Thanks Thanks:  0
Likes Likes:  1
Results 1 to 6 of 6

Thread: Reduction in Occurrence of Premonitory Urge

  1. #1
    Join Date
    Aug 2015
    Location
    Delaware
    Posts
    27

    Default Reduction in Occurrence of Premonitory Urge

    I've had TS for three years, and when it first began, my mother was anything but understanding. She grew frustrated with every twitch of my shoulder, and so I quickly learned the art of tic suppression and substitution, which came in handy as my tics got worse. I became even more aware of my body, a skill I'd already developed in PT for my Cerebral Palsy. As such, I quickly developed and am keenly aware of my premonitory urges and how long I can tolerate them. I believe my record for total suppression is about two hours, after which time I ran up to my room and practically exploded.

    However, I've noticed that particularly with my neck and head related tics, this sensation (which is a mixture of itchiness and stiffness) does not always happen anymore. I am more prone to having motor tics, and sometimes vocal tics, without any warning that they are about to happen.

    This is frustrating for both my parents and I. I did not begin the process of diagnoses until a few months ago, largely because I had suppressed and hidden my tics so well for so long that my mother believed that it truly was attention seeking behavior. I think they still anger her to a degree, and so I still suppress them more than I really have to. Because this premonitory urge is happening less and I can't suppress it as often, there's a lot more stress.

  2. #2
    Join Date
    Apr 2005
    Location
    Ottawa, Canada
    Posts
    5,945

    Default Re: Reduction in Occurrence of Premonitory Urge

    Jeremy,

    If you have not already done so, please have a look at the information thread: What is The Premonitory Urge? for more insight into premonitory urge.

    The experience you've described is common and typical among people who have been ticcing for any period of time.

    An analogy to explain how the dynamics of the premonitory urge can be "diminished" might be the way we respond to an alarm clock!


    When you get a new alarm clock, the first morning it goes off, you fumble and fidget while you try to figure out where the off button is located.

    A few mornings later, the clock will ring once or twice and you hit the button.

    A week later, the clock nearly has time to ring, and WHAM!...you hit that button with lightening speed.

    This analogy comes from a presentation by Dr. Doug Woods, where he explains how our brain works in a feedback circuit with the urge, the tic and relief from doing the tic.

    If you have 90 minutes to spare and want to learn about how tic symptoms work within the brain, please see this video: Video: Using Behavior Therapy to Manage Tic Disorders in Children

    Are your parents more understanding now, about the involuntary nature of your tic disorder?

  3. #3
    Join Date
    Aug 2015
    Location
    Delaware
    Posts
    27

    Default Re: Reduction in Occurrence of Premonitory Urge

    So... This decrease in the reliability of my premonitory urges would be similar to what sometimes happens when people become so used to their alarm that it fails to wake them?

    My premonitory urges seem to be doing the opposite of what you've described. While I was very sensitive to them for a very long time, they seem to be occurring less lately. I have even ticced and not been aware of it until afterwards.

    My parents are a bit more understanding these days, but I can tell it still frustrates them. I can see why it would. Who wants to hear the sound of a loudly yapping dog for several minutes at a time, all day long? Who wants to deal with a teenage boy who has to stop and jump every few minutes when you're in a rush to get somewhere? I think they sort of think, "If you could hide it so well for so long, why can't you shut up and sit still now?"

  4. #4
    Join Date
    Apr 2005
    Location
    Ottawa, Canada
    Posts
    5,945

    Default Re: Reduction in Occurrence of Premonitory Urge

    So... This decrease in the reliability of my premonitory urges would be similar to what sometimes happens when people become so used to their alarm that it fails to wake them?
    No, that is not how I would characterize the analogy. The analogy is intended to illustrate that we the feedback mechanism inside the brain, at a subconscious level, recognizes the urge virtually instantaneously, and satisfies the urge with the tic, instantly.

    If you listen to the video I suggested, the concept should become clear.

    My parents are a bit more understanding these days, but I can tell it still frustrates them. I can see why it would. Who wants to hear the sound of a loudly yapping dog for several minutes at a time, all day long? Who wants to deal with a teenage boy who has to stop and jump every few minutes when you're in a rush to get somewhere? I think they sort of think, "If you could hide it so well for so long, why can't you shut up and sit still now?"
    What you are saying is that you are being made to feel that your symptoms are some kind of failure on your part, which is not the case.

    Your symptoms are involuntary due to a neurological dysfunction within your brain chemistry. If you happen to be diabetic, would your parents become annoyed when you needed to take your insulin to avoid diabetic coma?

    Have your parents been informed about your disorder by your doctor, so they understand precisely why you are experiencing these involuntary symptoms?

  5. #5
    Join Date
    Aug 2015
    Location
    Delaware
    Posts
    27

    Default Re: Reduction in Occurrence of Premonitory Urge

    They're aware of it, but I think the ability to suppress and substitute tics confuses them, especially in my case, because I am able to hold back most of my tics for extended periods of time. I can sit in a movie theater and be just fine, if a bit fidgety.

    We went on vacation for a week just before I was diagnosed, and I only allowed my more obvious tics to come out at night or in noisy, crowded places they wouldn't have noticed them in. Everything was fine until I started clicking my tongue. I was exerting so much energy into holding back larger tics, and it seemed so mundane that I decided to not worry about suppressing it. Well, my mother took notice after a few days and we got into an argument. When I tried to explain, she held fast in her belief that tics are irrepressible. When we got home, I e-mailed her some research articles discussing the contrary. She never said anything. To this day she has never vocally acknowledged that she was wrong.

  6. #6
    Join Date
    Apr 2005
    Location
    Ottawa, Canada
    Posts
    5,945

    Default Re: Reduction in Occurrence of Premonitory Urge

    When we got home, I e-mailed her some research articles discussing the contrary.
    Well done! Your initiative demonstrates one of the two life skills necessary for people with Tourette...to advocate and to negotiate.

    As people living with Tourette, we frequently find ourselves in situations where we need to inform others of the facts and to dispel myths about the disorder, thereby advocating for ourselves. Additionally, situations might arise where we need to raise awareness in order to achieve certain requirements in school or later in the workplace, that might include special accommodations that are rightfully ours in order to do the work we are required to do.

    You are indeed correct, that Tourette tics, while involuntary are temporarily suppressible by many people. The amount and duration of suppression varies from one individual to another, and this ability to suppress, is the basis of why CBIT is thought to work.

    If you watched the video by Dr. Woods I suggested, or read article I wrote on CBIT, you would have seen how it is possible for a person with Tourette to actually change their brain circuitry using the conscious prefrontal cortex to manage the premonitory urge, relief, feedback cycle thought to occur in the basal ganglia....the area of the brain thought to be where Tourette tics originate.

    I'm attaching some slides relevant to this topic from my own CBIT presentation that illustrate these points.
    Attached Files Attached Files

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •