Dear Drew (or do you prefer DREW?):

Thank you for your thoughtful response and for sharing more about your situation. I understand that finding the right diagnosis and treatment can be challenging, especially with the added difficulty of accessing specialists and not being able to afford private treatment.

“I dismissed Tourette’s outright as I believed it’s always congenital, but if you’re right that it can be brought on throughout life, and even triggered by some medicines, then that fits with my suspicion that my involuntary vocalizations may have been caused by the pill I was taking when mine started.”

Tourette Syndrome (TS) is generally considered congenital, meaning it is present from birth and often manifests in early childhood, with the average onset occurring between the ages of 5 and 7 years old. It is strongly influenced by genetic factors, and it often runs in families.

While rare, there are documented cases of TS developing in adulthood. These cases may be triggered by factors such as stress, neurological injuries, infections, or certain medications.

“I don’t know about other tic disorders though – I’d need to research that.”

Tic disorders that include involuntary vocalizations, such as voicing thoughts out loud, include the following:

Tourette Syndrome (TS): Multiple motor tics and at least one vocal tic present for more than one year.

Persistent (Chronic) Motor or Vocal Tic Disorder: Either motor tics or vocal tics (but not both) present for more than one year.

Provisional Tic Disorder: Motor and/or vocal tics present for at least four weeks but less than one year.

Other Specified Tic Disorder: Tics that do not meet the criteria for the above disorders but still cause significant distress or impairment. The duration and presentation can vary.

Unspecified Tic Disorder: Tics present, but there is not enough information to make a more specific diagnosis. The duration varies.

Medication-induced tics are not classified as a separate tic disorder. Instead, they are considered a type of movement disorder caused by the side effects of certain medications. These tics can resemble those seen in tic disorders but are specifically triggered by medication use.

“I also don’t recognize the medicines you list, but perhaps mine is a culprit.”

The medications I mentioned, which can lead to the development of tics as a side effect, have different brand names. Here are some examples:

Methylphenidate: Ritalin, Concerta, Equasym XL, Medikinet, and Delmosart.

Dextroamphetamine: Dexedrine, Amfexa.

Haloperidol: Haldol, Serenace.

Risperidone: Risperdal, Consta.

There are several other medications that can result in tics or tic-like symptoms. These include medications that treat psychiatric symptoms, nausea and other gastroenterological issues (examples: Metoclopramide, promethazine, prochlorperazine, levosulpiride), allergies (examples: Hydroxyzine, promethazine), and antiepileptics.

“I have wondered about ADHD but only regarding impulse control: I’d never heard of it linked to vocalizing thoughts. But I thought that unlikely as I generally don’t have trouble concentrating; certainly not to the extent that I’ve heard described as typical for ADHD.”

It is possible to be diagnosed with ADHD even if not all of the symptoms apply. ADHD is a spectrum disorder, and different individuals present different combinations of symptoms with differing severity, often without all the listed symptoms being present.

If there’s anything more I can do to support you or if you have any further questions, please don’t hesitate to reach out. Wishing you all the best. Take care and stay strong 💪!

anita

Dear Drew: You are welcome and no worries about when you respond. I want to thoroughly read and reply to you Wed morning (it’s Tues afternoon here).

anita

Dear Zenith:

And how are you feeling about it, about the manager talking you out of applying to the internal job and about you changing your mind about it?

anita

Dear Aj:

Thank you for your thoughtful response. I’m glad to read that you’ve started recognizing the patterns of reassurance-seeking and how it affects you. This awareness is an important step towards managing your OCD.

It’s great that you’ve taken your sister’s advice to give into the uncertainty and stop your compulsions, even if it’s challenging, and that you deleted the internet for now and feel better for it. The “Maybe, maybe not” technique can be difficult at first, but it’s encouraging to read that you’re starting to feel clearer-minded.

Remember, you’re not alone in this journey. Seeking professional support from a therapist who specializes in OCD can provide you with the tools and strategies to manage these thoughts effectively.

Wishing you strength and clarity as you navigate these challenges.

anita

Dear Aj: I am working on a reply for you.

anita

How are you, Peter?

anita

Dear DREW:

“I continually find myself vocalizing my own thoughts (unintentionally), mostly noticing sometime through doing so, but also after I’ve finished saying them aloud!… Think of it: how often have you started scratching an itch BEFORE you’re aware that you’re doing so?”-

– It’s possible that you could be experiencing vocal tics, which can be a symptom of Tourette Syndrome (from which I suffer) or other tic disorders. Vocal tics are involuntary sounds or words that a person makes, and they can range from simple sounds like grunting or throat clearing to more complex vocalizations, including speaking words or phrases.

Many individuals with Tourette Syndrome report that their tics are preceded by uncomfortable sensations, often likened to an itch that needs to be scratched. From a UCLA study (escholarship.org): “Tourette syndrome (TS) and chronic tic disorder (CTD) are characterized by sudden, rapid, recurrent motor and/or vocal tics… In addition to these observable symptoms, many individuals with TS or CTD also experience frequent, uncomfortable sensory phenomena that immediately precede the tics… These sensory phenomena have been variously described as an itch, pressure, tension, urge, or ache that is temporarily relieved by the completion of the tic.”

“A few years ago I was temporarily prescribed a medicine by a specialist, and while on it a problem began which persists even now”- tic disorders, including Tourette Syndrome, can sometimes be triggered or exacerbated by certain medications. This phenomenon is known as “medication-induced tics.”

Medications such as methylphenidate (Ritalin) and dextroamphetamine (Adderall), commonly used to treat ADHD, have been reported to cause or worsen tics in some individuals. Certain antipsychotic medications, such as haloperidol (Haldol) and risperidone (Risperdal), can also lead to the development of tics as a side effect. Other medications, including some antidepressants and antiseizure medications, have been associated with the onset of tics in some cases.

There are several other potential explanations for your experience of unintentionally vocalizing your thoughts, aside from tics, or in combination with tics. Here are a few possibilities: (1) High levels of anxiety and stress can sometimes lead to involuntary vocalizations. This can be a way for the mind to release tension or cope with overwhelming emotions, (2) Obsessive-Compulsive Disorder (OCD) can involve intrusive thoughts and compulsions, which might include vocalizing thoughts out loud, (3) Attention Deficit Hyperactivity Disorder (ADHD): Individuals with ADHD may have difficulty with impulse control, which can lead to speaking thoughts out loud without realizing it. This can be part of the impulsivity associated with ADHD, (4) Medication side effects as mentioned above.

If in your evaluation, Drew, any of the above is a possibility, it might be helpful for you to seek an evaluation by a neurologist who can conduct a thorough evaluation and provide an accurate diagnosis and potential treatment options.

Personally, I have suffered since childhood from high levels of anxiety and stress, ADHD symptoms, and I was eventually diagnosed with Tourette Syndrome (TS) and Obsessive Compulsive Disorder (OCD). SELF CONTROL (in capital letters) has been indeed a core problem for me: I couldn’t control the motor and vocal tics, couldn’t control the OCD compulsions, couldn’t react to people and situations the way I wanted to.

“Have any of you managed this? If so, how? If not – PLEASE DON’T RESPOND!”- I did manage the OCD so well that I no longer fit the diagnosis, and my impulsivity problem had greatly improved! I am still working on reducing the frequency of the motor tics.

“This one is lifelong: something will happen to me, and I can’t / don’t respond in the way I want to. E.g. a person will ask me something, say something to me, or DO something to me, and instead of responding in a way I’d like, I just react, often in a way I’d prefer not to. I’ll either have done it before I know it, or find myself in the process of doing it and feel it’s too late to stop. Either way, I always regret it… What I WANT to do in all such situations is be fully aware of what’s going on, be fully aware of what I’m doing, and RESPOND in a deliberate, controlled, assertive way; and ideally be calm too.”-

– I can relate to this big-time as it’s been a lifelong problem for me until recently. I managed my impulsivity with what I call the NPARR method, which I’ve been practicing every day for years: first, I Notice stress within me, a disquiet. Next I Pause (before I act, before I say or do something that I may later regret). Next, I Address the situation. I ask myself: is there a situational problem that needs to be solved? What is the problem (define it)? Can I provide all of the required solution or pat of it? If I react mindlessly, automatically, will I be adding to the problem or creating a new problem? Etc. Next, I Respond, or not: I say or do something, or not. Finally, I Redirect my attention elsewhere. There is more to my method, and if you would like it, we can talk about it further.

anita

😊💖🤗