Source: The Conversation – USA
Imagine trying not to blink, resisting the urge to sneeze or refusing to scratch an intense itch. For a short time, you can probably succeed, but the effort becomes increasingly untenable until the urge eventually wins.
People with Tourette syndrome describe tic suppression in a similar manner. Tourette syndrome causes tics, or repeated movements and sounds, that a person cannot always control. These tics often come and go, change over time and may occur along with attention problems, anxiety or obsessive-compulsive behaviors.
Some people with Tourette’s can temporarily control tics, such as during a public interview, but that does not mean tics are voluntary. Nor does it mean the person is faking their diagnosis. Rather, suppression can be a hallmark of the disorder and, ironically, has become one of the foundations of modern treatment.
Yet suppression can come at a cost.
I have seen this firsthand as a neurologist who has been treating people with Tourette syndrome for over 20 years. Many of my patients have told me that while they can temporarily hold back tics through intense concentration, they later need to release them. They say it’s an exhausting process.
Understanding the neuroscience behind tic suppression and people’s experiences with it can help those without the disorder better recognize – and have compassion for – the dynamic and sometimes demanding symptoms of Tourette syndrome.
Misunderstanding Tourette’s
When singer-songwriter Billie Eilish publicly acknowledged in 2019 that she lives with Tourette syndrome, internet commentators responded in two ways: Some expressed support, while others questioned whether her tics were real.
Skeptics pointed to interviews or performances where she appeared to have no visible tics. Many concluded that she must be exaggerating or even faking her condition. But in a May 2026 interview on “Good Hang With Amy Poehler,” Eilish shared how suppressing her tics requires constantly using “everything in (her) power” to do so.
Many people with Tourette syndrome often deal with anxiety, obsessive-compulsive symptoms and attention-deficit/hyperactivity disorder, among other challenges, that have a far greater impact on quality of life than the motor or vocal tics themselves.
These invisible symptoms frequently interfere with friendships and school performance. A child may be teased because of involuntary blinking or shoulder movements, but what ultimately limits that child’s success may be untreated anxiety, overwhelming obsessive thoughts or difficulty sustaining attention in the classroom.
Samir Hussein/WireImage via Getty Images
What causes Tourette’s is still unknown, though researchers believe genetics and environment may play a role in its development.
Unpacking tics
Tourette syndrome affects less than 1% of children worldwide, although estimates vary across studies and populations.
While the disorder occurs around the globe, no two people experience Tourette syndrome in the same way. Some people have simple motor tics, such as blinking, shoulder shrugging or facial movements. Others have complex movements involving multiple muscle groups or elaborate sequences of actions.
Vocal tics may range from throat clearing and sniffing to repeating words or sounds. Some people develop rituals or repetitive behaviors that overlap with obsessive-compulsive symptoms, making it difficult to distinguish where a tic ends and an obsessive-compulsive behavior begins.
The condition exists on a spectrum. Each person’s combination of symptoms is unique.
People’s tics are also dynamic. They wax and wane and are influenced by stress, sleep deprivation and illness. Many people experience fewer visible tics while they are intensely focused on an activity, such as performing music or playing sports. Others say they have a dramatic increase in tics after returning home from school or work, where they can finally stop suppressing them.
This fluctuation is one of the defining characteristics of Tourette syndrome and can lead outside observers to wonder whether a person’s diagnosis is real.
Many tics are suppressible. People can suppress their tics for hours in situations where they fear embarrassment or judgment. Teachers or employers may conclude that the student or employee is fine. But once home, the person releases a storm of tics.
Suppressing tics as treatment
Suppressing tics can be distracting and exhausting, yet decades of research has shown that tic suppression can be strengthened and used therapeutically.
In 2019, the American Academy of Neurology recommended behavioral intervention as an evidence-based treatment for Tourette syndrome. Among these is a method called comprehensive behavioral intervention for tics, which teaches people to recognize the earliest warning sensations that precede a tic, understand the situations in which tics occur, and develop competing responses that reduce tic frequency and severity.
For example, someone may feel a building sensation in the throat just before a throat-clearing tic. Using behavior intervention, they can learn to respond by slowly breathing through the nose while keeping the mouth closed, making it harder to perform the tic until the urge passes.
They aren’t simply holding in their tics. This therapy helps people harness the brain’s natural capacity for self-regulation in a healthier and more sustainable way. Large clinical trials have shown that this treatment significantly reduces tic severity for many children and adults.
Other treatments include medication, behavioral therapy and for a small number of cases a surgical therapy called deep brain stimulation.
Building awareness and compassion
By allowing the public to see both her extraordinary talent and her neurological condition, Billie Eilish not only revealed a diagnosis but also contributed to a global conversation about what tics are and why they are so often misunderstood.
I believe public visibility reduces stigma, encourages families to seek evaluation earlier and inspires young people living with Tourette’s. It also motivates researchers like me to develop better treatments.
Awareness also includes understanding tic suppression. The ability to suppress tics does not make them voluntary or the Tourette syndrome less real. In fact, understanding the warning sensations and the ability to modify a person’s response to tics has helped inform treatment.
Understanding what people see, and, importantly, what people may not see, can be one of the most powerful ways to support those living with Tourette syndrome today and into the future.
Michael Okun serves as medical advisor the Parkinson’s Foundation, and has received research grants from NIH, Parkinson’s Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, the Smallwood Foundation, the Tourette Association of America, and the UF Foundation.