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Tremors/Tics - Male Student, Early Twenties
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Tremors/Tics - Male Student, Early Twenties

Hello,

I am a male college student in my early twenties. I have been experiencing facial tics and facial muscle tremors for a few years now. Soon after they began, they got so bad that they began affecting my social life severely and I went to talk to my Internist. Any type of excitement was causing them. Anger, good/bad/fun excitement, regular nervousness...anything that excited my nerves made muscles in my cheeks and mouth tremor and tic severely (sometimes, though not always, it would feel like my muscles were trying to force me to frown – even if I was laughing at something funny). I could feel how bad they were and others began noticing them as well.

My Internist ordered several blood and urine tests and referred me to a Neurologist who had several different blood tests done in addition to the ones my internist ordered. The neurologist also had me do a brain MRI w/contrast. Everything came back normal. After receiving all the results, although they did not specifically come out and tell me this, both doctors clearly came to the conclusion that my symptoms had purely psychological causes and didn't think any further attempts at diagnosis were necessary. As the symptoms appeared during a time when my stress level was above average, I reluctantly accepted the psychological diagnosis and attempted to make changes in my life that allowed more hours of sleep, less stress, and a more relaxed state of mind.

Although these changes over the last few years have reduced the occurrences of aggravating my nerves, therefore making my symptoms appear less often in a severe manner, the changes have not stopped the symptoms from appearing in a moderate manner when I am just “regularly” nervous and/or excited as most would be in a situation. In fact, a lot of my reduction in symptoms probably has to do with the fact that that I have been a less socially active (due to other reasons) shortly after I began making these changes in my life. Although these symptoms have not been happening at the slightest amounts of excitement when I am alone as they were in the beginning, my symptoms are still happening any time I have even the slightest amount (as in what any normal person experiences) of discomfort, anxiety, or nervousness in public or social environments. I still even have them in private environments (though on a much lesser scale) with the family and friends that I am the most comfortable conversing with. I can't even lightly smile for very long when talking with anyone because the nerves in my facial muscles immediately cause smiling to become physically fatiguing, as the smiling seems to conflict with what they are trying to do (tremble and/or strongly tense up). A few months after the symptoms started, a couple of new symptoms appeared as well. As with the others, any time I was barely nervous in a public or social environment, my neck would now also begin to stiffen up to where I couldn’t turn my head without my entire head jerking (the only way to avoid my neck/head jerking would be to turn my upper body with my head). And if I tried to talk at the same time, if my neck was stiff, my entire head would tic even without me attempting to turn it. This is any time I become more than slightly (moderately) nervous/uncomfortable in public.

What it all feels like:  For some reason the muscles in my body are tensing up all the time, even when I am alone, and any type of social activity causes them to tense more than they already  are, and this tension causes them to tremor and tic, eventually fatigue, which causes more severe trembling and tics. They do not feel psychological on a conscious level, because sometimes I completely forget about them, begin to talk to someone, and they suddenly start happening after a while, before I have even thought about them.

I could see how I could potentially have some kind of social anxiety due to being socially inactive for many years until the last few. But during the six months before these symptoms began (my first six months of college), I was increasingly socially active and was becoming increasingly comfortable in those activities. I was even participating in public speaking in front of audiences, with little to no nervousness, and certainly no fear (I never have had an actual fear or dislike of public speaking or for that matter any social activity – I have just been not used to it in previous years). But these symptoms came on suddenly, seemingly without warning, at a time when I was most confident and comfortable with social activity, were immediately severe (they did not start small), and have never gone away (and in fact, as I said a few new symptoms actually appeared a few months into the ordeal). Furthermore, these new symptoms even appear on a smaller magnitude with the people I am most used to talking with (and the symptoms did not exist with them before the symptoms began appearing in public). These facts just make it hard for me to accept that they are purely psychological.

OTHER NOTES: I have had depression for many years (due to circumstances) but have not allowed it to affect my life (whereas these symptoms ARE affecting my life) and I was least depressed at the point when these symptoms began to occur. Both a lack of sleep and semi- strenuous physical activity can sometimes increase the symptoms  

So my questions are:
1. Do these symptoms sound purely psychological in nature considering the “normal” results that came back for blood/urine/MRI?

2. If not, what advice would you give in identifying and/or getting help in identifying their physical/neurological origins?

3. If they are probably psychological due to some combination of anxiety, stress, and/or depression, how would I go about attempting to resolve them? I have tried to increase my sleep and reduce stress to no avail when it comes to these symptoms. Although I believe in prescription drugs being a last resort, I am beginning to wander if I have no other options, due to the severe effect this can easily have in the near future (such as when I begin interviewing for jobs later this year – high stress situations that may either aggravate my symptoms extremely or distract me as I attempt to control them). Nothing I do seems to be effective in combating it. Should my post be moved to the Anxiety forum instead?

Any advice would be appreciated. Thank You.
Related Discussions
Avatar_dr_f_tn
Hi there.  I understand your dilemma. Facial tic is a repeated spasm involving the eyes and muscles of the face.  It occurs in youngsters and with no known cause. it is short lived and a chronic motor tic disorder also exists called as Gilles de la Tourette syndrome. Symptoms are repeated, uncontrolled spasm lie muscle movements like eye blinking, grimacing, mouth twitching, squinting, repeated throat clearing etc. treatment is a non-stressful environment and stress reduction programs. If tics are disabling, medications like clonidine or risperdal or risperidone may help control them.  Consult your doctor again with these speculations and tell him you still have tics despite stress reduction techniques. Take care and keep us posted.


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