ARE YOU A HAIR-TWIRLER OR A NAIL-BITER?
Are you a toe-tapper, hair-twirler, eye-blinker, head-nodder, nail-biter, knuckle-cracker, skinpicker, lip-licker, shoulder-shrugger or a chin-stroker?
Call it a nervous habit or tic, almost everybody has at least one — whether they are aware of it or not.
Tics exist on a spectrum ranging from barely noticeable to extremely annoying to potentially injurious.
While research has focused mostly on the more severe forms associated with neurobehavioral disorders such as Tourette syndrome and autism, there’s a growing realization of the pervasiveness of repetitive, nonfunctional motor behaviors and that the degree to which you engage in them is a barometer of your peace of mind.
“Our stressful society definitely brings it out more,” said Dr. Alon Mogilner, a neurosurgeon at New York University Langone Medical Center. “It’s a delicate balance within the circuitry of the brain so you are able to tamp down on things you don’t want to do.”
Experts divide repetitive, nonfunctional motor behaviors into three overlapping, and not always agreed upon, categories. First, there are classic tics, which typically involve quick, jerky motions of the head, neck or arms preceded by an urge, akin to an itch that needs to be scratched. Tics can also be phonic such as throatclearing.
Next are stereotypies (pronounced steer-ee-AHta-peez), which usually don’t have a premonitory feeling and are more fluid and rhythmic like body rocking and leg bobbing. Lastly, there are body focused repetitive behaviors, which are essentially grooming gone awry like compulsive nail-biting, hair-pulling and skin-picking.
All of these behaviors are what experts call “unvoluntary,” as opposed to an involuntary muscle twitch. You can stop the tic when asked to or when distracted but the problem is, sooner or later, you go back to doing it. In some circumstances the behavior is distressing to the person, particularly if it is injurious or embarrassing, but more often the movement or mannerism is just maddening to those in proximity.
“If we dive into the research and look at disordered, unwanted repetitive behaviors as well as nonclinical, nonimpairing repetitive behaviors, they all involve the region of the brain called the basal ganglia, which is involved in motor control,” said Ali Mattu, a clinical psychologist who specializes in body focused repetitive behaviors at Columbia University Medical Center.
Though still poorly understood, the basal ganglia are sort of like the movement command center of the brain that responds to situations by choosing from a menu of motions or gestures that you’ve learned. The theory is that when situations are frustrating or stressful because you are either over- or under-stimulated your basal ganglia manage by selecting (or perhaps failing to inhibit) a default motor behavior, which would be the tic, ste-reotypy or motor habit.
In this way, we are not so different from animals. Go to many zoos and you’ll see anxious or bored animals rocking, jerking their heads, plucking out their feathers, pacing in circles, swinging their arms and mouthing themselves or various objects.
“The whole point of a habit is you don’t have to use cognitive resources to do it,” said Doug Woods, a professor of psychology at Marquette University in Milwaukee who studies and treats people with tics and other repetitive behaviors. He said that for many of his patients, the tics somehow become associated with a reward — whether it’s temporary distraction, satisfaction or release.
Most repetitive behaviors, regardless of etiology, begin in childhood. The immature brain, unable to recognize and process emotions as an adult does, resorts to motor activity to cope. Except for children with severe autism, most kids grow out of habits like head-shaking and armflapping as they become better able to understand and manage their feelings. Or they just find a way to convert the behavior into something more socially acceptable and “adult.” Rocking might morph into leg-bobbing, mouth-stretching turns into gum-chewing or finger-wiggling may become iPhone-fiddling.
Most people don’t seek treatment and indeed, many find their repetitive behavior comforting. Help is generally only sought when the movement or vocalization becomes so insistent and frequent it impairs daily functioning or is a turnoff in relationships. Neck tics can harm vertebrae, for example; skin-picking can lead to unsightly scabs and employers tend not to hire people who can’t stop blinking during an interview.
To help people stop, doctors first rule out drugs such as antihistamines, antidepressants, ADHD medications, methamphetamine or heroin as a cause or aggravating factor.
Also important is to look at when it’s happening.
“People don’t realize it, but there’s a situational profile to all these problems,” said Dr. Kieron O’Connor, a professor of psychiatry at Institut Universitaire en Santé Mentale in Montreal, who develops treatment programs for people with tic and motor habit disorders.
The repetitive behavior is often the result of situations that make people feel overwhelmed with emotion because either they didn’t see something coming or don’t know how to deal with it.
“We try to figure out on what dimension they are lacking whether it’s awareness of emotion, recognition of emotion or coping with emotion,” O’Connor said.