Lift Your Eyes

Anxiety in Antwerp

Photo by the Author, taken in Antwerp

Pulling my suitcase over the cobblestone streets of Antwerp toward the train station, I felt like every bump was a jarring reminder of the chaos in my own life. I should have been enjoying this vacation with a friend, but instead I kept replaying every worry and unsettling change happening at home. What made it worse was that many of these stresses were actually good things — so I piled on guilt for not being happier.

I had just married the love of my life (yay!) and finally had the chance to live outside the United States. Since my husband is Canadian, we decided to move there (double yay!). But with that came worries about selling my home, navigating the permanent resident visa process, tax implications on rental properties, and more. It all felt out of my control.

As the more seasoned traveler, I led the way to Antwerpen Centraal Station (with GPS in hand) but made a wrong turn. Realistically, it was a minor inconvenience for my friend and me, but layered on top of my swirling thoughts, it felt overwhelming. Tears welled up, and my hands shook as tics jerked at my neck.

It’s Not Tourette’s

Years ago, during a severe bout of anxiety and PTSD symptoms, a psychiatrist told me I had Tourette’s. I disagreed, but he wasn’t convinced. “Well, your brothers must have Tourette’s,” he said. Also no. He had observed my involuntary head movements and twitching foot. At that time, I occasionally experienced verbal tics, usually after prolonged suppression of the motor ones.

A clinical diagnosis of Tourette’s requires at least two motor tics and one vocal tic, with onset before age 18. It has to persist for more than a year, and cause significant social, professional, or functional impairment.

If he had asked, I would have told him I never experienced tics before the age of 24. My first episode lasted several months after a traumatic event, then disappeared for nearly a decade. Now, I have occasional flare-ups every few years, tied to periods of heightened anxiety. Objectively, this does not meet the criteria for Tourette’s.

Functional (Formerly “Psychogenic”) Tics

Wanting answers, I turned to research. At first, Google offered the usual shortcut: “anxiety causes tics.” But tic disorders and anxiety aren’t the same thing, and neurologists are careful not to lump them. In the DSM-5-TR, primary tic disorders like Tourette’s sit in the neurodevelopmental category, with childhood onset. For tic presentations that don’t meet those criteria — including adult-onset tics — there’s a catch-all called Unspecified Tic Disorder (307.20). And for tic-like movements that appear in the context of psychological stress or trauma, there’s a separate category entirely: Functional Neurological Symptom Disorder (conversion disorder), 300.11, in the somatic symptom and related disorders section.

That last category is where the term I eventually landed on lives: functional tics. (You’ll still see them called psychogenic tics in older literature; the field has moved away from that word because it implied the symptoms were imagined rather than neurological, which misses the point — they involve real changes in how the nervous system functions under stress.)

Functional tics describe tic-like movements that arise from emotional distress or trauma rather than the neurodevelopmental origins of Tourette’s. The clinical profile that’s emerged over the last several years looks roughly like this: abrupt onset, typically in adolescence or young adulthood; often no family history of tics; frequently a precipitating event or period of acute psychosocial stress; and high rates of co-occurring anxiety and depression. That profile lined up with mine.

I’ll add the caveat that I am a psychologist writing from my own lived experience, not a patient who’s been formally evaluated by a movement disorder specialist. There are other possibilities — a primary adult-onset tic disorder, for instance, or tics that are simply being exacerbated by anxiety — that I can’t definitively rule out without a proper workup. But of the frameworks I’ve read, functional tics fits the picture best.

(One thing I won’t lean on, which I used to: the idea that functional tics can be distinguished from Tourette’s by the absence of a “premonitory urge” — that tingling or pressure sensation that Tourette’s patients describe before a tic. Recent research has complicated that picture, finding that people with functional tics report premonitory urges at a similar frequency to people with Tourette’s, even if the quality is sometimes less localized. So urge alone isn’t the tell.)

Emotional Regulation

I’m a psychologist, so part of me feels like I should be better at managing emotions. I know the strategies, of course — but in the midst of real-life stress, it’s hard to access them. Still, as I pushed through the crowds in Antwerp, I focused on slowing my breathing, engaging my senses, and practicing acceptance. It helped a little, but honestly, I was still a mess.

Then we turned a corner. I looked up — and there it was. A breathtaking brick building towering against a bright blue sky, with a fluffy white cloud drifting by. I’ve always admired Europe’s architecture, but this moment was different. For just a second, it pulled me out of my head. My racing thoughts paused, and I felt my chest loosen.

Anxiety can shrink our world until it feels like nothing but problems and obstacles. But that building reminded me to lift my eyes — literally and metaphorically — to notice the beauty and wonder that still exist, even in struggle. Stress still needs to be addressed, but I can also make space for awe and gratitude alongside it. That makes life more bearable — and even joyful.

You don’t have to be walking the streets of Belgium to find this. Maybe it’s a flower on your morning walk, sunlight filtering through your window, or a kind word from a friend. My mom even collects heart-shaped rocks on her daily walks. Small moments like these can anchor us, reminding us that even when life feels heavy, there is still light to be found — if we take notice.