Tourette syndrome involves multilevel dysfunction linking internal states to motor output via negative reinforcement

BackgroundTourette syndrome (TS) has traditionally been conceptualized as a movement disorder characterized by involuntary motor and vocal tics. However, growing evidence suggests that tic generation involves complex interactions between neural, physiological, and psychological processes, particularly the role of premonitory urges (PU).ObjectiveThis paper aims to develop an integrative model of tic generation by synthesizing recent evidence across neurobiological, neurophysiological, and psychological domains.MethodsA narrative review of PubMed-indexed literature (2020–2026) was conducted, complemented by landmark earlier studies. Evidence was selected and synthesized to explore the relationships between cortico–striato–thalamo–cortical dysfunction, motor inhibition, interoception, and reinforcement mechanisms.ResultsFindings indicate that TS is associated with multilevel dysfunction, including impaired inhibitory control, altered cortical excitability, and abnormal interoceptive processing. Premonitory urges emerge as central drivers of tic behavior, linking internal states to motor output. Tic execution produces temporary relief, reinforcing behavior through negative reinforcement mechanisms. These processes form a dynamic urge–action–relief loop, further shaped by perception–action coupling and neural noise.ConclusionsTS can be conceptualized as a disorder of action regulation, in which tics arise from the interaction between dysfunctional neural systems, abnormal interoceptive signals, and reinforcement-based learning processes. The proposed model provides a unified and testable framework for understanding tic generation and has potential implications for clinical intervention targeting the functional relationship between urges and behavior.