Living with a tic disorder: managing anxiety and finding support

Much of what the public thinks it knows about tics comes from a small and unrepresentative fraction of how they might present. The version television often defaults to is involuntary swearing. In reality, tic disorders can involve a wide range of involuntary movements and sounds, from blinking, facial movements, and head jerking to coughing, throat clearing or vocalisations, for example.

It is also useful to distinguish between tic disorders and Tourette syndrome. Tic disorders are a broader term covering conditions involving motor and/or vocal tics. Tourette syndrome is a specific neurological condition characterised by multiple motor tics and at least one vocal tic over a sustained period. Not everyone who experiences tics has Tourette syndrome, although many of the emotional and social challenges associated with living with tics can overlap.

For adults living with tics, one of the hardest parts may not be the tic itself. It can be the effort of trying to hold it in, worrying about how other people will react, or becoming increasingly aware of the feeling of being watched.

Anxiety and tics can also feed into one another, creating a loop that is difficult to interrupt. Understanding that relationship, developing ways to cope with difficult situations and finding greater acceptance can all form part of learning to live more comfortably with a tic disorder.

How can anxiety and tics feed each other?

For some people, anxiety and tics might affect each other. Rising anxiety or stress may make tics more noticeable or frequent, while worrying about ticcing, particularly in public, can itself increase anxiety for some people.

Your tics might be relatively quiet when you are relaxed at home, then become much harder to manage in the ten minutes before a meeting where you desperately do not want anybody to notice them.

This can create anticipatory anxiety. Instead of only responding to what is happening now, you begin worrying about what might happen. Will I tic during the meeting? Will somebody stare? Will I have to explain myself? Will people think I am behaving strangely? Over time, the anticipation itself can become exhausting.

Tics can also change in type, frequency and intensity. That unpredictability can be difficult because it makes planning harder. Something you managed relatively easily last month may suddenly feel more challenging.

Recognising this pattern does not make the tics disappear. What it can do is help separate the neurological experience of having tics from the self-criticism that can develop around them.

What is the impact of suppressing tics?

Some people can suppress their tics temporarily, but doing so can require considerable concentration and effort. Holding a tic in means part of your attention is continually occupied with monitoring your body. That is attention you cannot fully give to the meeting, conversation, journey or task in front of you.

For some people, there may also be a stronger urge to tic afterwards once you reach somewhere that feels safer. Someone might spend an afternoon at work suppressing their tics and then experience more when they get into the car or arrive home.

To somebody else, it could look as though the tics are worse at home. In reality, home may simply be the place where that person no longer feels they have to suppress them. That distinction can be important for partners and families too. An increase in tics in a safe environment does not necessarily mean that environment is causing them. It may mean the person finally feels able to stop monitoring themselves.

Navigating other people’s reactions

If you've had difficult experiences with other people's reactions to your tics, you may become more aware of how others might respond in social situations. You may find yourself scanning a room without consciously deciding to. Who has noticed? Is somebody staring? Should I explain? Where can I sit where I will feel less exposed?

Over the years, this can influence decisions that appear to have little to do with tics. You might avoid eating out, travelling on a busy train, speaking in meetings or applying for a job that involves presentations.

This is where support can become particularly valuable. The aim isn't to force yourself into uncomfortable situations or pretend other people's reactions do not matter. It can be about understanding which adjustments genuinely help you and which behaviours have gradually made your world smaller.

Acceptance can also be important here. Acceptance does not mean liking your tics or never finding them frustrating. It can mean reducing the amount of energy spent fighting, hiding or judging yourself for something you cannot simply choose to stop.

How can counselling help someone living with tics?

Counselling does not treat the neurological cause of tics, and it should not promise to make them disappear. What counselling can work with is the emotional and psychological impact of living with them.

This might include anxiety, shame, self-consciousness, exhaustion from suppression, avoidance, difficult experiences with other people and beliefs about yourself that have developed after years of feeling noticed or judged.

The practical work will depend on the individual. For example, somebody who feels anxious about ticcing in public might begin by exploring exactly what they fear will happen. Perhaps they expect everybody in a café to look at them, worry that colleagues will think they are unprofessional, or feel responsible for making other people uncomfortable.

Rather than simply being told not to worry, counselling offers somewhere to examine those fears properly. You might look at what happens before, during and after a difficult situation. What thoughts appear? What happens in your body? Do you start suppressing your tics? Do you leave early or avoid the situation altogether? What helps you feel safer?

From there, you can begin developing ways of responding differently. For one person, that might involve gradually becoming more comfortable allowing a tic to happen around trusted people rather than constantly suppressing it. For another, it could mean preparing a simple explanation they can use if somebody asks about their tics, so they no longer feel caught off guard. Someone else might work on returning to an activity they have gradually stopped doing because being observed felt too uncomfortable.

Counselling can also provide space to explore anger, embarrassment or sadness about previous experiences. If somebody has been stared at, mocked or misunderstood for years, being told simply to ignore other people's reactions is unlikely to be helpful. Those experiences can have a real emotional impact.

The aim is not to persuade somebody that difficult situations are easy. It is to help them find ways of coping that require less vigilance, avoidance and self-criticism.

Finding the right support

If you are considering counselling, it is reasonable to ask a therapist whether they have experience working with people who have tics or Tourette syndrome. A counsellor should be clear about the boundaries of their role and should not promise that talking therapy will remove a neurological condition.

Depending on your circumstances, counselling may sit alongside other forms of support rather than replacing them. If you are concerned about tics, need a diagnosis or want to discuss treatment options, your GP can advise on appropriate services and referrals.

Living with a tic disorder can bring different challenges, but those experiences do not have to dictate every decision you make. With appropriate understanding and support, it is possible to work towards greater acceptance, develop ways of handling difficult situations and feel more confident in everyday life.