TY - JOUR
T1 - Self-esteem in adults with Tourette syndrome and chronic tic disorders
T2 - The roles of tic severity, treatment, and comorbidity
AU - Weingarden, Hilary
AU - Scahill, Lawrence
AU - Hoeppner, Susanne
AU - Peterson, Alan L.
AU - Woods, Douglas W.
AU - Walkup, John T.
AU - Piacentini, John
AU - Wilhelm, Sabine
N1 - Funding Information:
This work was supported by the National Institute of Mental Health grants 5R01MH069877 (Dr. Wilhelm), R01MH069874 (Dr. Scahill), and R01MH069875 (Dr. Petersen), with subcontracts to Drs. Piacentini and Woods. Dr. Walkup consulted on this grant. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding agency played no role in design of this study; the collection, analysis, and interpretation of data; the writing of this report; or the decision to submit this article for publication.
Funding Information:
The authors report the following disclosures: Dr. Piacentini receives author royalties from Oxford University Press for the treatment manual used in this study and is an investigator for a Psyadon Pharmaceutical's funded treatment study for youth with Tourette's disorder. Dr. Woods also receives book royalties from Oxford University Press, and he receives speaking fees from the Tourette Association of America. Dr. Wilhelm has received research support in the form of free medication and matching placebo from Forest Laboratories for clinical trials funded by the NIH. Dr. Wilhelm is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier Publications, Guilford Publications, New Harbinger Publications, and Oxford University Press. Dr. Wilhelm has also received speaking honorarium from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation and the Tourette Association of America. In addition, she received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor for the Behavior Therapy journal, as well as from John Wiley & Sons, Inc. for her role as Associate Editor on the journal Depression & Anxiety. Dr. Wilhelm has also received salary support from Novartis and Telefonica Alpha, Inc. Dr. Walkup has past research support for federally funded studies including free drug and placebo from Pfizer's pharmaceuticals in 2007 to support the Child Adolescent Anxiety Multimodal study; free medication from Abbott pharmaceuticals in 2005 for the Treatment of the Early Age Media study; free drug and placebo from Eli Lilly in 2003 for the Treatment of Adolescents with Depression study. He currently receives research support from the Tourette Association of America and the Hartwell Foundation. He also receives royalties from Guilford Press and Oxford Press for multi-author books published about Tourette syndrome. Dr. Weingarden has received salary support from Telefonica Alpha, Inc. Drs. Peterson, Scahill, and Hoeppner report no conflicts of interest.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/7
Y1 - 2018/7
N2 - Background: Tourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings. Method: This study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST). Results: Baseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST. Conclusions: Comorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD.
AB - Background: Tourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings. Method: This study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST). Results: Baseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST. Conclusions: Comorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD.
KW - Chronic tic disorder
KW - Comorbidity
KW - Comprehensive Behavioral Intervention for Tics
KW - Self-esteem
KW - Tourette syndrome
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U2 - 10.1016/j.comppsych.2018.04.008
DO - 10.1016/j.comppsych.2018.04.008
M3 - Article
C2 - 29729555
AN - SCOPUS:85046461033
SN - 0010-440X
VL - 84
SP - 95
EP - 100
JO - Comprehensive Psychiatry
JF - Comprehensive Psychiatry
ER -