Review DEPRESSION AND ANXIETY 27 : 600–610 (2010) TIC DISORDERS: SOME KEY ISSUES FOR DSM-V John T. Walkup, M.D., 1Ã Ygor Ferra˜o, M.D. M.Sc., 2 James F. Leckman, M.D., 3 Dan J. Stein, M.B., 4 and Harvey Singer, M.D. 5 This study provides a focused review of issues that are relevant to the nosology of the tic disorders and presents preliminary recommendations to be considered for DSM-V. The recommended changes are designed to clarify and simplify the diagnostic criteria, reduce the use of the residual category, tic disorder not otherwise specified, and are not intended to alter substantially clinical practice or the continuity of past and future research. Specific recommendations include: (1) a more precise definition of motor and vocal tics; (2) simplification of the duration criterion for the tic disorders; (3) revising the term ‘‘transient tic disorder’’ for those with tic symptoms of less than 12-month duration; (4) establishing new tic disorder categories for those with substance induced tic disorder and tic disorder due to a general medical condition; and (5) including a motor tic only and vocal tic only specifier for the chronic motor or vocal tic disorder category. Depression and Anxiety 27:600–610, 2010. r r 2010 Wiley-Liss, Inc. The tic disorders are childhood onset neuropsychiatric disorders commonly associated with other psychiatric disorders including attention deficit hyperactivity dis- order and obsessive–compulsive disorder. [1] Although the cause of the tic disorders is not known there have been substantial advances in our understanding of the phenomenology, [2] epidemiology, [3] genetics, [4] patho- physiology, [5,6] course, [7] and treatment [8,9] of these disorders since the last version of DSM was published. The tic disorders were first included in DSM-III [10] and there have been three important changes to the criteria in subsequent editions. In DSM-IV [11] the age of onset was changed from before 21 years to before 18 years and an impairment criterion was added and required for diagnosis. In DSM-IV-TR [12] the impair- ment criterion was removed, due to concerns regarding patients who had the cardinal features of Tourette’s disorder (i.e. chronic motor and vocal tics), but who did not experience impairment. [13,14] This review focuses on nosological issues specific to revision of the tic disorder diagnostic categories and criteria for DSM-V in light of the clinical and research knowledge that has accumulated since the publication of DSM-IV. Although our understanding of the epidemiology, genetics, course, and treatment of the tic disorders has improved substantially since DSM-IV, the core phenomenology of the tic disorders as described over a century ago by Gilles de la Tourette is essentially unchanged. [15] Recommendations for changes to the diagnostic criteria are intended to clarify and simplify the diagnostic criteria and are not intended to alter substantially clinical practice or the continuity of past and current research. Published online in Wiley InterScience (www.interscience.wiley. com). DOI 10.1002/da.20711 Received for publication 30 December 2009; Revised 11 April 2010; Accepted 15 April 2010 Ã Correspondence to: John T. Walkup, Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, Box 140, 525 E. 68th Street, New York, NY 10065. E-mail: j.walkup@med.cornell.edu This Article is being co-published by Depression and Anxiety and the American Psychiatric Association. Conflict of Interest Statement: John Walkup is Chair of the Medical Advisory Board of the Tourette Syndrome Association, receives honoraria for talks presented on behalf of the joint CDC- Tourette Syndrome Association educational outreach program. He also receives royalties from Guildford and Oxford Press for books on Tourette syndrome. 1 Department of Psychiatry, Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, New York 2 Department of Psychiatry, University of Sa˜o Paulo Medical School, Sa˜o Paulo, Brazil 3 Yale Child Study Center, New Haven, Connecticut 4 Department of Psychiatry, University of Cape Town, Cape Town, South Africa 5 Department of Neurology, Division of Child Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland r r 2010 Wiley-Liss, Inc.