Vomiting and retching are behaviours that are part of the clinical manifestation of several disorders. Rarely,
vomiting is actually
tic and, when not recognized, may mislead physicians and other caregivers to erroneously diagnose a medical or
psychiatric disorder without considering a
tic-disorder. We report on an 18 year old male patient who demonstrated
vomiting as main symptom. Initially, he was diagnosed with an
eating disorder,
bulimia nervosa purging type (DSM-IV TR). Firstly, he was not very able to suppress his
vomiting, but later the
vomiting became forced by putting fingers in his throat. This self-induced
vomiting had a compulsive component and was performed after almost every meal. Psychiatric assessment disclosed a specific sequence of a premonitory epigastric feeling preceding the
vomiting and relief after
vomiting. History taking revealed that he had a childhood onset of
motor tics (copropraxia which consisted of grabbing his genitalia, bilateral facial grimacing and sudden movements of the head) and phonic
tics (sniffing and gargling). Furthermore, he had been treated with
methylphenidate for a childhood diagnosis of Attention Deficit and Hyperactivity Disorder and suffered from obsessive-compulsive symptoms (OCS). His
vomiting was considered a
tic in the course of a
Tourette syndrome. His score on the Yale Global
Tic Severity Scale dropped from 74 at the first assessment to a score of 50 at week 4 of treatment with
risperidone 0,5 mg/day and sertralin 25 mg/day. Sedation and sexual dysfunction occurred as adverse events.
Vomiting as a
tic is rare clinical manifestation, but this possibility should be considered when patients have a history of
tics.