Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette Syndrome

Abstract: The use of philosophical phenomenology for conceptual debates in psychiatric nosology and psychopathology is beginning to be recognized. In this paper, we extend this trajectory to include Tourette syndrome (TS), focusing on so-called premonitory urges (PU) preceding Tourettic tics. We clarify some inconsistencies around typology in both phenomenological description and medical classification (i.e., in the Diagnostic and Statistical Manual of Mental Disorders , 5th edition, Text Revision, International Classification of Diseases , 10th edition [World Health Organization, 2004], and the scales that elicit PU). We show how a less typological approach might be usefully deployed in the field, that being the dimensional approach developed by Fernandez (2019a; 2019b). We test both the typological and dimensional approaches in relation to the experience and etiological role of PU in Tourette syndrome. Based on our synthesis of existing studies and new information garnered through phenomenological interviews (using an approach associated with "micro-phenomenology"), we argue that the role of PU in nosology challenges both the current "operational" criteria favored by the Diagnostic and Statistical Manual of Mental Disorders , 5th edition, Text Revision, that are focused on behaviorally observed symptoms, as well as essential and prototypical phenomenological descriptions about a given "type" of experience.