Billie Eilish isn’t one to shy away from sharing her personal struggles with the public. The “Happier Than Ever” singer has opened up about issues with her mental health and body image, and now she’s opening up about Tourette’s syndrome — a diagnosis characterized by sudden, repetitive, rapid, and sudden movements or vocal sounds. side effects called tics, depending on the National Institute of Neurological Disorders and Stroke.

In an interview with David Letterman for his Netflix series “My next guest needs no introduction“, Eilish shared how she navigates the neurological problem while being in the public eye.

“The most common way people react [to seeing my tics] are they laughing, because they think I’m trying to be funny, and I’m still incredibly offended by that,” Eilish said. (According to the Cleveland Clinictics cannot be controlled or prevented, as they are “involuntary”.)

Eilish, who was diagnosed with Tourette syndrome at age 11, told Letterman that her tics include arm curl, jaw snapping, eyebrow raising, eye rolling back and forth, movement of the ears, etc.

“These are things that you will never notice as if you were just having a conversation with me, but for me they are very exhausting.” On 200,000 people in the United States live with “a severe form of Tourette’s disease“, according to the Cleveland Clinic. Many agree that exhaustion is a very common problem live.

Eilish said her tics started small when she was a child – quickly closing her eyes or opening her mouth wide. When Letterman asked her if she knew what caused it, Eilish responded by saying, “I have no idea, the tics are so weird.”

According to Mayo Clinic, the cause of Tourette syndrome is unknown. “This is a complex disorder likely caused by a combination of hereditary (genetic) and environmental factors,” the Mayo Clinic states, although “chemicals in the brain that transmit nerve impulses (neurotransmitters), including including dopamine and serotonin, may play a role”.

In her interview with Letterman, the 20-year-old said acting on stage seemed to help her tics: “When I move, I don’t even have tics at all.”

In 2018, Eilish publicly revealed for the first time that she has Tourette syndrome. The announcement came after compilation videos of her tics were uploaded to YouTube. In an Instagram story, she addressed the videos: “I’ve never talked about it on the internet because no one thinks I’m a jerk, as well as the fact that I never wanted people to think of Tourettes at every time they think of me.”

Eilish told Letterman that the disorder is still very confusing to her, but she loves talking about it. “I really like answering questions about it, because it’s very, very interesting,” she said.

If you think you might be living with undiagnosed Tourette syndrome, talk to a healthcare professional about your symptoms. If you are looking for more resources for living with Tourette syndrome, you can check out Tourette Association of America.