An article by Dr. Annet Heijerman, Netherlands
Tic disorders are diagnosed more often in boys than in girls, and even in scientific research, the majority of participants are boys or men. But is this picture really representative of girls with tics?
Girls generally have less severe tics, especially at a younger age. However, their tic severity often increases with age, while in boys it usually decreases. During adolescence, tic severity is similar for both. Girls and women tend to experience greater limitations from tics on average, especially in adulthood. They feel more hindered in their daily life and social interactions, and more often feel ‘different’ or abnormal compared to men with similar tics.
In addition, tics in girls often seem to be more complex, possibly because they appear later and girls generally develop their first tics at a later age. In girls, tics are more often accompanied by emotional problems, such as anxiety and mood disorders. During adolescence, they more frequently have compulsive behaviors alongside their tics, like counting, making things symmetrical, or checking. Furthermore, eating problems and other compulsive behaviors—such as hair-pulling or skin-picking—are more common in girls than in boys with tics. On the other hand, ADHD, behavioral disorders, and learning problems are diagnosed less often in girls than in boys with tics. Girls with tics also less frequently show characteristics of autism and have fewer attention or hyperactivity issues compared to boys with tics.
For some girls and women, tics increase after the first menstruation and worsen around their period. A drop in estrogen levels in the brain may influence sensitivity to dopamine. This chemical in the brain plays a role in suppressing tics.
Boys, on the other hand, show more severe tics at a younger age, often along with other – more noticeable – problems than girls, which may explain why tic disorders are noticed earlier in boys.
In short:
• Tics are diagnosed more often in boys than in girls, possibly partly because tics in girls are less well recognized due to differences in the clinical picture.
• In girls, tics tend to peak at a later age and then decrease less strong than in boys.
• Tics in girls are more often associated with emotional problems, like anxiety and low mood, compared to boys.
• Girls with tics show fewer signs of attention problems, hyperactivity, or autism than boys.
• Girls generally experience more limitations from tics, especially in adulthood.
Sources:
Garcia-Delgar, B., Servera, M., Coffey, B.J., Lázaro, L., Openneer, T., Benaroya-Milshtein, N., … & EMTICS collaborative group (2022). Tic disorders in children and adolescents: does the clinical presentation differ in males and females? A report by the EMTICS group. European Child & Adolescent Psychiatry, 31(10), 1539–1548.
Garris, J, & Quigg, M. (2021). The female Tourette patient: Sex differences in Tourette Disorder. Neuroscience & Biobehavioral Reviews, 129, 261-268.