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ICD-10 Learning Lab Exit Presentation Mode

Category: F90 F91 F92 F93 F94 F95 F98

F95 — Tic disorders: facilitator sheet

Teaching objective

F95 requires involuntary, sudden, rapid, non-rhythmic movements or vocalizations; the fourth character is then decided by duration (less than 12 months versus 12 months or more) and by type (motor tics only, vocal tics only, or both motor and multiple vocal tics together, as in Tourette syndrome) — never by severity, social impact, or the presence of any particular vocal content.

Choose material

Worked example · Case: Motor and vocal tics together, no swearing · Case: Rocking at bedtime

Worked example

Show scenario

A 10-year-old has had frequent, involuntary eye-blinking and facial grimacing for 14 months. Over the past 3 months, he has also developed an involuntary throat-clearing sound that occurs multiple times a day. Both are worse when he is anxious and absent while he sleeps.

(or reveal one step at a time below)
  1. Reveal step 1

    Step 1 — Check involuntariness and character: the movements and sound are sudden, non-rhythmic, and involuntary, worse with stress and absent in sleep — consistent with tics generally.

  2. Reveal step 2

    Step 2 — Check duration: the motor tics have been present for 14 months, meeting the 12-month threshold for a chronic (not transient) tic disorder.

  3. Reveal step 3

    Step 3 — Check type: both motor tics (blinking, grimacing) and a vocal tic (throat-clearing) are now present together.

  4. Reveal step 4

    Conclusion — Combined motor and vocal tics present for 12 months or more support F95.2 (combined vocal and multiple motor tic disorder), not F95.0 or F95.1.

Comparison points

F95 is distinguished from F98.4 (stereotyped movement disorder) by tic's sudden, rapid, non-rhythmic, suppressible-but-involuntary quality, versus F98.4's more rhythmic, sustained, often self-soothing repetitive movement pattern. Duration (under versus at least 12 months) and type (motor-only, vocal-only, or combined) decide the fourth character — not severity or the specific content of any vocalization.

Misconception prompt

Believing Tourette syndrome requires involuntary swearing (coprolalia): "There's no swearing mentioned, so it can't be Tourette syndrome."

Ask the class why this reasoning fails before revealing the explanation below.

Reveal why it fails

Coprolalia (involuntary swearing) is a popular media stereotype of Tourette syndrome but affects only a minority of people with the condition. F95.2 is defined by the combination of multiple motor tics and one or more vocal tics present for 12 months or more — never by the presence of any particular vocal content. Requiring swearing before considering F95.2 will cause the diagnosis to be missed in the great majority of genuine cases, which present with tics such as blinking, throat-clearing, sniffing, or grunting rather than words.

Discussion prompts

(or reveal one at a time below)
  1. Prompt 1

    Name the two factors that decide F95's fourth character.

  2. Prompt 2

    Explain why coprolalia is not required for a Tourette syndrome (F95.2) diagnosis.

Summary

Involuntary, sudden, rapid, non-rhythmic movements or vocalizations — duration (under/over 12 months) and type (motor, vocal, or combined) decide the fourth character, never severity or content.