Dr. Schubiner's Blog Can tics be contagious?

Originally written by Dr. Schubiner on February 7, 2012

The story from upstate New York doesn’t want to go away. There have been at least three national TV spots in the last few weeks about the 12 high school students who have developed tics. Neurologists consider tics and Tourette’s syndrome to be chronic neurologic disorders that are primarily inherited. The treatment consists of medications to attempt to control the abnormal movements and it is not generally believed that individuals can have any control over their tics.

However, the mini-epidemic in LeRoy High School near Buffalo is believed by excellent neurologists to be caused by a conversion disorder, i.e. a physical symptom that is not a pathological or structural process, but is caused by stress and unresolved emotions. In other words, this is a manifestation of Mind Body Syndrome (MBS) or a Psychophysiologic Disorder (PPD). (I will use these terms interchangeably.)

When one looks at the history of mini-epidemics of PPD, evidence abounds that PPD is a contagious disorder. There have been well-documented epidemics of repetitive stress injury, sick building syndrome, and psychogenic seizure-like activity (also known as pseudo-seizures). There is an interesting research article from Germany that demonstrates that back pain appeared to be contagious after the fall of the Berlin Wall. So, it isn’t really surprising that almost any symptom can be caused by MBS. Once a careful medical history, physical exam, and environmental evaluation rules out evidence for a pathological disorder, the diagnosis of MBS should be confirmed.

In the LeRoy High School situation, experts have done this and have concluded that the girls are suffering from PPD. However, this apparently hasn’t gone over very well with the patients, their parents, or many members of the community. Today’s report showed angry parents filling a meeting of the school board asking them to prove that their buildings are safe. Of course, they have a clean bill of building health from the state of New York and the CDC. Yet, a psychological explanation for physical symptoms doesn’t seem to ring true or satisfy most people.

Over the past few weeks, I have encountered several stories about tics and Tourette’s syndrome that suggest that it may not be as much of a neurological disease as we once thought. Story #1: A friend told me about a young man who suffered with Tourette’s for his whole childhood and adolescence. As an adult, he participated in an intensive psychological retreat during which he expressed and processed many emotional issues from his life. The tics resolved.

Story #2: I met a psychologist who told me that he cured a teenager of Tourette’s “by accident.” The young man was sitting in the psychologist’s office and while waiting, he was throwing some balls into a box over and over. When the psychologist entered, the boy apologized for his behavior and stopped. But the psychologist suggested that it was fine to throw these balls and encouraged him to continue to do so, which he did. During the course of a single one hour session, the boy expressed many issues that were bothering him and threw the balls more forcefully. Following the session, he seemed relieved. The tics disappeared and never returned.

Story #3: I was telling these stories to a friend. He immediately began to tell me his story. As a child, he was diagnosed with Tourette’s syndrome. The tics were incredibly embarrassing and humiliating to him. He hated them and vowed to stop them. He decided to resist them and spent many nights in bed holding his body against the urge to “tic.” After a few weeks of mental effort directed to stopping the tics, they went away and have not recurred.

I am not suggesting that all tics or all Tourette’s syndrome is caused by PPD, but it wouldn’t surprise me if many cases are. It is interesting that over time, people with Tourette’s tend to grimace and even swear uncontrollably. Grimacing and swearing, of course, are signs of anger. Could it be that some people with Tourette’s syndrome have unresolved resentment, anger, or rage? It would certainly be wonderful if there were a relatively simple solution to these horrible disorders. We need to do some studies to determine if tics and Tourette’s may respond to our usual MBS approach and treatment. If you know of people with these disorders who are interested, please have them contact me at hschubiner@gmail.com

It shouldn’t be too surprising that some neurological events are contagious. Patterns of speech are clearly neurological events. People who grow up in the south have different speech patterns and inflections than do those from the north. Phrases such as “like” and “you know” have become ubiquitous in the speech patterns of teenagers (and adults) in recent years. If these neurological events are contagious, why not tics?

To your health,
Howard Schubiner, MD

 

It is interesting to observe that some people retain their accent. I have a friend who has a strong NYC accent after 25 years in Vermont. I have been told that my NYC area accent only comes out when I speak fast or am excited. Some people loose their accents I find it interesting to try to guess where someone is from by listening to their accent.