Tourette Syndrome And Tics — What Doctors Want You To Know

Public interest in Tourette syndrome intensified after advocate John Davidson, whose experience with the condition inspired the film I Swear, involuntarily vocalized offensive language during the BAFTA Awards’ broadcast last weekend.

“We deeply understand that these words can cause hurt, but at the same time, it is vital that the public understands a fundamental truth about Tourette syndrome: tics are involuntary,” said Emma McNally, CEO of Tourettes Action. “They are not a reflection of a person’s beliefs, intentions, or character.”

While the idea of saying something unintentionally may be hard to imagine, such involuntary vocalizations are a hallmark symptom for some people with TS. Despite Davidson’s lack of control over these vocalizations, the incident quickly dominated headlines, highlighting widespread misunderstandings about the condition and emphasizing the need for greater public awareness and education.

Davidson left the ceremony early, unable to fully experience the remainder of the evening on a night when Robert Aramayo, who portrayed Davidson in I Swear, won the EE Rising Star Award and Leading Actor awards. The moment highlighted the challenges Davidson has long navigated while advocating for greater awareness and understanding of TS — often by openly sharing moments like the one that unfolded at the BAFTAs.

“I want to be really clear that the intent behind them is zero,” Davidson said of his tics in an interview with Variety. He noted that he contacted the studio behind Sinners to apologize to Michael B. Jordan and Delroy Lindo, the actors presenting when he shouted a racial slur, and production designer Hannah Beachler, who said he uttered the same slur to her. “What you hear me shouting is literally the opposite of what I believe.”

What is Tourette Syndrome?

TS begins in childhood and peaks during adolescence. Current estimates suggest that approximately 1% of school-aged children have TS. It is characterized by motor and vocal tics—sudden, brief, and repetitive movements or sounds that occur involuntarily.

Tics reflect variations in neural networks that affect how the brain coordinates movement and behavior. Motor tics are involuntary movements and can include eye blinking, facial grimacing and head and shoulder movements. Vocal tics are involuntary sounds, which can include grunting, throat clearing, sniffing and repeating sounds or words.

Many people with TS experience a gradual buildup of internal tension before a tic occurs. This premonitory urge can intensify over time until the tic is released, after which they may experience relief.

Tics can be quite uncomfortable, and sometimes embarrassing, for the person with TS because they can occur at any moment. Some people with TS may attempt to mask or blend their tics with less noticeable actions. For example, someone with a vocal tic may cough or clear their throat to cover up an involuntary sound. This process, sometimes referred to as “camouflaging” or “tic suppression,” can help reduce unwanted attention or embarrassment in public settings. However, constantly trying to hide tics can be exhausting and may increase anxiety or discomfort, making it even more challenging for individuals to manage their symptoms.

Worries about being judged, misunderstood or stigmatized can weigh heavily, sometimes making the social impact of tics harder to manage than the physical symptoms. In some cases, that fear is enough to cause people with TS to avoid social gatherings or skip important events altogether — quietly narrowing their world in ways others may never notice.

What is Coprolalia?

One of the more distressing symptoms associated with TS is involuntary swearing, known as coprolalia.

“Coprolalia is a rare but widely misunderstood symptom of Tourette syndrome that leads to the involuntary expression of socially unacceptable, emotionally charged, and offensive language,” says Dr. Jerome Lisk, clinical assistant professor of neurology at the University of North Texas Health Science Center.

Although often portrayed as a defining feature of TS in popular culture, “coprolalia occurs in only 10–30% of individuals with Tourette syndrome and is more commonly seen in those with additional diagnoses such as obsessive-compulsive disorder or attention-deficit/hyperactivity disorder,” explains Dr. Ulrick Vieux, associate professor of psychiatry and behavioral health at Hackensack Meridian School of Medicine.

Some people are able to suppress the urge to swear temporarily, waiting until they are alone or in a setting where the vocalization is less likely to draw attention. Others are not always able to hold it back, which can lead to awkward, painful or misunderstood moments.

Importantly, coprolalia originates from brain networks involved in impulse control and inhibition so the words that come out during a vocal tic are not chosen on purpose. Instead, they are influenced by the culture a person lives in. Every society has words that are considered especially offensive, taboo, or emotionally charged, and those are often the words that appear in tics. This can make the tics sound shocking, even though they do not reflect the person’s beliefs, intentions, or character.

Coprolalia can worsen during periods of stress, fatigue or emotional intensity and may improve with treatment and supportive environments.

More Than Tics: Conditions Associated With TS

People with TS frequently experience additional psychiatric conditions alongside their tics. Common co-occurring disorders include ADHD, which can involve difficulties with focus, impulse control and hyperactivity; OCD, characterized by intrusive thoughts and repetitive behaviors; and various forms of anxiety. These overlapping conditions can complicate daily life and may sometimes be more disruptive than the tics themselves.

Treatment Options For Tourette Syndrome

“Formal treatment options include behavioral therapies such as habit reversal therapy and comprehensive behavioral intervention for tics,” says Dr. Vieux, who also serves as the chief of the division of child and adolescent psychiatry at Hackensack University Medical Center. These evidence-based approaches focus on helping people identify the early warning sensations that come before a tic and apply alternative, intentional behaviors to lessen its impact or prevent it altogether.

In most cases, medications for tics are not necessary, and many children experience a significant reduction — or complete resolution — of tics by adulthood. Tics also tend to lessen when a person is deeply focused or engaged in an activity, such as playing a musical instrument or performing a skilled task. I recall working with a physician during medical school who had prominent motor tics, including arm flailing. Yet each time he began a procedure, the tic reliably disappeared until he completed the procedure.

Exercise may help reduce tic severity for some individuals by providing an outlet for built-up physical and emotional tension, as well as by supporting better regulation of the nervous system. Engaging in physical activity may temporarily suppress tics and lessen the premonitory urge. Additionally, regular exercise can promote overall well-being, reduce stress and anxiety and improve mood, all of which may contribute to a reduction in tic frequency or intensity for some people with TS. However, the effects of exercise can vary from person to person, and not everyone will experience the same level of benefit.

It is also important to emphasize that not everyone with TS requires treatment. If tics are not distressing or functionally impairing, some individuals may reasonably choose to forgo treatment altogether.

Understanding Matters

Greater public awareness and understanding of TS has the power to change lives — not by eliminating tics, but by reducing stigma. When society better understands that tics are involuntary neurologic symptoms, not reflections of character or intent, it creates space for compassion, inclusion and dignity. For people living with TS, that understanding can make everyday moments — at work, at school or in public — far easier to navigate.