Diagnostic Criteria for Primary Tic Disorders: Time for Reappraisal

Congratulations to Drs. Irene Malaty and Michael Okun on the publication of “Diagnostic Criteria for Primary Tic Disorders: Time for Reappraisal,” which appears in the June edition of Movement Disorders as a viewpoint article.

The Relevance of the Problem
The most widely applied diagnostic criteria for Tourette syndrome (TS) and other persistent motor and vocal tic disorders (PMVTD) are those included in the Diagnostic and Statistical Manual (DSM) of Mental Disorders of the American Psychiatric Association.1 These criteria have remained substantially unchanged for the past 30 years since the DSM-IV was published in 1994.2 DSM-IV and DSM-5-text revised (TR) criteria for primary tic disorders (Table 1) have set clear diagnostic standards for tic disorders. However, an increasingly shared view among experienced clinicians is that these criteria neither reflect the critical thinking behind the diagnosis of tic disorders nor the neurobiology of these conditions. Moreover, the current criteria may fail to
separate neurobiological different conditions also manifesting with tics and tic-like behaviors.