Rage and Aggression
About 25% of referred patients with TS (percentages vary greatly in different studies) have significant problems with labile emotions, impulsivity, and aggression directed at others. Fits of temper that include screaming, punching holes in walls, threatening others, hitting, biting and kicking are common in such patients. The majority of such problems occur in comorbid cases, especially with combined ADHD, OCD and mood disorder. “Rage” should not be regarded as an integral part of TS, since several studies now show that it is uncommon in TS-Only cases. Problems of emotional control create much consternation in schools and great anguish for the patients and their families. The treating physician or counselor is often asked whether these behaviours are as involuntary as tics, or whether they can be controlled. Rather than trying to make such a distinction, it is perhaps more helpful to think of such patients as having a “thin barrier” between aggressive thoughts and the expression of those thoughts through actions.
Management of these behaviours is often difficult and may involve adjustment of medications, individual therapy, family therapy or behaviours retraining. The intensity of these behaviours sometimes covaries with the tics.