Is That a Nervous Habit, or Something Else?
Tardive dyskinesia (TD) is a movement disorder that causes involuntary, repetitive movements, most often affecting the face, mouth and limbs. It usually develops after long-term use of certain medications, especially antipsychotic drugs. Because early symptoms can be subtle, TD often goes unnoticed at first. Recognizing the subtle warning signs of tardive dyskinesia early can help prevent symptoms from becoming more severe or permanent.
1. Lip Smacking and Puckering
One of the earliest and most common signs of tardive dyskinesia is unusual mouth movement. This may look like frequent lip smacking, puckering or pursing. The person may appear to be chewing gum when they are not.
What to look for:
- Repeated lip movements without a clear reason.
- Puckering or tightening of the lips.
- Chewing motions when no food is present.
These movements are involuntary, meaning the person is not choosing to do them and often cannot stop them easily.
2. Tongue Movements
The tongue is often affected early in TD. People may stick out their tongue without meaning to or have rapid side-to-side movements inside the mouth.
What to look for:
- Tongue darting in and out.
- Wiggling or rolling of the tongue.
- Trouble keeping the tongue still.
Tongue movements can interfere with speaking clearly, chewing food and swallowing.
3. Facial Grimacing
Another early symptom involves the face. A person may make strange or exaggerated facial expressions without realizing it. These may come and go throughout the day.
What to look for:
- Tightening or twitching of the face.
- Repeated blinking or squinting.
- Grimacing or frowning for no clear reason.
These movements may increase during stress, anxiety or fatigue.
4. Jaw and Chewing Movements
Some people with early TD develop repeated jaw motions, such as clenching or shifting the jaw. These movements can be uncomfortable and sometimes painful.
What to look for:
- Jaw thrusting forward or side to side.
- Teeth grinding or clenching.
- Clicking or popping sensations in the jaw.
Over time, jaw movements can lead to dental issues or jaw soreness.
5. Finger and Hand Movements
Tardive dyskinesia does not only affect the face. Early signs may also include small, repetitive motions in the fingers and hands.
What to look for:
- Finger tapping.
- Writhing or twisting hand movements.
- Movements that resemble playing an invisible piano.
These motions may be mistaken for nervous habits at first.
6. Toe Tapping and Foot Movements
Feet and toes can also be involved in TD. These movements are often subtle early on.
What to look for:
- Repeated toe tapping.
- Rocking the feet back and forth.
- An inability to keep the feet still while sitting.
At first, these motions may seem harmless, but over time they can become more noticeable.
7. Shoulder and Upper Body Movements
In some cases, early TD causes mild rocking, shrugging or twisting of the shoulders and upper body.
What to look for:
- Repeated shoulder shrugging.
- Swaying while sitting.
- Small twisting motions of the upper torso.
These movements may worsen when the person is distracted or under stress.
8. Trouble Speaking or Changes in Voice
Because TD often affects facial and tongue muscles, speech can also be affected early on.
What to look for:
- Slurred words.
- Trouble pronouncing certain sounds.
- A change in voice tone or volume.
These changes may be mild at first but can become more noticeable over time.
Who is at Higher Risk?
While TD can affect anyone taking certain medications, some people have a higher risk, including:
- Adults over age 50.
- Women.
- People who take antipsychotic medications long term.
- Individuals with diabetes or mood disorders.
Even people who have stopped taking the medication may still develop symptoms later.
When to See a Doctor
You should see a doctor right away if you or a loved one notices any repeated, uncontrollable movements of the face, mouth, hands or feet—especially if the person is currently taking or has previously taken antipsychotic medications, anti-nausea drugs or certain antidepressants.
Early medical care is important because:
- Symptoms may become permanent if ignored.
- Medication adjustments may reduce or stop symptoms.
- New treatments are available that can help control TD.
Do not stop taking any prescribed medication without talking to a doctor first. Suddenly stopping certain medicines can cause serious health problems. A healthcare provider can review medications, confirm a diagnosis and discuss treatment options safely.
Keep reading to learn about the signs of drug addiction.