The largely non-specific and/or multiply-determined etiologies of aggressive symptoms in TS pose significant impediments to effective clinical management. At this time, treatment requires comprehensive neuropsychiatric assessment with a systematic prioritization of the different psychiatric co-morbidities that require intervention. Medication side effects, psychosocial stressors and environmental triggers must also be identified and addressed. The future elucidation of meaningful clinical and genetic subtypes of TS will have important consequences for the more specific prevention and treatment of aggressive symptoms.