Ask the PhysicianComments by R. Barkley Clark, M.D., TSA-RMR Board Member & Chair of Professional Outreach Committee. Dr. Clark is a Psychiatrist in private practice in Denver. Q: Is Tourette’s a neurological/medical disorder OR is it a psychological/behavioral disorder? A: The simple, and yet very complicated, answer is that Tourette’s is BOTH. Tourette’s is the prototypical example of a NEUROPSYCHIATRIC DISORDER, meaning that its primary underlying cause is rooted in abnormal brain function, but some of its most troublesome symptoms are emotional and/or behavioral, and life experiences can modify the symptoms of the disorder, for better or for worse. Q: Is there a “core problem” in Tourette’s? A: Yes, the theme of dealing with “INHIBITING URGES” is a common part of the struggle with Tourette’s. Whether it is the urge to move a muscle or perform an action, to make a sound or even speak a phrase or an obscenity, to perform a compulsive ritual in response to a bothersome thought, or to act impulsively without pausing to think sufficiently about the consequences, all can be a part of Tourette’s. The ultimate treatment challenge is to either lessen the intensity of the urges, and/or increase the ability to inhibit the action that follows the urge. Real life analogies include inhibiting an itch or squelching a sneeze; they are tough. Q: What are the cornerstones of treatment for Tourette’s? A: Threefold…first and foremost, ongoing education about the nature of the disorder, so that ignorance does not unnecessarily promote shame in the child, and interpersonal conflict between adult caretakers and the child; second, skill building in the areas of self esteem, self control, and stress management; and third, medicine, if needed, to diminish urges and/or enhance the ability to inhibit action. TELL US ABOUT YOUR ACCOMPLISHMENTS!! TSA-RMR would like to hear about YOUR successes!! - send or e-mail your news to the TSA-RMR Office.
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