally intense situations and rated their abilities to take other people’s perspectives lower 12 . An experienced clinician who has done research on “rage attacks” in TS has provided a clinically useful summary of current knowledge regarding aggressive symptoms in TS, OCD, ADHD and mood disorders, and described treatment options 13 . Given that emotional regulation difficulties are frequently associated with greater tic severity, improving emotional modulation skills may be an appropriate target of psychological interventions.…”

“…In December, 2015, a special issue on Tourette Syndrome appeared in the new journal Current Developmental Disorders Reports . Four of the 5 articles are clinically focused 13 , 93 – 95 . The other article summarizes some of the recent advances in TS neuroimaging 96 .…”

Clinical Features That Evoke the Concept of Disinhibition in Tourette Syndrome

“…response inhibition), overall academic performance and psychosocial functioning (60), patients with tics and ADHD more often exhibit disruptive behaviors like those related to oppositional defiant disorder (ODD) and conduct disorder (61) and episodic rage outbursts, also known as rage attacks, compared to patients with tics without ADHD. This latter set of behaviors is characterized by discrete episodes of failure to resist aggressive impulses leading to overt behaviors, where the degree of aggression is grossly disproportionate to any precipitating stressors (62). A body of evidence supports the association between these different behavioral manifestations and ADHD comorbidity in patients with tic disorders.…”

Aggression Toward Others Misdiagnosed as Primary Tics

“…Indeed, medical literature has documented the presence of aggressive incidents, including self-injurious behaviors 4 and intermittent episodes of explosive anger (sometimes also referred to as "rage attacks"), in the presence of neuropsychiatric comorbidities, such as ADHD. [5][6][7] In summary, these 3 cases help raise awareness over the differences between repetitive allo-aggression and primary tics. The potential legal ramifications of such behaviors, which may have different etiologies, should be clearly distinguished from tics and their associations.…”