The Modulating Role of Stress in the Onset and Course of Tourette's Syndrome: A Review

Judith Buse, Clemens Kirschbaum, James F. Leckman, Alexander Münchau, Veit Roessner*

*Corresponding author for this work
14 Citations (Scopus)


Accumulating data indicate a common occurrence of tic exacerbations and periods of psychosocial stress. Patients with Tourette's syndrome (TS) also exhibit aberrant markers of hypothalamic-pituitary-adrenal (HPA) axis activation. Based on these findings, a functional relationship between stress and tic disorders has been suggested, but the underlying mechanism of how stress may affect tic pathology remains to be elucidated. We suggest that dopaminergic and noradrenergic neurotransmission as well as immunology play a crucial role in mediating this relationship. Two possibilities of causal direction might be assumed: (a) psychosocial stress might lead to an exacerbation of tics via activation of HPA axis and subsequent changes in neurotransmission or immunology and (b) TS-related abnormalities in neurotransmission or immunology result in a higher vulnerability of affected patients to respond to psychosocial stress with a strong activation of the HPA axis. It may also be the case that both assumptions hold true and interact with each other.

Original languageEnglish
JournalBehavior Modification
Issue number2
Pages (from-to)184-216
Number of pages33
Publication statusPublished - 01.01.2014


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