They can be embarrassing or even painful. They are easily distinguished from simple muscular twitches or rapid fasciculations, like blinking. Complex motor tics are often slower, more purposeful in appearance, and more easily described with terms used for deliberate actions. Complex motor tics can be virtually any type of movement that the body can produce including hopping, clapping, tensing arm or neck muscles, touching people or things, and obscene gesturing. The need to do and then redo or undo the same action a certain number of times is compulsive in quality and accompanied by considerable internal discomfort.
Vocal tics extend over a similar spectrum of complexity and disruption as motor tics.
With simple vocal tics, patients emit linguistically meaningful words, phrases, sentences. Vocal symptoms may interfere with the smooth flow of speech and resemble a stammer, stutter, or other speech irregularities. Often, but not always, vocal symptoms occur at points of linguistic transition, such as at the beginning of a sentence where there may be blocking or difficulties in the initiation of speech, or at phrase transitions. Patients suddenly may alter speech volume, slur a phrase, emphasize a word, or assume an accent. It should be emphasized that a diagnosis of TS does not require that coprolalia is present.