Tourette and tic disorders in ICD-11: standing at the diagnostic crossroads

Abstract

This article reflects discussion by the WHO ICD-11 Working Group on the Classification of ObsessiveCompulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a) maintain consistency with the DSM-5 diagnostic labels for tic disorders, (b) add a minimum duration guideline for a provisional tic disorder diagnosis, (c) remove the multiple motor tic guideline for the diagnosis of Tourette disorder, and (d) co-parent the tic disorder diagnoses in the disorders of the nervous system and the mental and behavioral disorders categories, with secondary co-parenting in the obsessivecompulsive and related disorders and neurodevelopmental disorders sections.

Understanding the covariation of tics, attention‐deficit/hyperactivity, and obsessive‐compulsive symptoms: A population‐based adult twin study

“…Our finding of a greater shared genetic overlap between tics and obsessive‐compulsive symptoms is in line with proponents that advocate that these disorders should be grouped together within an obsessive‐compulsive spectrum category. In fact, there is a proposal for ICD‐11 to list TD in the OCD and related disorders section, as well as in other sections [Woods and Thomsen, ].…”

The classification of Obsessive–Compulsive and Related Disorders in the ICD-11

“…The Working Group has recommended that Tourette syndrome be cross-referenced to the OCRD grouping for several reasons (Woods and Thomsen, 2014). First, studies of Tourette syndrome have demonstrated its high comorbidity with OCD (Freeman et al, 2000;Scharf et al, 2012).…”

“…Finally, OCD and Tourette syndrome share the phenomenology of repetitive behaviours serving to temporarily reduce aversive experiences, primarily obsessions in the case of OCD, and sensory "premonitory urges" in the case of Tourette syndrome (Miguel et al, 1995). The essential features proposed for a diagnosis of Tourette syndrome in ICD-11 (Woods and Thomsen, 2014) include the presence of one or more motor tics and one or more vocal tics, which may or may not manifest concurrently or continuously, over a period of at least one year with onset during the developmental period. The guidelines emphasize that tics wax and wane through time (e.g., worsening during periods of stress) (Woods and Thomsen, 2014).…”

“…The essential features proposed for a diagnosis of Tourette syndrome in ICD-11 (Woods and Thomsen, 2014) include the presence of one or more motor tics and one or more vocal tics, which may or may not manifest concurrently or continuously, over a period of at least one year with onset during the developmental period. The guidelines emphasize that tics wax and wane through time (e.g., worsening during periods of stress) (Woods and Thomsen, 2014). The proposed guidelines recognize the challenge of differentiating Tourette syndrome from OCD, and specify that repetitive, recurrent movements or vocalizations in Tourette syndrome are differentiated because they appear unintentional in nature, clearly utilize a discrete muscle group, and are not aimed at neutralizing obsessions or reducing anxiety.…”

Dissociable Response Inhibition in Children With Tourette’s Syndrome Compared With Children With ADHD

“…The forthcoming revision of ICD-10 (ICD-11 is scheduled for publication in 2017) is expected to be harmonized with the DSM-5 criteria (Baird, 2013;Reed, 2010). The DSM and ICD criteria are broadly congruent with each other in the diagnosis of TS and require the presence of multiple motor tics and one or more vocal tics persisting for more than one year and the absence of another medical reason that might cause tics (Woods & Thomsen, 2014). Even though no other symptoms are required for diagnosis of TS, the disorder has long been associated with a variety of social, emotional and behavioral problems that are often considered more troublesome for the child than the tics themselves (Singer, 2005).…”