Tourette's Syndrome: A Model Disorder for Integrating Psychoanalysis and Biological Perspectives

Tourette's syndrome of persistent, multiple motor and phonic tics has been of interest to psychoanalysts since Freud and can serve as a model neuropsychiatric disorder of childhood. The tics generally start during the school age years and continue, with waxing and waning, for decades or throughout life. Tics often are accompanied by other behavioural and psychiatric problems, such as inattention, hyperactivity, obsessions and compulsions; these may become the major source of functional impairment. Genetic studies point to an autosomal dominant mode of transmission of the vulnerability to Tourette's syndrome but there is a broad spectrum of clinical expression, ranging from episodes of simple tics through incapacitating multiple tics and severe obsessive compulsive disorder. Neurobiological factors have been implicated but no specific biochemical abnormality is yet known. The child with Tourette's syndrome attempts to understand what is under his control and what invades his consciousness, he tries to conceptualize his symptoms through various fantasies, and he struggles to develop and maintain a stable sense of self. Psychoanalytic investigation can help clarify the bridges between biological substrate and psychological processes, the child's inner life and his experience of his symptoms and the response of others, and the many factors which shape the severity and range of expression of the disorder and the development of the whole child.