Are you a hair-twirler or a nail-biter?

Tics exist on a spectrum ranging from barely noticeable to potentially injurious.

Are you a toe-tapper, hair-twirler, eye-blinker, head-nodder, nail-biter, knuckle-cracker, skin-picker, lip-licker, shoulder-shrugger or a chin-stroker?

Call it a nervous habit or tic, almost everybody has at least one — whether they are aware of it or not.

Tics exist on a spectrum ranging from barely noticeable to extremely annoying to potentially injurious.

While research has focused mostly on the more severe forms associated with neurobehavioural disorders such as Tourette syndrome and autism, there’s a growing realisation of the pervasiveness of repetitive, nonfunctional motor behaviours and that the degree to which you engage in them is a barometer of your peace of mind.

“Our stressful society definitely brings it out more,” said Dr Alon Mogilner, a neurosurgeon at New York University Langone Medical Centre. “It’s a delicate balance within the circuitry of the brain so you are able to tamp down on things you don’t want to do.”

Experts divide repetitive, non-functional motor behaviours into three overlapping, and not always agreed upon, categories. First, there are classic tics, which typically involve quick, jerky motions of the head, neck or arms preceded by an urge, akin to an itch that needs to be scratched. Tics can also be phonic such as throat-clearing.

Next are stereotypies (pronounced steer-ee-AH-ta-peez), which usually don’t have a premonitory feeling and are more fluid and rhythmic like body rocking and leg bobbing. Lastly, there arebody focused repetitive behaviours, which are essentially grooming gone awry like compulsive nail-biting, hair-pulling and skin-picking.

‘Unvoluntary’ behaviours
All of these behaviours are what experts call “unvoluntary,” as opposed to an involuntary muscle twitch. You can stop the tic when asked to or when distracted but the problem is, sooner or later, you go back to doing it. In some circumstances the behaviour is distressing to the person, particularly if it is injurious or embarrassing, but more often the movement or mannerism is just maddening to those in proximity.

“If we dive into the research and look at disordered, unwanted repetitive behaviours as well as non-clinical, non-impairing repetitive behaviours, they all involve the region of the brain called the basal ganglia, which is involved in motor control,” said Ali Mattu, a clinical psychologist who specialises in body focused repetitive behaviours at Columbia University Medical Centre.

Though still poorly understood, the basal ganglia are sort of like the movement command centre of the brain that responds to situations by choosing from a menu of motions or gestures that you’ve learned. The theory is that when situations are frustrating or stressful because you are either over- or under-stimulated your basal ganglia manage by selecting (or perhaps failing to inhibit) a default motor behaviour, which would be the tic, stereotypy or motor habit.

Most repetitive behaviours, regardless of etiology, begin in childhood. The immature brain, unable to recognise and process emotions as an adult does, resorts to motor activity to cope. Except for children with severe autism, most kids grow out of habits like head-shaking and arm-flapping as they become better able to understand and manage their feelings. Or they just find a way to convert the behaviour into something more socially acceptable and “adult.” Rocking might morph into leg-bobbing, mouth-stretching turns into gum-chewing or finger-wiggling may become iPhone-fiddling.

“These behaviours persist, it’s just the person learns to have more control over it or learns to do it in private or under the table,” said Dr Harvey Singer, professor of neurology at Johns Hopkins School of Medicine and specialist in childhood stereotypies.

Most people don’t seek treatment and indeed, many find their repetitive behaviour comforting. Help is generally only sought when the movement or vocalisation becomes so insistent and frequent it impairs daily functioning or is a turnoff in relationships. Neck tics can harm vertebrae, for example; skin-picking can lead to unsightly scabs and employers tend not to hire people who can’t stop blinking during an interview. It probably goes without saying that such behaviour is not an asset in dating.

To help people stop, doctors first rule out drugs such as antihistamines, antidepressants, ADHD medications, methamphetamine or heroin as a cause or aggravating factor. Assuming this isn’t the case, treatment begins with raising the person’s awareness of the tic or motor habit since it’s become so automatic. This usually involves describing it to a therapist in detail including any urges that precede it and every aspect and nuance of the movement.

Also important is to look at when it’s happening.

“People don’t realise it, but there’s a situational profile to all these problems,” said
Dr Kieron O’Connor, a professor of psychiatry at Institut Universitaire en Santé Mentale in Montreal, who develops treatment programs for people with tic and motor habit disorders. “Tics and motor habits, people tend to do in some situations and not others so we work on helping patients to evaluate those problematic situations differently.”

The repetitive behaviour is often the result of situations that make people feel overwhelmed with emotion because either they didn’t see something coming or don’t know how to deal with it.

“We try to figure out on what dimension they are lacking whether it’s awareness of emotion, recognition of emotion or coping with emotion,” O’Connor said.

In addition to the cognitive component, therapies often include a behavioural or habit reversal component where a person finds a more acceptable competing or inhibitory action. These can include strategies like squeezing a ball instead of knuckle-cracking, pulling in the chin to avoid chronic head-nodding or getting rid of magnifying mirrors to prevent face-picking.

For more severe and debilitating cases, anti-psychotic medication, botulinum toxin injections and implantation of a deep brain stimulation device might be considered, although all of those options are riskier, can have unpleasant side effects and are not entirely effective.

There’s growing consensus among experts that behaviour is a form of communication and it’s important to first understand what the tic or habit is telegraphing (anxiety, boredom, anger, sadness, tension, etc) in order to help the person cope rather than just trying to stop, modify or provide a substitute behaviour. Alas, prescribing a fidget spinner is not a long-term fix.