Esoteric Philosopher: Study of the Endless Path of Wisdom

Obsession And Behavioural Problems

The Alice Leighton Cleather Basil Crump 1929 attack on Theosophy
Teaching planned by Hierarchy
No further messenger until 1975
Mother of the World
Dear Friends of Humanity and of the Ageless Wisdom
The original Sanskrit root of the Satanic races
Pre Adamic Satanic Races
The Golden Wheel Head Centre
Shigatse and Tda-shi-Hlumpo Monastery
The Forbidden City
Red Caps and Sect Worship
Five India's
The Lotus Sleep
Entrenched with Debt
Cosmic Etheric Vision and Septenary Clairvoyance
HPB: The Hierarchial Link
The Ocean of Reasoning: Tsong Khapa
The Essence of True Eloquence: Tsong khapa
A Golden Lotus Sutra
Three buddhic vestures, three human vehicles.
The Source Measure 43
Third sub plane of the Fifth manasic plane
Initiations and Atomic Matter
Telepathic/Etheric Transmission
Divine Light of the Cosmic Atom
Book of Imperfections
Magnetic power of Master
Formula of Creative Combinations
Golden Rays of the Sun
Radiation of the Master
Etheric plane vibrational frequencies
Cosmic Physical plane vibrational frequencies
Formula of Karmic Mass: Km = mdlc²
Differentiated Molecules
Light and Matter United
The 49/I/6 VIOLET/White/Red
Hiawatha: Line of the Red Ray
Zionist Movement: The seperating door
A stand against Soviet Communism
"the central triangle at the heart"
The Race for the Atom Bomb
The Zionist Question Today
Age Of Aquarius @ 1945
Failure to register adequate dynamic incentives
First Ray Magnetic Corruption
Sevenfold Intent to Destroy
Higher and Lower Ray expressions as used by the White and Black Lodges
The Black Master
The Horoscope, Invalid Upon Liberation
Fenian Dynamiters The Clan na Gael
The Fourth Fundamental of the Ageless Wisdom
The Dark Star, Carbonic Gas and the Global Atmosphere
The Jurassic Period and the Lords of the Flame
Manifestation, Withdrawal And Externalization Of Hierarchy
Significance of the year 1945
The Divine Avatars Maitreya Christ, Maitreya Buddha.
A "culture of respect."
Age Of Aquarius & The Years 1900, 1945, and 2035.
Ida, Pingala, and the Central Sushumna.
Fervid Gold And Gold Fever
Colonel H. S. Olcott And Abraham Lincoln
Colonel H. S. Olcott
The Red Rajputs And The Moryan Dynasty
Ozone And Climatic Conditions On Earth
Clouds the Atmosphere and Meteoric Dust
Chronic Fatigue Syndrome
"Four Requirements" Refinement of the physical body is an Essential
The Freedom Of The Seven Solar Systems
Shining Face and Alkaid: A minor constellation. One of the Seven.
The Leading Great Rishi and Pleiad, Alkaid And Alcylone
The Law of Solar Union and The Cycle Of Sunship
Seven Rishis, Seven Timekeepers
The 'Sacred Triangle of all-inclusive Force'
Mars: Karttikeya. Agnibhu "fire born."
August Neptune: Arisen over the Horizon
Earth Base, reproduction of third un-named scheme.
Thomas Alva Edison
J.W. Keely, un-conscious Occultist. A "natural-born magician."
Keely, Edison and Tesla.
J.W. Keely and the Vril
Sedna and Xena
The Christ in the KH Letters
Earth Kundilini Base Scheme, Eventual Heart Triangle
Eire : Ireland
Tara And The Druids
Sisera and the Battle Of Megiddo
Root - Sub Races
Rays And Jewels
The Dark Ones
Cycles of Pralaya and the Rise to Sunship in future Kalpas
The Divine Circulatory Flow of the Cosmic Mother/Love
Obsession And Behavioural Problems
Vaisyas and Sudras shall tread the highest path
The School for Warriors
The School of Beneficent Magicians
The Schools of Aspiration and Painful Endeavor
Earth Mercury Anguish Aspiration
"mass intellectual wrong emphasis"
Magnetism, Radiation, Attraction and Repulsion
Austerity And Sternness
The Way of Resistance To Evil
Light or Darkness?
The Five Kumaras Of Manasic Energy
Four Kumaras: The Holy Four
The Ancient Of Days And William Blake
Plato: The Great Thinker
The Blood
Criminality: A Psychic Disease
Labor: a battle with chaos
H.P.B. And The Battle Of Mentana
Fohat, Para-Fohat, Pan-Fohat!
Treason And The Traitor
Jesus/Joshua, Appollonius, Origen.
Bruce Lee: The Worrier Within. The Art of the Soul.
Opinion, from Latin opnr, to think.
Mars: Her Descher. The Red One.
Mt. Everest
The Year 1952
The Year 1936
Poles Of Light And Darkness
Zero Ray
Diamonds Are Forever
Respiration, Prana, Breath, Ozone:
"racial purity"
Intoxicants and Narcotics
The Chohan Hilarion: The Annunciator!
Henry Lewis Stimson
Cosmic Dust
Egypt, Chemi, Kham.
The United States: Banner Of Light Against Totalitarianism
John Law: Corrupt Scottish Financier
New Orleans: Seven Brothers of the Blood
Black Holes@Zero Points, Laya Centers and Gravitation
The Vitrified Forts of Scotland
7x7=49 degrees of the Negative pole and of the Positive pole.
Teachings on the Third Reich
Tamas and Teros
Arhat, Adept, Chohan.
Hatha Yoga
Port Said (bûr sacîd)
Sir Edward Bulwer Lytton. Lord Lytton.
A Christian reflection On the New Age
T. Subba Rao
Hitlers Indian Army
Winston Churchill
Otto von Bismarck and the Realm of the Holy Roman Empire
William Q. Judge
Lord Ripon Governor-General Viceroy of India and Grand Master Mason
Venus, Light Bearer To Earth:
Great Britain/Prydian and Llyn-llion/Lyonness
Gaza Mustafa Kemal Atatürk
Benjamin Disraeli 'Beaconsfield' 1st Earl of
Telepathic Discourse and the Amanuensis
Napolean The Great
The Pancreas
The Spleen, Organ Of Solar Prana
Kashmere: Brahman Mahatma Of the Lunar Race.
The Roman Empire

One of the activities ahead of the occult student is the study and the scientific observation of this matter. DK.

Dear Brothers,


Keeping in mind the anti social, often criminal activity and social problem presented by children and adults, who have various behavioural disorders perhaps commonly and collectively known as ADHD, Aspurgers Syndrome, Autism, Obsessive Compulsive disorder and Personality disorders of various kinds, those unbalances of the mental, Astral and Physical vehicles, let us consider, perhaps theoretically, yet with a keen attention, some of the conditions related to us from the Masters of Wisdom. 


Keep in mind brothers, that obsession, according to MM manifests from an almost imperceptible eccentricity, up to and including violence, including self harm I would add, and criminal activity ect. I would think it fair to say that children and adults of all ray types may be affected.


Bear in mind that all true ADHD, Aspurgic, Autistic and Tourette Syndrome persons are viewed as chronic and severe, as are the manifold types of personality disorders which display abnormal behaviour patterns, abnormal cognitive recognition and communicative understanding and paranoia particularly with regard to and relating to the age of the patient within his or her social and peer setting.


General so-called high spirits, naughty or bad behaviour does not necessarily make a person with these conditions. Let us be mindful also that DK states that murder is nothing but extreme selfishness. I think this might be the extreme selfishness either of the rightful occupant of the body though more commonly of the obsessing occupant.


The essential oil par excellence which entities avoid is Sandalwood. I also recommend Cedar, Lavender and Orange oil. It is said in the Agni Yoga teachings among other things, that to use oils beneath the bed particularly, are beneficial in such circumstances.


They are powerful purifiers and obsessing ones generally speaking do not like purity, routine or discipline. Hence as in my experience and observation, the aversion to bathing, cleaning, tidiness, purity of thought and word ect. Meat will attract bad entities also, so may well make for more aggressive tendencies if used in the diet. The one who prepares the diet of the child if possible should avoid it.


I believe the esoteric words below, as given by the masters of the wisdom, if deeply considered and given due reflection, and taking sometimes a key sentence or few words, will relate much that is occurring with regard to those in society suffering from behavioural and co-operation difficulties.


These words are absolutely crucial in understanding the true underlying nature of the common and prominent psychological conditions that society and the medical profession are confronted with today. Some thoughts for consideration. JPC.


It is not easy for the scientific psychological investigator to accept the premise of the substitution of the consciousness of another entity in the place of the consciousness of the one who has been unable to hold the link within the brain with adequate positiveness. But, speaking as one who knows, such cases frequently occur. EP2 420.


One of the activities ahead of the occult student is the study and the scientific observation of this matter. DK.


Obsession must be very clearly defined. Heart 213.


Hence, physicians could do so much useful work by directing attention to obsession. Ask the physician whether he did not notice special peculiarities in the eyes of obsessed persons. For one can judge duality of existence by the eyes.


But I do not refer to a purely superficial manifestation such as a dull or shifting glance. Other symptoms must be observed. One can also observe symptoms in the walk, the voice, and even a change in the weight.


Do not ask psychiatrists about it, because their theories are fossilized, but physicians of the new type can observe impartially. And yet, how greatly such observations are needed, now when obsession is becoming epidemic! Heart 219.


Pay attention to the unprecedented obsession. Heart 266.


Obsession occurs easily during such a depleted condition. Do not regard it as an exaggeration that almost half of the planet's population is exposed to this danger.


It varies in degree, yet once the decomposition sets in it progresses rapidly. FW1 185.


At this particular period of the world's history the emotional plane is so densely populated and the response of the physical to the emotional is now becoming so exquisitely attuned, that the danger of obsession is greater than ever heretofore. LOM 123.


The infection of obsession. FW3 557.


The influence of mania or obsession. FW3 57.


Obsession and insanity are very closely allied. LOM 126.


During obsession a most objectionable violation takes place, and rational cooperation is eliminated from the consciousness. FW1 555.


Such lack of self-control indicates obsession. SM1 167.


One must primarily discriminate where there is Good, and where essentially there is harm.


Thus, the flaming heart will discern immediately where obsession is concealed. Heart 213.


Is it possible to conceive of cooperation with a traitor or a blasphemer? FW2 445.


You know how obsession gradually destroys the organism; the paralysis of certain nerve centers is inevitable. Heart 219.


One should pay attention to the different shades of the manifestations. Primarily, observation will reveal a general design, but the attentive observer will detect a great number of original details. AUM 206.


True, it varies in degree, yet once the decomposition sets in it progresses rapidly. FW1 185.


One can observe chronic, protracted or temporary symptoms. FW1 278.


Condemnation. Violent and abusive/threatening language:


It happens that people are so savage of spirit that they can only live by condemning each other. This is not an inspection of another's armor with the view of helping; on the contrary, condemnation becomes the meaning of life. If one deprives such a condemner of his tongue, he will perish and wither like a plant without water.


Such a manifestation can be investigated from a medical point of view. One can see in this condemnation a kind of obsessive vampirism, when the possession of more active vital fluids is needed to nourish the obsessed one.


This aspect of life ought and must be investigated with a scientific purpose. Heart 169.


Symptoms of obsession are assuming the proportions of an epidemic. They are far more numerous than the human mind imagines.


Moreover, the varieties are highly diverse-from an almost imperceptible eccentricity up to violence. FW1 278.


The malevolent (or if you prefer eccentric) Mahatma Letters.


Selfish and malevolent purposes or kind-hearted. adapted. CWL.


Whether benevolent or malevolent. Mahatma Letters.


It already has been said that upon discovering obsession one must either drive out the obsessor or leave the obsessed person alone in quiet and solitude; because then the obsessor, unable to find a field of activity, will become bored and depart.


Of course, it is best not to allow the obsessed persons either weapons or alcohol, but in such a way that they shall not in the least feel their isolation. Heart 235.


People often do not understand wherein lies the boundary of violence. Some tend to use violence, others seek violence both are against the nature of the Fire. FW2 24.


Fear is not attractive, violence is repellent. FW2 28.


Precisely, ignorant compulsion can violate the harmony of combinations. Nature, both in the small and the great, is opposed to any violence. FW2 251.


There is too much obsession on Earth. The sole path to the Higher Communion is through the heart. Violence must not stain this fiery path. Can people possibly think that the invocation of lower entities can go unpunished! FW2 249.


The most common form of obsession…

It leads, in the ensuing struggle, to the violent scenes of screaming lunatics and to the paroxysms of the epileptic. LOM126.


It often occurs during a temporary blacking out of consciousness, when, as some researchers believe, the consciousness comes in contact with waves of chaos and the abnormality results. This observation is undoubtedly sound. SMD2 284.


Also tell the physician that not all obsessions are necessarily dark ones. There may be influences from the middle spheres, which, in the belief of the obsessors, are directed for good, although no especially good results will be derived.


The obsessors are of such low degrees and the vehicles within their reach are of no high development, thus, duality of thinking, imbalance, and a lack of self-control result. There are many such people, who are called weak-willed; in fact, the two wills weaken each other.


One can cure such persons only by giving them the work that they prefer, but in very intensive measure. The obsessor becomes irked, remaining without an outlet during such concentrated work, for every obsessor seeks to express his own ego. FW1 283.


May work out on the physical plane as powerful action and even violent action, and may lead a man into much trouble, into conflict with organized society, thus making him anti-social and at variance with the forces of law and order. EP2 460.


It can be said that the majority of those suffering from venereal disease are not strangers to obsession. FW1 278.


It may be the desire to kill, or desire to have abnormal sexual experience, or even the desire to be ever on the move and thus constantly active. EP2 460.


The physician is correct in wishing to visit not only insane asylums but also prisons. It would not be out of place to visit the stock exchange also, or the deck of a ship in time of danger. FW1 278.


Let us not forget that obsession is sometimes manifested cutaneously, or by twitchings of the face. FW1 137.


There is a low vitality, a lack of desire impulses, a failure to register adequate dynamic incentives, immaturity and sometimes obsession or possession. EP2 419.


Very often a single conversation about the significance of Agni begins to act upon the obsessor. Fearing fire, the very mention of the fiery energy angers him and forces him to retreat. FW1 373.


Periodically there may be a relaxation of the obsession, such a method is employed by the obsessors if they value the victim. AUM 305.



Obsessive Compulsive Disorder:


That psychological phenomenon called id e fixe. EP2 454.


There is a curious state of mind called id e fixe. I am not referring to possession, which may have similar symptoms, but to obsessive, constantly repeated assertions, which can have a special significance.


Medical science considers the id e fixe to be dangerous, but this is a baseless judgment. If we accept this opinion, we must then consider many splendid scientific minds insane! SMD2 360.


Mental insanity or id e fixe. Glam 29.


In any case - again for a disciple - any id e fixe (beyond that of a right spiritual orientation) can be a deterrent to progress, if fanatically motivated. DINA1 583.


Obsession and insanity are very closely allied. LOM 126.


Those in which the mind is unduly fixed and static and controls the brain so unreasonably that there seems only one point of view, one attitude to life, and no fluidity and capability of adjustment. Such individuals may suffer, for instance, from what is called id e fixe, or they may be completely the victim of some obsessing mental thought. EH 317.


The tendency to crystallize, to harden, or to have an "id e fixe." In this connection, it will usually be discovered that the man who succumbs to an "id e fixe" has not only a fifth ray mental body but either a sixth ray personality or a sixth ray emotional body. EP2 293.


Obsessive-Compulsive Disorder:

People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness.


Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive


The essential feature of this disorder is recurrent obsessional thoughts or compulsive acts. (For brevity, "obsessional" will be used subsequently in place of "obsessive-compulsive" when referring to symptoms.) Obsessional thoughts are ideas, images or impulses that enter the individual's mind again and again in a stereotyped form. They are almost invariably distressing (because they are violent or obscene, or simply because they are perceived as senseless) and the sufferer often tries, unsuccessfully, to resist them. They are, however, recognized as the individual's own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks.


The individual often views them as preventing some objectively unlikely event, often involving harm to or caused by himself or herself. Usually, though not invariably, this behaviour is recognized by the individual as pointless or ineffectual and repeated attempts are made to resist it; in very long-standing cases, resistance may be minimal. Autonomic anxiety symptoms are often present, but distressing feelings of internal or psychic tension without obvious autonomic arousal are also common. There is a close relationship between obsessional symptoms, particularly obsessional thoughts, and depression. Individuals with obsessive-compulsive disorder often have depressive symptoms, and patients suffering from recurrent depressive disorder may develop obsessional thoughts during their episodes of depression. In either situation, increases or decreases in the severity of the depressive symptoms are generally accompanied by parallel changes in the severity of the obsessional symptoms.


Obsessive-compulsive disorder is equally common in men and women, and there are often prominent anankastic features in the underlying personality. Onset is usually in childhood or early adult life. The course is variable and more likely to be chronic in the absence of significant depressive symptoms.


Diagnostic Guidelines:

For a definite diagnosis, obsessional symptoms or compulsive acts, or both, must be present on most days for at least 2 successive weeks and be a source of distress or interference with activities. The obsessional symptoms should have the following characteristics:


(a) they must be recognized as the individual's own thoughts or impulses:

(b) there must be at least one thought or act that is still resisted unsuccessfully, even though others may be present which the sufferer no longer resists;

(c) the thought of carrying out the act must not in itself be pleasurable (simple relief of tension or anxiety is not regarded as pleasure in this sense);

(d) the thoughts, images, or impulses must be unpleasantly repetitive.



Tourette Syndrome And Other Tic Disorders (TS): 

first described by Gilles de la Tourette, can be the most debilitating tic disorder, and is characterized by multiform, frequently changing motor and phonic tics. The prevailing diagnostic criteria include onset before the age of 21; recurrent, involuntary, rapid, purposeless motor movements affecting multiple muscle groups; one or more vocal tics; variations in the intensity of the symptoms over weeks to months (waxing and waning); and a duration of more than one year.


While the criteria appear basically valid, they are not absolute. First, there have been rare cases of TS which have emerged later than age 21. Second, the concept of "involuntary" may be hard to define operationally, since some patients experience their tics as having a volitional component - a capitulation to an internal urge for motor discharge accompanied by psychological tension and anxiety. Finally, the diagnostic criteria do not adequately portray the full range of behavioral difficulties that are commonly observed in TS patients, such as attentional problems, compulsions, and obsessions.



The varied symptoms of TS can be divided into motor, vocal, and behavioral manifestations (Table 1). Simple motor tics are fast, darting, meaningless muscular events . They can be embarrassing or even painful (such as jaw snapping). They are easily distinguished from simple muscular twitches or rapid fasciculations, e.g., of the eyelid or lip. Complex motor tics often are slower, more purposeful in appearance, and more easily described with terms used for deliberate actions (Table 2). Complex motor tics can be virtually any type of movement that the body can produce including gyrating, hopping, clapping, tensing arm or neck muscles, touching people or things, and obscene gesturing.


At some point in the continuum of complex motor tics, the term "compulsion" seems appropriate for capturing the organized, ritualistic character of the actions. The need to do and then redo or undo the same action a certain number of times (e.g., to stretch out an arm ten times before writing, to even up, or to stand up and push a chair into "just the right position") is compulsive in quality and accompanied by considerable internal discomfort. Complex motor tics may greatly impair school work, e.g., when a child must stab at a workbook with a pencil or must go over the same letter so many times that the paper is worn thin. Self-destructive behaviors, such as head banging, eye poking, and lip biting, also may occur.


Vocal tics extend over a similar spectrum of complexity and disruption as motor tics (Table 3). With simple vocal tics, patients emit linguistically meaningless sounds or noises, such as hissing, coughing, or barking. Complex vocal tics involve linguistically meaningful words, phrases, or sentences, e.g., "wow," "Oh boy, now you've said it," "Yup, that's it," "but, but...." Vocal symptoms may interfere with the smooth flow of speech and resemble a stammer, stutter, or other speech irregularities. Often, but not always, vocal symptoms occur at points of linguistic transition, such as at the beginning of a sentence where there may be blocking or difficulties in the initiation of speech, or at phrase transitions. Patients suddenly may alter speech volume, slur a phrase, emphasize a word, or assume an accent.


The most socially distressing complex vocal symptom is coprolalia, the explosive utterance of foul or "dirty" words or more elaborate sexual and aggressive statements. While coprolalia occurs in only a minority of TS patients (from 5-40%, depending on the clinical series), it remains the most well known symptom of TS. It should be emphasized that a diagnosis of TS does not require that coprolalia is present.


Some TS patients may have a tendency to imitate what they have just seen (echopraxia), heard (echolalia), or said (palilalia). For example, the patient may feel an impulse to imitate another's body movements, to speak with an odd inflection, or to accent a syllable just the way it has been pronounced by another person. Such modeling or repetition may lead to the onset of new specific symptoms that will wax and wane in the same way as other TS symptoms.


Simple motor tics:

Eye blinking, grimacing, nose twitching, lip pouting, shoulder shrugging, arm jerking, head jerking, abdominal tensing, kicking, finger movements, jaw snapping, tooth clicking, frowning, tensing parts of the body, and rapid jerking of any part of the body.


Complex motor tics:

Hopping, clapping, touching objects (or others or self), throwing, arranging, gyrating, bending, "dystonic" postures, biting the mouth, the lip, or the arm, headbanging, arm thrusting, striking out, picking scabs, writhing movements, rolling eyes upwards or side-to-side, making funny expressions, sticking out the tongue, kissing, pinching, writing over-and-over the same letter or word, pulling back on a pencil while writing, and tearing paper or books.



"Giving the finger" and other obscene gestures.



Imitating gestures or movements of other people.


The symptoms of TS can be characterized as mild, moderate, or severe by their frequency, their complexity, and the degree to which they cause impairment or disruption of the patient's ongoing activities and daily life. For example, extremely frequent tics that occur 20-30 times a minute, such as blinking, nodding, or arm flexion, may be less disruptive than an infrequent tic that occurs several times an hour, such as loud barking, coprolalic utterances, or touching tics.


There may be tremendous variability over short and long periods of time in symptomatology, frequency, and severity. Patients may be able to inhibit or not feel a great need to emit their symptoms while at school or work. When they arrive home, however, the tics may erupt with violence and remain at a distressing level throughout the remainder of the day.


It is not unusual for patients to "lose" their tics as they enter the doctor's office. Parents may plead with a child to "show the doctor what you do at home," only to be told that the youngster "just doesn't feel like doing them" or "can't do them" on command. Adults will say "I only wish you could see me outside of your office," and family members will heartily agree.


A patient with minimal symptoms may display more usual severe tics when the examination is over. Thus, for example, the doctor often sees a nearly symptom-free patient leave the office who begins to hop, flail, or bark as soon as the street or even the bathroom is reached.


In addition to the moment-to-moment or short-term changes in symptom intensity, many patients have oscillations in severity over the course of weeks and months. The waxing and waning of severity may be triggered by changes in the patient's life; for example, around the time of holidays, children may develop exacerbations that take weeks to subside. Other patients report that their symptoms show seasonal fluctuation. However, there are no rigorous data on whether life events, stresses, or seasons, in fact, do influence the onset or offset of a period of exacerbation. Once a patient enters a phase of waxing symptomatology, a process seems to be triggered that will run its course - usually within 1-3 months.


In its most severe forms, patients may have uncountable motor and vocal tics during all their waking hours with paroxysms of full-body movements, shouting, or self-mutilation. Despite that, many patients with severe tics achieve adequate social adjustment in adult life, although usually with considerable emotional pain. The factors that appear to be of importance with regard to social adaptation include the seriousness of attentional problems, intelligence, the degree of family acceptance and support, and ego strength more than the severity of motor and vocal tics.


In adolescence and early adulthood, TS patients frequently come to feel that their social isolation, vocational and academic failure, and painful and disfiguring symptoms are more than they can bear. At times, a small number may consider and attempt suicide. Conversely, some patients with the most bizarre and disruptive symptomatology may achieve excellent social, academic, and vocational adjustments.


Associated Behaviors and Cognitive Difficulties:


As well as tics, there are a variety of behavioral and psychological difficulties that are experienced by many, though not all, patients with TS. Those behavioral features have placed TS on the border between neurology and psychiatry, and require an understanding of both disciplines to comprehend the complex problems faced by many TS patients.


The most frequently reported behavioral problems are attentional deficits, obsessions, compulsions, impulsivity, irritability, aggressivity, immaturity, self-injurious behaviors, and depression. Some of the behaviors (e.g., obsessive compulsive behavior) may be an integral part of TS, while others may be more common in TS patients because of certain biological vulnerabilities (e.g., ADHD). Still others may represent responses to the social stresses associated with a multiple tic disorder or a combination of biological and psychological reactions.


Obsessions and Compulsions:


Although TS may present itself purely as a disorder of multiple motor and vocal tics, many TS patients also have obsessive-compulsive (OC) symptoms that may be as disruptive to their lives as the tics - sometimes even more so. There is recent evidence that obsessive-compulsive symptomatology may actually be another expression of the TS gene and, therefore, an integral part of the disorder. Whether this is true or not, it has been well documented that a high percentage of TS patients have OC symptoms, that those symptoms tend to appear somewhat later than the tics, and that they may be seriously impairing.


The nature of OC symptoms in TS patients is quite variable. Conventionally, obsessions are defined as thoughts, images, or impulses that intrude on consciousness, are involuntary and distressful, and while perceived as silly or excessive, cannot be abolished. Compulsions consist of the actual behaviors carried out in response to the obsessions or in an effort to ward them off. Typical OC behaviors include rituals of counting, checking things over and over, and washing or cleaning excessively. While many TS patients do have such behaviors, there are other symptoms typical of TS patients that seem to straddle the border between tics and OC symptoms. Examples are the need to "even things up," to touch things a certain number of times, to perform tasks over and over until they "feel right," as well as self-injurious behaviors.


Attention Deficit Hyperactivity Disorder (ADHD):


Up to 50% of all children with TS who come to the attention of a physician also have attention deficit hyperactivity disorder (ADHD), which is manifested by problems with attention span, concentration, distractibility, impulsivity, and motoric hyperactivity. Attentional problems often precede the onset of TS symptoms and may worsen as the tics develop. The increasing difficulty with attention may reflect an underlying biological dysfunction involving inhibition and may be exacerbated by the strain of attending to the outer world while working hard to remain quiet and still. Attentional problems and hyperactivity can profoundly affect school achievement. At least 30-40% of TS children have serious school performance handicaps that require special intervention, and children with both TS and ADHD are especially vulnerable to serious, long term educational impairment.


Attention deficits may persist into adulthood and together with compulsions and obsessions can seriously impair job performance.


Emotional Lability, Impulsivity, and Aggressivity:


Some TS patients (percentages vary greatly in different studies) have significant problems with labile emotions, impulsivity, and aggression directed to others. Temper fits that include screaming, punching holes in walls, threatening others, hitting, biting, and kicking are common in such patients. Often they will be the patients who also have ADHD, which makes impulse control a considerable problem. At times the temper outbursts can be seen as reactions to the internal and external pressures of TS. A specific etiology for such behavioral problems is, however, not well understood. Nevertheless, they create much consternation in teachers and great anguish both to TS patients themselves and to their families. The treating physician or counselor is often asked whether those behaviors are involuntary, as tics are, or whether they can be controlled. Rather than trying to make such a distinction, it is perhaps more helpful to think of such patients as having a "thin barrier" between aggressive thoughts and the expression of those thoughts through actions. Those patients may experience themselves as being out of control, a concept that is as frightening to themselves as it is to others.


Management of those behaviors is often difficult and may involve adjustment of medications, individual therapy, family therapy, or behavioral retraining. The intensity of those behaviors often increases as the tics wax and decreases as the tics wane.

Jeremy Condick.

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