Tourette Syndrome Mimicking an Eating Disorder

Tourette syndrome occurs in approximately 1% of school children between 6 and 7 years of age. These young children have multiple motor tics and at least one phonic tic that begins before adulthood and lasts at least one year (American Psychiatric Association, 2000). Vomiting is a rare tic among these children.

An 18-year-old white male student (body mass index: 22.2 kg/m2) was initially mistakenly referred to a center for eating disorders with a suspected diagnosis of bulimia nervosa, purging type. At first the young man had been unable to suppress his vomiting but later forced vomiting by sticking his fingers down his throat. This self-induced vomiting occurred after almost every meal. Psychiatric assessment revealed that that the student had a warning “feeling” in the epigastrium before vomiting, and felt relief afterward.

As reported in the Turkish Journal of Psychiatry (2008; 18:1) the patient had been treated with methylphenidate for a childhood diagnosis of attention deficit and hyperactivity disorder and also had obsessive-compulsive symptoms. Psychiatric assessment disclosed a specific sequence of a premonition of vomiting and relief afterward, and his history also revealed that he had a childhood-onset of motor tics (copropraxia, including grabbing his genitalia), bilateral facial grimaces, sudden movements of the head, sniffing and gargling.

Dr. Frederique Van den Eynde and co-workers note that vomiting may have several causes, including reactions to medications, and numerous neuropsychiatric disorders, such as phobias, panic disorder, epilepsy, and migraine. Taking a thorough history will usually help rule out a suspected eating disorder. In this case, the vomiting that led to the misdiagnosis was actually a tic. Only two cases of Tourette syndrome coexisting with an eating disorder have been reported. The main diagnostic tool used to differentiate Tourette syndrome from an eating disorder is a thorough psychiatric evaluation.