Transsexualism
The essential features of this disorder are a persistent discomfort and sense of
inappropriateness about one's assigned sex in a person who has reached
puberty. In addition, there is persistent preoccupation, for at least two years, with
getting rid of one's primary and secondary sex characteristics and acquiring the
sex characteristics of the other sex. Therefore, the diagnosis is not made if the
disturbance is limited to brief periods of stress. Invariably there is the wish to live
as a member of the other sex. In the rare cases in which physical intersexuality or
a genetic abnormality is present.
People with this disorder usually complain that they are uncomfortable
wearing the clothes of their assigned sex and therefore dress in clothes of the
other sex. Often they engage in activities that in our culture tend to be associated
with the other sex. These people often find their genitals repugnant, which may
lead to persistent requests for sex reassignment by hormonal and surgical
means.
To varying degrees, the behavior, dress, and mannerisms become those of
the other sex. With cross-dressing and hormonal treatment (and for males,
electrolysis), some males and some females with the disorder will appear
relatively indistinguishable from members of the other sex. However, even after
sex reassignment, many people still have some physical features of their
originally assigned sex that the alert observer can recognize.
Cross-culturally, the Hijra of India and the corresponding group in Burma may
have conditions that, according to this manual, would be diagnosed as
male-to-female Transsexualism. The Hijra, however, traditionally undergo
castration, not hormonal and surgical feminization (creation of a vagina).
Associated features. Generally there is a moderate to severe coexisting
personaIity disturbance. Frequently the person experiences considerable anxiety
and depression, which he or she may attribute to the inability to live in the role of
the desired sex.
Course. Without treatment, the course of the disorder is chronic, but cases
with apparently spontaneous remission do occur. The long-term outcome of
combined psychiatric, hormonal, and surgical sex-reassignment treatment is not
well known. Many people function better for years after such treatment, but a
number of cases in which re-reassignment has been desired have also been
reported.
People who have female-to-male Transsexualism appear to represent a more
homogeneous group than those who have male-to-female Transsexualism in that
they are more likely to have a history of homosexuality and a more stable course,
with or without treatment.
Age at onset. People who develop Transsexualism almost invariably report
having had a gender identity problem in childhood Some assert that they were
secretly aware of their gender problem, but that it was not evident to their family
and friends. Although onset of the full syndrome is most often in late adolescence
or early adult life, in some cases the disorder has a later onset.
Impairment and complications. Frequently, social and occupational
functioning are markedly impaired, partly because of associated psychopathology
and partly because of problems encountered in attempting to live in the desired
gender role. Depression is common, and can lead to suicide attempts. ln rare
instances, males may mutilate their genitals.
Predisposing factors. Extensive, pervasive childhood femininity in a boy or
childhood masculinity in a girl increases the likelihood of Transsexualism. It
seems usually to develop within the context of a disturbed relationship with one or
both parents. Some cases of Gender ldentity Disorder of Adolescence or
Adulthood, Nontranssexual Type, evolve into Transsexualism.
Prevalence. The estimated prevalence is one per 30,000 for males and one
per 100,000 for females.
Sex ratio. Males seek help at clinics specializing in the treatment of this
disorder more commonly than do females. The ratio varies from as high as 8.1 to
as low as 1:1.
Familial pattern. No information.
Differential diagnosis. Some people with disturbed gender identity may, in
isolated periods of stress, wish to belong to the other sex and to be rid of their
own genitals ln such cases a diagnosis of Gender Identity Disorder Not
Otherwise Specified should be considered, since the diagnosis of
Transsexualism is made only when the disturbance has been continuous for at
least two years. In Schizophrenia there may be delusions of belonging to the
other sex, but this is rare. The Insistence by a person with Transsexualism that
he or she is of the other sex is, strictly speaking, not a delusion, since what is
invariably meant is that the person feels like a member of the other sex rather
than truly believes that he or she is a member of the other sex. ln very rare cases
however, Schizophrenia and Transsexualism may coexist.
In both Transvestic Fetishism and Gender Identity Disorder of Adolescence
or Adulthood, Nontranssexual Type, there may be cross-dressing. But unless
these disorders evolve into Transsexualism, there is no wish to be rid of one's
own genitals.
Types. The disorder is subdivided according to the history of sexual
orientation, as asexual, homosexual (toward same sex), heterosexual (toward
opposite sex), or unspecified. In the first, "asexual," the person reports never
having had strong sexual feelings. Often there is an additional history of little or
no sexual activity or pleasure derived from the genitals. In the second group,
"homosexual," a predominantly homosexual arousal pattern preceding the onset
of the Transsexualism is acknowledged, although often such people deny that the
orientation is homosexual because of their conviction that they are "really" of the
other sex. ln the third group, "heterosexual," the person claims to have had a
heterosexual orientation.
A. Persistent discomfort and sense of inappropriateness about one's
assigned sex.
B. Persistent preoccupation for at least two years with getting rid of one's
primary and secondary sex characteristics and acquiring the sex
characteristics of the other sex.
C. The person has reached puberty.
Specify history of sexual orientation; asexual, homosexual, heterosexual,
or Unspecified.
Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual
Type (GIDAANT)
The essential features of this disorder are a persistent or recurrent discomfort
and sense of inappropriateness about one's assigned sex, and persistent or
recurrent cross-dressing in the role of the other sex, either in fantasy or in
actuality, in a person who has reached puberty. This disorder differs from
Transvestic Fetishism in that the cross-dressing is not for the purpose of sexual
excitement; it differs from Transsexualism in that there is no persistent
preoccupation (for at least two years) with getting rid of one's primary and
secondary sex characteristics and acquiring the sex characteristics of the other
sex.
Some people with this disorder once had I transvestic Fetishism, but no
longer experience sexual arousal with cross dressing. Other people with this
disorder are homosexuals who cross-dress. This disorder is common among
female impersonators.
Cross-dressing phenomena range from occasional solitary wearing of female
clothes to extensive feminine identification in males and masculine identification
in females, and involvement in a transvestic subculture. More than one article of
clothing of the other sex is involved, and the person may dress entirely as a
member of the opposite sex. The degree to which the cross-dressed person
appears as a member of the other sex varies, depending on mannerisms, body
habitues, and cross-dressing skill. When not cross-dressed, the person usually
appears as an unremarkable member of his or her assigned sex.
Associated features. Anxiety and depression are common, but are often
attenuated when the person is cross-dressing.
Age at onset and course. Age at onset and course are variable In most
cases, before puberty there was a history of some or all of the features of Gender
Identity Disorder of Childhood. However, by definition, GIDAANT is diagnosed
only once puberty has been reached. The initial experience may involve partial or
total cross-dressing; when it is partial, it often progresses to total. Cross-dressing,
although intermittent in the beginning, often becomes more frequent, and may
become habitual. A small number of people with GlDAANT, as the years pass,
want to dress and live permanently as the other sex, and the disorder may evolve
into Transsexualism.
Impairment. Unless there is another diagnosis in addition to GIDAANT, the
impairment is generally restricted to conflicts with family members and other
people regarding the cross-dressing.
Complications. The major complication is Transsexualism.
Predisposing factors. As noted above, both Gender Identity Disorder of
Childhood and Transvestic Fetishism sometimes evolve into GIDAANT
Prevalence. Although its prevalence is unknown, the disorder is probably
more common than Transsexualism.
Sex ratio. The disorder is more common in males.
Familial pattern No information.
Differential diagnosis. In Transvestic Fetishism, the cross-dressing is for
the purpose of sexual excitement. In Transsexualism, there is a persistent (for
more than two years) wish to get rid of one's primary and secondary sex
characteristics and acquire the sex characteristics of the other sex. In those rare
instances in which a person with GIDAANT develops Transsexualism, the
diagnosis of GIDAANT is changed accordingly.
Subtypes. The disorder is subdivided according to the history of sexual
orientation, as asexual, homosexual (toward same sex), heterosexual (toward
opposite sex) or unspecified. In the first, "asexual," the person reports never
having had strong sexual feelings. Often there is an additional history of little or
no sexual activity or pleasure derived from the genitals. In the second group,
homosexuaI," a predominantly homosexual arousal pattern preceding the onset of
the GIDAANT is acknowledged. In the third group, "heterosexual," the person
claims to have had a heterosexual orientation.
(Diagnostic Criteria for Gender Identity Disorder of Adolescence, Nontranssexual
Type)
A. Persistent or recurrent discomfort and sense of inappropriateness about
one's assigned sex.
B. Persistent or recurrent cross-dressing in the role of the other sex, either in
fantasy or actuality, but not for the purpose of sexual excitement (as in
Transvestic Fetishism).
C. No persistent preoccupation (for at least two years) with getting rid of one's
primary and secondary sex characteristics and acquiring the sex
characteristics of the other sex (as in Transsexualism).
D. The person has reached puberty.
Specify history of sexual orientation: asexual, homosexual1 heterosexual,
or Unspecified.
Gender Identity Disorder Not Otherwise Specified
Disorders in gender identity that are not classifiable as a specific Gender identity
Disorder.
Examples:
(1) children with persistent cross-dressing without the other criteria for
Gender identity Disorder of Childhood
(2) adults with transient, stress related cross dressing behavior
(3) adults with the clinical features of Transsexualism of less than two years'
duration
(4) people who have a persistent preoccupation with castration or peotomy
with-out a desire to acquire the sex characteristics of the other sex
TIC DISORDERS
Tics are the essential feature of the three disorders in this subclass; Tourette's
Disorder, Chronic Motor or Vocal Tic Disorder, and Transient Tic Disorder. There
is evidence from genetic and other studies that Tourette's Disorder and Chronic
Motor or Vocal Tic Disorder represent different symptomatic expressions of the
same underlying disorder. However, they are included in this manual as separate
disorders because they generally involve different degrees of impairment (the
former being more disabling) and they have different treatment implications.
A tic is an involuntary, sudden, rapid, recurrent, nonrhythmic, stereotyped
motor movement or vocalization. It is experienced as irresistible, but can be
suppressed for varying lengths of time. All forms of tics are often exacerbated by
stress and usually are markedly diminished during sleep. They may become
attenuated during some absorbing activities, such as reading or sewing.
Both motor and vocal tics may be classified as either simple or complex,
although the boundaries are not well defined. Common simple motor tics are
eye-blinking, neckjerking, shoulder-shrugging, and facial grimacing. Common
simple vocal tics are coughing, throat-clearing, grunting, sniffing, snorting, and
barking. Common complex motor tics are facial gestures, grooming behaviors,
hitting or biting self jumping, touching, stamping, and smelling an object. Common
complex vocal tics are repeating words or phrases out of context, coprolalia (use
of socially unacceptable words, frequently obscene), palilalia (repeating one's
own sounds or words), and echolalia (repeating the last-heard sound, word, or
phrase of another person, or a last-heard sound). Other complex tics include
echokinesis (imitation of the movements of someone who Is being
observed).
Associated features. Discomfort in social situations, shame,
self-consciousness, and depressed mood are common, especially with Tourette's
Disorder.
Predisposing factors. A controversy exists as to whether or not the onset of
some cases of Tic Disorders is precipitated by exposure to phenothiazines, head
trauma, or the administration of central nervous system stimulants. It is estimated
that in one-third of cases of Tourette's Disorder, the severity of the tics is
exacerbated by administration of central nervous system stimulants, which may
be a dose-related phenomenon.
Impairment. Social, academic, and occupational functioning may be impaired
because of rejection by others or anxiety about having tics in social situations. In
addition, in severe cases of Tourette's Disorder, the tics themselves may interfere
with daily activities, such as reading or writing. Although most people with
Tourette's Disorder do not have marked impairment, in general the impairment is
more severe than in Chronic Motor or Vocal Tic Disorder. Impairment in Transient
Tic Disorder rarely is marked.
Differential diagnosis of tics. Tics should be distinguished from other
movement disturbances. Choreiform movements are dancing, random, irregular,
nonrepetitive movements. Dystonic movements are slower, twisting movements
interspersed with prolonged states of muscular tension. Athetoid movements are
slow, irregular, writhing movements, most frequently in the fingers and toes, but
often involving the face and neck. Myoclonic movements are brief, shocklike
muscle contractions that may affect parts of muscles or muscle groups, but not
synergistically. Hemiballismic movements are intermittent, coarse, large
amplitude, unilateral movements of the limbs. Spasms are stereotypic, slower,
and more prolonged than tics, and involve groups of muscles. Hemifacial spasm
consists of irregular, repetitive, unilateral jerks of facial muscles. Synkinesis
consists of movements of the corner of the mouth when the person intends to
close the eye, and its converse. Dyskinesas, such as tardive dyskinesia, are
oral-buccal-lingual masticatory movements of the face arid choreoathetoid
movements of the limbs.
Stereotyped movements, such as head-banging, rocking, or repetitive hand
movements, are apparently intentional behaviors and are often rhythmic.
Compulsions, as in Obsessive Compulsive Disorder, are differentiated from tics in
that they are intentional behaviors, whereas tics are involuntary.
Page 13
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The essential features of this disorder are a persistent discomfort and sense of inappropriateness about one's assigned sex in a person who has reached puberty. In addition, there is persistent preoccupation, for at least two years, with getting rid of one's primary and secondary sex characteristics and acquiring the sex characteristics of the other sex. Therefore, the diagnosis is not made if the disturbance is limited to brief periods of stress. Invariably there is the wish to live as a member of the other sex. In the rare cases in which physical intersexuality or a genetic abnormality is present.
People with this disorder usually complain that they are uncomfortable wearing the clothes of their assigned sex and therefore dress in clothes of the other sex. Often they engage in activities that in our culture tend to be associated with the other sex. These people often find their genitals repugnant, which may lead to persistent requests for sex reassignment by hormonal and surgical means.
To varying degrees, the behavior, dress, and mannerisms become those of the other sex. With cross-dressing and hormonal treatment (and for males, electrolysis), some males and some females with the disorder will appear relatively indistinguishable from members of the other sex. However, even after sex reassignment, many people still have some physical features of their originally assigned sex that the alert observer can recognize.
Cross-culturally, the Hijra of India and the corresponding group in Burma may have conditions that, according to this manual, would be diagnosed as male-to-female Transsexualism. The Hijra, however, traditionally undergo castration, not hormonal and surgical feminization (creation of a vagina).
Associated features. Generally there is a moderate to severe coexisting personaIity disturbance. Frequently the person experiences considerable anxiety and depression, which he or she may attribute to the inability to live in the role of the desired sex.
Course. Without treatment, the course of the disorder is chronic, but cases with apparently spontaneous remission do occur. The long-term outcome of combined psychiatric, hormonal, and surgical sex-reassignment treatment is not well known. Many people function better for years after such treatment, but a number of cases in which re-reassignment has been desired have also been reported.
People who have female-to-male Transsexualism appear to represent a more homogeneous group than those who have male-to-female Transsexualism in that they are more likely to have a history of homosexuality and a more stable course, with or without treatment.
Age at onset. People who develop Transsexualism almost invariably report having had a gender identity problem in childhood Some assert that they were secretly aware of their gender problem, but that it was not evident to their family and friends. Although onset of the full syndrome is most often in late adolescence or early adult life, in some cases the disorder has a later onset.
Impairment and complications. Frequently, social and occupational functioning are markedly impaired, partly because of associated psychopathology and partly because of problems encountered in attempting to live in the desired gender role. Depression is common, and can lead to suicide attempts. ln rare instances, males may mutilate their genitals.
Predisposing factors. Extensive, pervasive childhood femininity in a boy or childhood masculinity in a girl increases the likelihood of Transsexualism. It seems usually to develop within the context of a disturbed relationship with one or both parents. Some cases of Gender ldentity Disorder of Adolescence or Adulthood, Nontranssexual Type, evolve into Transsexualism.
Prevalence. The estimated prevalence is one per 30,000 for males and one per 100,000 for females.
Sex ratio. Males seek help at clinics specializing in the treatment of this disorder more commonly than do females. The ratio varies from as high as 8.1 to as low as 1:1.
Familial pattern. No information.
Differential diagnosis. Some people with disturbed gender identity may, in isolated periods of stress, wish to belong to the other sex and to be rid of their own genitals ln such cases a diagnosis of Gender Identity Disorder Not Otherwise Specified should be considered, since the diagnosis of Transsexualism is made only when the disturbance has been continuous for at least two years. In Schizophrenia there may be delusions of belonging to the other sex, but this is rare. The Insistence by a person with Transsexualism that he or she is of the other sex is, strictly speaking, not a delusion, since what is invariably meant is that the person feels like a member of the other sex rather than truly believes that he or she is a member of the other sex. ln very rare cases however, Schizophrenia and Transsexualism may coexist.
In both Transvestic Fetishism and Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type, there may be cross-dressing. But unless these disorders evolve into Transsexualism, there is no wish to be rid of one's own genitals.
Types. The disorder is subdivided according to the history of sexual orientation, as asexual, homosexual (toward same sex), heterosexual (toward opposite sex), or unspecified. In the first, "asexual," the person reports never having had strong sexual feelings. Often there is an additional history of little or no sexual activity or pleasure derived from the genitals. In the second group, "homosexual," a predominantly homosexual arousal pattern preceding the onset of the Transsexualism is acknowledged, although often such people deny that the orientation is homosexual because of their conviction that they are "really" of the other sex. ln the third group, "heterosexual," the person claims to have had a heterosexual orientation.
A. Persistent discomfort and sense of inappropriateness about one's assigned sex.
B. Persistent preoccupation for at least two years with getting rid of one's primary and secondary sex characteristics and acquiring the sex characteristics of the other sex.
C. The person has reached puberty.
Specify history of sexual orientation; asexual, homosexual, heterosexual, or Unspecified.
Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type (GIDAANT) The essential features of this disorder are a persistent or recurrent discomfort and sense of inappropriateness about one's assigned sex, and persistent or recurrent cross-dressing in the role of the other sex, either in fantasy or in actuality, in a person who has reached puberty. This disorder differs from Transvestic Fetishism in that the cross-dressing is not for the purpose of sexual excitement; it differs from Transsexualism in that there is no persistent preoccupation (for at least two years) with getting rid of one's primary and secondary sex characteristics and acquiring the sex characteristics of the other sex.
Some people with this disorder once had I transvestic Fetishism, but no longer experience sexual arousal with cross dressing. Other people with this disorder are homosexuals who cross-dress. This disorder is common among female impersonators.
Cross-dressing phenomena range from occasional solitary wearing of female clothes to extensive feminine identification in males and masculine identification in females, and involvement in a transvestic subculture. More than one article of clothing of the other sex is involved, and the person may dress entirely as a member of the opposite sex. The degree to which the cross-dressed person appears as a member of the other sex varies, depending on mannerisms, body habitues, and cross-dressing skill. When not cross-dressed, the person usually appears as an unremarkable member of his or her assigned sex.
Associated features. Anxiety and depression are common, but are often attenuated when the person is cross-dressing.
Age at onset and course. Age at onset and course are variable In most cases, before puberty there was a history of some or all of the features of Gender Identity Disorder of Childhood. However, by definition, GIDAANT is diagnosed only once puberty has been reached. The initial experience may involve partial or total cross-dressing; when it is partial, it often progresses to total. Cross-dressing, although intermittent in the beginning, often becomes more frequent, and may become habitual. A small number of people with GlDAANT, as the years pass, want to dress and live permanently as the other sex, and the disorder may evolve into Transsexualism.
Impairment. Unless there is another diagnosis in addition to GIDAANT, the impairment is generally restricted to conflicts with family members and other people regarding the cross-dressing.
Complications. The major complication is Transsexualism.
Predisposing factors. As noted above, both Gender Identity Disorder of Childhood and Transvestic Fetishism sometimes evolve into GIDAANT
Prevalence. Although its prevalence is unknown, the disorder is probably more common than Transsexualism.
Sex ratio. The disorder is more common in males.
Familial pattern No information.
Differential diagnosis. In Transvestic Fetishism, the cross-dressing is for the purpose of sexual excitement. In Transsexualism, there is a persistent (for more than two years) wish to get rid of one's primary and secondary sex characteristics and acquire the sex characteristics of the other sex. In those rare instances in which a person with GIDAANT develops Transsexualism, the diagnosis of GIDAANT is changed accordingly.
Subtypes. The disorder is subdivided according to the history of sexual orientation, as asexual, homosexual (toward same sex), heterosexual (toward opposite sex) or unspecified. In the first, "asexual," the person reports never having had strong sexual feelings. Often there is an additional history of little or no sexual activity or pleasure derived from the genitals. In the second group, homosexuaI," a predominantly homosexual arousal pattern preceding the onset of the GIDAANT is acknowledged. In the third group, "heterosexual," the person claims to have had a heterosexual orientation.
(Diagnostic Criteria for Gender Identity Disorder of Adolescence, Nontranssexual Type)
A. Persistent or recurrent discomfort and sense of inappropriateness about one's assigned sex.
B. Persistent or recurrent cross-dressing in the role of the other sex, either in fantasy or actuality, but not for the purpose of sexual excitement (as in Transvestic Fetishism).
C. No persistent preoccupation (for at least two years) with getting rid of one's primary and secondary sex characteristics and acquiring the sex characteristics of the other sex (as in Transsexualism).
D. The person has reached puberty.
Specify history of sexual orientation: asexual, homosexual1 heterosexual, or Unspecified.
Gender Identity Disorder Not Otherwise Specified
Disorders in gender identity that are not classifiable as a specific Gender identity Disorder.
Examples:
(1) children with persistent cross-dressing without the other criteria for Gender identity Disorder of Childhood
(2) adults with transient, stress related cross dressing behavior
(3) adults with the clinical features of Transsexualism of less than two years' duration
(4) people who have a persistent preoccupation with castration or peotomy with-out a desire to acquire the sex characteristics of the other sex
TIC DISORDERS
Tics are the essential feature of the three disorders in this subclass; Tourette's Disorder, Chronic Motor or Vocal Tic Disorder, and Transient Tic Disorder. There is evidence from genetic and other studies that Tourette's Disorder and Chronic Motor or Vocal Tic Disorder represent different symptomatic expressions of the same underlying disorder. However, they are included in this manual as separate disorders because they generally involve different degrees of impairment (the former being more disabling) and they have different treatment implications.
A tic is an involuntary, sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization. It is experienced as irresistible, but can be suppressed for varying lengths of time. All forms of tics are often exacerbated by stress and usually are markedly diminished during sleep. They may become attenuated during some absorbing activities, such as reading or sewing.
Both motor and vocal tics may be classified as either simple or complex, although the boundaries are not well defined. Common simple motor tics are eye-blinking, neckjerking, shoulder-shrugging, and facial grimacing. Common simple vocal tics are coughing, throat-clearing, grunting, sniffing, snorting, and barking. Common complex motor tics are facial gestures, grooming behaviors, hitting or biting self jumping, touching, stamping, and smelling an object. Common complex vocal tics are repeating words or phrases out of context, coprolalia (use of socially unacceptable words, frequently obscene), palilalia (repeating one's own sounds or words), and echolalia (repeating the last-heard sound, word, or phrase of another person, or a last-heard sound). Other complex tics include echokinesis (imitation of the movements of someone who Is being observed).
Associated features. Discomfort in social situations, shame, self-consciousness, and depressed mood are common, especially with Tourette's Disorder.
Predisposing factors. A controversy exists as to whether or not the onset of some cases of Tic Disorders is precipitated by exposure to phenothiazines, head trauma, or the administration of central nervous system stimulants. It is estimated that in one-third of cases of Tourette's Disorder, the severity of the tics is exacerbated by administration of central nervous system stimulants, which may be a dose-related phenomenon.
Impairment. Social, academic, and occupational functioning may be impaired because of rejection by others or anxiety about having tics in social situations. In addition, in severe cases of Tourette's Disorder, the tics themselves may interfere with daily activities, such as reading or writing. Although most people with Tourette's Disorder do not have marked impairment, in general the impairment is more severe than in Chronic Motor or Vocal Tic Disorder. Impairment in Transient Tic Disorder rarely is marked.
Differential diagnosis of tics. Tics should be distinguished from other movement disturbances. Choreiform movements are dancing, random, irregular, nonrepetitive movements. Dystonic movements are slower, twisting movements interspersed with prolonged states of muscular tension. Athetoid movements are slow, irregular, writhing movements, most frequently in the fingers and toes, but often involving the face and neck. Myoclonic movements are brief, shocklike muscle contractions that may affect parts of muscles or muscle groups, but not synergistically. Hemiballismic movements are intermittent, coarse, large amplitude, unilateral movements of the limbs. Spasms are stereotypic, slower, and more prolonged than tics, and involve groups of muscles. Hemifacial spasm consists of irregular, repetitive, unilateral jerks of facial muscles. Synkinesis consists of movements of the corner of the mouth when the person intends to close the eye, and its converse. Dyskinesas, such as tardive dyskinesia, are oral-buccal-lingual masticatory movements of the face arid choreoathetoid movements of the limbs.
Stereotyped movements, such as head-banging, rocking, or repetitive hand movements, are apparently intentional behaviors and are often rhythmic. Compulsions, as in Obsessive Compulsive Disorder, are differentiated from tics in that they are intentional behaviors, whereas tics are involuntary.