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In a large study of psychiatric comorbidity in TS, approximately 800 families were recruited primarily from TS specialty clinics in four different countries over a 16-year period \citep{25671412}. A total of 1374 participants with TS and 1142 family members unaffected by TS were included. 86% of the TS participants had at least one psychiatric comorbidity and 72% had either OCD or ADHD. Other disorders, involving mood, anxiety or disruptive behavior, each occurred in approximately 30% of the TS participants. The genetic correlations between TS and mood were accounted for by ADHD and OCD, while ADHD alone accounted for the genetic correlations of TS with anxiety and disruptive behavior disorders. See also \citep*{Prime:Hirschtritt:2015}.  A study of 400 patients seen at a TS specialty clinic found that 39% had coprolalia and 20% had copropraxia \citep{26089672}. When the 222 patients with full comorbidity data were examined, only 13.5% had "pure" TS (i.e., without comorbidities). None of the "pure" TS group had coprolalia and none had a family history of obsessive-compulsive disorder. In contrast, 39% of the group with comorbidities exhibited coprolalia. These researchers also found findings support previous findings  that individuals people  with complex tics were significantly more likely "pure" TS are substantially different from those who have comorbidities in addition  to report premonitory urges than individuals with simple tics. TS.  Emotional regulation difficulties were described in three studies reminding us that TS patients often report that tics are the least of their problems. An experienced clinician clinician,  who has done research on "rage attacks" in TS TS,  has provided a clinically useful summary of current knowledge regarding aggressive symptoms in TS, OCD, ADHD and mood disorders and described treatment options  \citep{Budman_2015}. In another study, greater irritability was seen in TS adults with more severe tics and those with comorbid ADHD \citep{25716486}. \citep{26144583} found that both male and female TS subjects had significantly higher scores for personal distress and rated their abilities to take other people's perspectives lower than the control subjects did. Given that emotional regulation difficulties are frequently associated with greater tic severity, improving emotional modulation skills may also be an appropriate target of psychological interventions.  More research is also being conducted on personality differences associated with TS. A small study of 17 male adolescents \citep{26078419} found that the only difference between the TS subjects and 51 age- and gender-matched controls on the Minnesota Multiphasic Personality Inventory-Adolescent was that the TS subjects scored significantly higher on the Obsessiveness Content Scale. In contrast a study of 50 TS adults in Germany used a variety of instruments to measure psychological symptoms and personality traits \citep{26112450}. Comorbidities were common with 41% having OCD, 28% being depressed and 26% having ADHD. Patients with OCD had more severe tics and there was a trend for those with ADHD to have more severe tics. Only 29% of the patients had no pathological personality traits. The demand-anxious trait was the most common personality trait (measured with the Inventory of Clinical Personality Accentuations) seen in patients and was present in 39% while histrionic personality traits were not found in any of these patients. Personality traits in patients with "pure" TS were comparable to those of the control group. Interestingly, ADHD did not contribute to increased probability of pathological personality traits. Although quality of life was affected by both personality traits and comorbidities, personality traits had a larger impact on quality of life. These two studies  ### Course