Dimensions not types: on the phenomenology of premonitory urges in Tourette Syndrome

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, 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 DSM-5-TR, ICD-10, and the scales that elicit premonitory urges). We show how a less typological approach might be usefully deployed in the field, that being the dimensional approach developed by Fernandez (2019a; Fernandez 2019b). We test both the typological and dimensional approaches in relation to the experience and etiological role of PU in Tourette’s. 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 DSM-5-TR that are focused on behaviorally observed symptoms, as well as essential and prototypical phenomenological descriptions about a given “type” of experience.