The first symptom is often eye blinking, though movements often progress to include many other body regions.
Vocalizations usually have a later age of onset.
The illness progresses in a fluctuating manner often described as waxing and waning. Although the psychological consequences can be severe, this, at least in part, results from a combination of factors which include the socially intrusive nature of the symptoms and the social ostracism experienced early on as a result of the more obvious movements and sounds. The disorder itself is not believed to produce primary mental problems except for it being associated with certain comorbid conditions which present with learning difficulties, attentional disturbance, hyperactivity, obsessions, compulsions, and impulsive behaviors. Prior to the recognition that TS was a specific disorder, victims were often considered to be possessed. In more recent times, because of lack of public and medical awareness of the disorder, patients have often been considered to be deliberately provocative or to be suffering from a mental illness.