Clinical Features, Mechanisms, and Management of Anxiety in Youth with Tic Disorders: A Narrative Review.

Tourette syndrome (TS) and related tic disorders (TD) are neurodevelopmental conditions primarily characterized by motor and vocal tics. However, coexistent anxiety has emerged as a pivotal yet under-recognized clinical determinant, at times overshadowing core tic symptomatology. This review delineates distinct anxiety phenotypes in youth with TD that differ from primary anxiety disorders. These specific presentations exert a profound impact on quality of life, adult outcomes, and socio-emotional functioning. By synthesizing recent literature, we highlight shared neurobiological substrates under this comorbidity, specifically focusing on aberrant connectivity within cortico-striato-thalamo-cortical (CSTC) circuits, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and a shared genetic risk basis. Anxiety is not only a secondary symptom, but a component intertwined with the TD neurodevelopmental spectrum. The review advocate for integrated diagnosis and specific therapies to address the interplay between tics and anxiety, providing a clear framework to improve long-term psychosocial outcomes.