Abstract
Functional tic-like behaviours (FTLB) are a female predominant functional neurological disorder that escalated in incidence during the SARS CoV2 pandemic. This study compared social and adaptive functioning, social media use, pandemic experiences, and psychiatric comorbidities between FTLB (n = 35), Tourette Syndrome (TS) (n = 22), and neurotypical (NT) (n = 25) participants ages 11 to 25 years. The psychiatric comorbidity burden for participants with FTLB was formidable, with frequencies ranging from 1.5 to 10 times higher for major depressive disorder and panic disorder compared to TS and NT participants. Borderline personality disorder (BPD), agoraphobia, social anxiety disorder, and generalized anxiety disorder were also significantly more common in FTLB compared to NT participants. Vulnerable attachment scores, social phobia and social interaction anxiety symptoms were higher in participants with FTLB than NT but not TS. Overall distress tolerance, resilient coping, suggestibility, hours on social media, and exposure to tic and TS content were not significantly different between groups. FTLB participants rated their mental health declined more severely during the pandemic than both TS and NT participants and were more likely to experience trouble sleeping, loneliness, and difficulty affording housing and food than NT participants. Participants with FTLB were significantly more likely to identify as gender minority people than TS and NT, though there were no significant differences based on gender identity in the study variables within the FTLB group. The association and potential pathways explaining how psychiatric disorders may be contributing to FTLB, and why certain groups appear at particular risk are discussed.
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Baker, R., Holloway, J., Thomas, P. W., Thomas, S., & Owens, M. (2004). Emotional processing and panic. Behaviour Research and Therapy, 42(11), 1271–1287. https://doi.org/10.1016/j.brat.2003.09.002.
Barsky, A. J., Orav, E. J., & Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry, 62(8), 903–910. https://doi.org/10.1001/archpsyc.62.8.903.
Berg, L., Pringsheim, T. M., & Martino, D. (2022). Sudden onset tic and tic-like presentations in older adolescents and adults. Current Developmental Disorders Reports, 9(4), 146–155. https://doi.org/10.1007/s40474-022-00263-3.
Bifulco, A., Mahon, J., Kwon, J. H., Moran, P. M., & Jacobs, C. (2003). The vulnerable attachment style questionnaire (VASQ): An interview-based measure of attachment styles that predict depressive disorder. Psychological Medicine, 33(6), 1099–1110. https://doi.org/10.1017/s0033291703008237.
Bowman, S. J., Hakeem, A., Demant, D., Mcaloon, J., & Wootton, B. M. (2022). Assessing gender dysphoria: Development and validation of the gender preoccupation and stability questionnaire – 2nd edition (GPSQ-2). Journal of Homosexuality, 1–25. https://doi.org/10.1080/00918369.2022.2132440.
Busch, F. N. (2014). Clinical approaches to somatization. Journal of Clinical Psychology, 70(5), 419–427. https://doi.org/10.1002/jclp.22086.
Buts, S., Duncan, M., Owen, T., Martino, D., Pringsheim, T., Byrne, S., McWilliams, A., Murphy, T., Malik, O., Liang, H., Heyman, I., & Hedderly, T. (2022). Paediatric tic-like presentations during the COVID-19 pandemic. Archives of Disease in Childhood, 107(3), e17–d.
CAMH COVID Health Tracker. Center for Addiction and CAMH, & Health, M. (2021). https://www.camh.ca/en/health-info/mental-health-and-covid-19/covid-19-national-survey.
Cavanna, A. E., Purpura, G., Riva, A., Nacinovich, R., & Seri, S. (2023). New-onset functional tics during the COVID-19 pandemic: Clinical characteristics of 105 cases from a single centre. European Journal of Neurology, 30(8), 2411–2417.
Chodzen, G., Hidalgo, M. A., Chen, D., & Garofalo, R. (2019). Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. Journal of Adolescent Health, 64(4), 467–471. https://doi.org/10.1016/j.jadohealth.2018.07.006.
Direk, N., Kulaksizoglu, I. B., Alpay, K., & Gurses, C. (2012). Using personality disorders to distinguish between patients with psychogenic nonepileptic seizures and those with epileptic seizures. Epilepsy & Behavior, 23(2), 138–141. https://doi.org/10.1016/j.yebeh.2011.11.013.
Evans, J., Seri, S., & Cavanna, A. E. (2016). The effects of Gilles De La Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: A systematic review. European Child & Adolescent Psychiatry, 25(9), 939–948. https://doi.org/10.1007/s00787-016-0823-8.
Gadermann, A. C., Thomson, K. C., Richardson, C. G., Gagné, M., McAuliffe, C., Hirani, S., & Jenkins, E. (2021). Examining the impacts of the COVID-19 pandemic on family mental health in Canada: Findings from a national cross-sectional study. British Medical Journal Open, 11(1), e042871. https://doi.org/10.1136/bmjopen-2020-042871.
Galupo, M. P., & Pulice-Farrow, L. (2020). Subjective ratings of gender dysphoria scales by transgender individuals. Archives of Sexual Behavior, 49(2), 479–488. https://doi.org/10.1007/s10508-019-01556-2.
Ganos, C., Martino, D., Espay, A. J., Lang, A. E., Bhatia, K. P., & Edwards, M. J. (2019). Tics and functional tic-like movements: Can we tell them apart? Neurology, 93(17), 750–758.
Gelauff, J. M., Rosmalen, J. G. M., Gardien, J., Stone, J., & Tijssen, M. A. J. (2020). Shared demographics and comorbidities in different functional motor disorders. Parkinsonism & Related Disorders, 70, 1–6. https://doi.org/10.1016/j.parkreldis.2019.11.018.
Goldberg, A. E., Kuvalanka, K. A., Budge, S. L., Benz, M. B., & Smith, J. Z. (2019). Health care experiences of transgender binary and nonbinary university students. The Counseling Psychologist, 47(1), 59–97. https://doi.org/10.1177/0011000019827568.
Goldhammer, H., Crall, C., & Keuroghlian, A. S. (2019). Distinguishing and addressing gender minority stress and borderline personality symptoms. Harvard Review Psychiatry, 27(5), 317–325. https://doi.org/10.1097/HRP.0000000000000234.
Han, V. X., Kozlowska, K., Kothur, K., Lorentzos, M., Wong, W. K., Mohammad, S. S., Savage, B., Chudleigh, C., & Dale, R. C. (2022). Rapid onset functional tic-like behaviours in children and adolescents during COVID-19: Clinical features, assessment and biopsychosocial treatment approach. Journal of Paediatrics and Child Health, 58(7), 1181–1187.
Heimberg, R. G., Mueller, G. P., Holt, C. S., Hope, D. A., & Liebowitz, M. R. (1992). Assessment of anxiety in social interaction and being observed by others: The social interaction anxiety scale and the social phobia scale. Behavior Therapy, 23(1), 53–73. https://doi.org/10.1016/s0005-7894(05)80308-9.
Hidalgo, M. A., Petras, H., Chen, D., & Chodzen, G. (2019). The gender minority stress and resilience measure: Psychometric validity of an adolescent extension. Clinical Practice in Pediatric Psychology, 7(3), 278–290. https://doi.org/10.1037/cpp0000297.
Hunter, J., Butler, C., & Cooper, K. (2021). Gender minority stress in trans and gender diverse adolescents and young people. Clinical Child Psychology and Psychiatry, 26(4), 1182–1195. https://doi.org/10.1177/13591045211033187.
Iverson, A. M., & Black, K. J. (2022). Why tic severity changes from then to now and from here to there. Journal of Clinical Medicine, 11(19), 5930. https://doi.org/10.3390/jcm11195930.
Jenkins-Guarnieri, M. A., Wright, S. L., & Johnson, B. (2013). Development and validation of a social media use integration scale. Psychology of Popular Media Culture, 2(1), 38–50. https://doi.org/10.1037/a0030277.
Jungilligens, J., Paredes-Echeverri, S., Popkirov, S., Barrett, L. F., & Perez, D. L. (2022). A new science of emotion: Implications for functional neurological disorder. Brain, 145(8), 2648–2663. https://doi.org/10.1093/brain/awac204.
Kattari, S. K., Bakko, M., Hecht, H. K., & Kattari, L. (2020). Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. Social Science in Medicine - Population Health, 10, 100525. https://doi.org/10.1016/j.ssmph.2019.100525.
Kotov, R. I., Bellman, S. B., & Watson, D. B. (2004). Multidimensional Iowa Suggestibility Scale (MISS) brief manual. https://renaissance.stonybrookmedicine.edu/sites/default/files/MISSBriefManual.pdf.
Kustov, G. V., Zinchuk, M. S., Rider, F. K., Pashnin, E. V., Voinova, N. I., Avedisova, A. S., & Guekht, A. B. (2022). Comorbidity of psychogenic non-epileptic seizures with mental disorders. Neuroscience and Behavioral Physiology, 122(2), 28–35. https://doi.org/10.17116/jnevro202212202128.
Lacey, C., Cook, M., & Salzberg, M. (2007). The neurologist, psychogenic nonepileptic seizures, and borderline personality disorder. Epilepsy & Behavior, 11(4), 492–498. https://doi.org/10.1016/j.yebeh.2007.09.010.
Leckman, J. F., Riddle, M. A., Hardin, M. T., Ort, S. I., Swartz, K. L., Stevenson, J., & Cohen, D. J. (1989). The Yale global tic severity scale: Initial testing of a clinician-rated scale of tic severity. Journal of American Academy of Child & Adolescent Psychiatry, 28(4), 566–573. https://doi.org/10.1097/00004583-198907000-00015.
Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 377(9759), 74–84. https://doi.org/10.1016/S0140-6736(10)61422-5.
Macchi, Z. A., Kletenik, I., Olvera, C., & Holden, S. K. (2021). Psychiatric comorbidities in functional movement disorders: A retrospective cohort study. Movement Disorder Clinical Practice, 8(5), 725–732. https://doi.org/10.1002/mdc3.13226.
Martino, D., Hedderly, T., Murphy, T., Muller-Vahl, K. R., Dale, R. C., Gilbert, D. L., Rizzo, R., Hartmann, A., Nagy, P., Anheim, M., Owen, T., Malik, O., Duncan, M., Heyman, I., Liang, H., McWilliams, A., O’Dwyer, S., Fremer, C., Szejko, N., & Pringsheim, T. M. (2023). The spectrum of functional tic-like behaviours: Data from an international registry. European Journal of Neurology, 30(2), 334–343. https://doi.org/10.1111/ene.15611.
Matsuno, E., & Israel, T. (2018). Psychological interventions promoting resilience among transgender individuals: Transgender resilience intervention model (TRIM). The Counseling Psychologist, 46(5), 632–655. https://doi.org/10.1177/0011000018787261.
Mcguire, J. K., Berg, D., Catalpa, J. M., Morrow, Q. J., Fish, J. N., Rider, N., Steensma, G., Cohen-Kettenis, T., P. T., & Spencer, K. (2020). Utrecht gender dysphoria scale - gender spectrum (UGDS-GS): Construct validity among transgender, nonbinary, and LGBQ samples. International Journal of Transgender Health, 21(2), 194–208. https://doi.org/10.1080/26895269.2020.1723460.
Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2, 209–213. https://doi.org/10.1037/sgd0000132.
Moore, S. E., Wierenga, K. L., Prince, D. M., Gillani, B., & Mintz, L. J. (2021). Disproportionate impact of the COVID-19 pandemic on perceived social support, mental health and somatic symptoms in sexual and gender minority populations. Journal of Homosexuality, 68(4), 577–591. https://doi.org/10.1080/00918369.2020.1868184.
Morsy, S. K., Huepe-Artigas, D., Kamal, A. M., Hassan, M. A., Abdel-Fadeel, N. A., & Kanaan, R. A. A. (2021). The relationship between psychosocial trauma type and conversion (functional neurological) disorder symptoms: A cross-sectional study. Australasian Psychiatry, 29(3), 261–265. https://doi.org/10.1177/10398562211009247.
Myers, L., Gray, C., Roberts, N., Levita, L., & Reuber, M. (2022). Shame in the treatment of patients with psychogenic nonepileptic seizures: The elephant in the room. Seizure, 94, 176–182. https://doi.org/10.1016/j.seizure.2021.10.018.
Nilles, C., Pringsheim, T. M., & Martino, D. (2022). The recent surge of functional movement disorders: Social distress or greater awareness? Current Opinion in Neurology, 35(4), 485–493. https://doi.org/10.1097/WCO.0000000000001074.
Orfanelli, L., & Borkowski, W. J. Jr. (2006). Conversion disorder in a pediatric transgender patient. Journal of Neuroscience Nursing, 38(2), 114–116. https://doi.org/10.1097/01376517-200604000-00007.
Oussi, A., Hamid, K., & Bouvet, C. (2023). Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping. Journal of Behavior Therapy and Experimental Psychiatry, 79, 101835. https://doi.org/10.1016/j.jbtep.2023.101835.
Pannekoek, J. N., van der Werff, S. J., van Tol, M. J., Veltman, D. J., Aleman, A., Zitman, F. G., Rombouts, S. A., & van der Wee, N. J. (2015). Investigating distinct and common abnormalities of resting-state functional connectivity in depression, anxiety, and their comorbid states. European Neuropsychopharmacology, 25(11), 1933–1942. https://doi.org/10.1016/j.euroneuro.2015.08.002.
Pareés, I., Kojovic, M., Pires, C., Rubio-Agusti, I., Saifee, T. A., Sadnicka, A., Kassavetis, P., Macerollo, A., Bhatia, K. P., Carson, A., Stone, J., & Edwards, M. J. (2014). Physical precipitating factors in functional movement disorders. Journal of the Neurological Sciences, 338(1), 174–177. https://doi.org/10.1016/j.jns.2013.12.046.
Poquiz, J. L., Coyne, C. A., Garofalo, R., & Chen, D. (2021). Comparison of gender minority stress and resilience among transmasculine, transfeminine, and nonbinary adolescents and young adults. Journal of Adolescent Health, 68(3), 615–618. https://doi.org/10.1016/j.jadohealth.2020.06.014.
Pringsheim, T., Ganos, C., McGuire, J. F., Hedderly, T., Woods, D., Gilbert, D. L., Piacentini, J., Dale, R. C., & Martino, D. (2021). Rapid onset functional tic-like behaviors in young females during the COVID-19 pandemic. Movement Disorders, 36(12), 2707–2713. https://doi.org/10.1002/mds.28778.
Pringsheim, T., Ganos, C., Nilles, C., Cavanna, A. E., Gilbert, D. L., Greenberg, E., Hartmann, A., Hedderly, T., Heyman, I., Liang, H., Malaty, I., Malik, O., Debes, N. M., Vahl, K. M., Munchau, A., Murphy, T., Nagy, P., Owen, T., Rizzo, R., & Martino, D. (2023). European society for the study of Tourette syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders. European Journal of Neurology, 30(4), 902–910. https://doi.org/10.1111/ene.15672.
Reuber, M., Roberts, N. A., Levita, L., Gray, C., & Myers, L. (2022). Shame in patients with psychogenic nonepileptic seizure: A narrative review. Seizure, 94, 165–175. https://doi.org/10.1016/j.seizure.2021.10.017.
Rief, W., Martin, A., Klaiberg, A., & Brähler, E. (2005). Specific effects of depression, panic, and somatic symptoms on illness behavior. Psychosomatic Medicine, 67(4). https://journals.lww.com/psychosomaticmedicine/Fulltext/2005/07000/Specific_Effects_of_Depression,_Panic,_and_Somatic.13.aspx.
Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006). Panic disorder. The Lancet, 368(9540), 1023–1032. https://doi.org/10.1016/S0140-6736(06)69418-X.
Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63(4), 503–505. https://doi.org/10.1016/j.jadohealth.2018.02.003.
Sansone, R. A., & Sansone, L. A. (2015). Borderline personality in the medical setting. Primary Care Companion CNS Disorders, 17(3). https://doi.org/10.4088/PCC.14r01743.
Sansone, R. A., Tahir, N. A., Buckner, V. R., & Wiederman, M. W. (2008). The relationship between borderline personality symptomatology and somatic preoccupation among internal medicine outpatients. The Journal of Clinical Psychiatry, 10(04), 286–290. https://doi.org/10.4088/pcc.v10n0403.
Santomauro, D. F., Herrera, M., Shadid, A. M., Zheng, J., Ashbaugh, P., Pigott, C., Abbafati, D. M., Adolph, C., Amlag, C., Aravkin, J. O., Bang-Jensen, A. Y., Bertolacci, B. L., Bloom, G. J., Castellano, S. S., Castro, R., Chakrabarti, E., Chattopadhyay, S., Cogen, J., Collins, R. M., & Ferrari, J. K., A. J (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet, 398(10312), 1700–1712. https://doi.org/10.1016/s0140-6736(21)02143-7.
Schneider, C., Cerwenka, S., Nieder, T. O., Briken, P., Cohen-Kettenis, P. T., De Cuypere, G., Haraldsen, I. R., Kreukels, B. P. C., & Richter-Appelt, H. (2016). Measuring gender dysphoria: A multicenter examination and comparison of the Utrecht gender dysphoria scale and the gender identity/gender dysphoria questionnaire for adolescents and adults. Archives of Sexual Behavior, 45(3), 551–558. https://doi.org/10.1007/s10508-016-0702-x.
Sharp, C., Steinberg, L., Temple, J., & Newlin, E. (2014). An 11-item measure to assess borderline traits in adolescents: Refinement of the BPFSC using IRT. Personality Disorders: Theory Research and Treatment, 5(1), 70–78. https://doi.org/10.1037/per0000057.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–57. https://www.ncbi.nlm.nih.gov/pubmed/9881538.
Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010). Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). Journal of Clinical Psychiatry, 71(3), 313–326. https://doi.org/10.4088/JCP.09m05305whi.
Silva, D. C., Salati, L. R., Villas-Boas, A. P., Schwarz, K., Fontanari, A. M., Soll, B., Costa, A. B., Hirakata, V., Schneider, M., & Lobato, M. I. R. (2021). Factors associated with ruminative thinking in individuals with gender dysphoria. Frontiers in Psychiatry, 12, 602293. https://doi.org/10.3389/fpsyt.2021.602293.
Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion, 29(2), 83–102. https://doi.org/10.1007/s11031-005-7955-3.
Sinclair, V. G., & Wallston, K. A. (2004). The development and psychometric evaluation of the brief resilient coping scale. Assessment, 11(1), 94–101. https://doi.org/10.1177/1073191103258144.
Smith, W. B., Goldhammer, H., & Keuroghlian, A. S. (2019). Affirming gender identity of patients with serious mental illness. Psychiatric Services, 70(1), 65–67. https://doi.org/10.1176/appi.ps.201800232.
Stone, J., Carson, A., Duncan, R., Coleman, R., Roberts, R., Warlow, C., Hibberd, C., Murray, G., Cull, R., Pelosi, A., Cavanagh, J., Matthews, K., Goldbeck, R., Smyth, R., Walker, J., Macmahon, A. D., & Sharpe, M. (2009). Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain, 132(Pt 10), 2878–2888.
Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development of the gender minority stress and resilience measure. Psychology of Sexual Orientation and Gender Diversity, 2, 65–77. https://doi.org/10.1037/sgd0000081.
Villagrán, A., Eldøen, G., Duncan, R., Aaberg, K. M., Hofoss, D., & Lossius, M. I. (2022). The effect of attachment style on long-term outcomes in psychogenic nonepileptic seizures: Results from a prospective study. Epilepsy & Behavior, 135, 108890. https://doi.org/10.1016/j.yebeh.2022.108890.
Weiner, L., Perroud, N., & Weibel, S. (2019). Attention deficit hyperactivity disorder and Borderline personality disorder in adults: A review of their links and risks. Neuropsychiatric Disease and Treatment, 15, 3115–3129. https://doi.org/10.2147/NDT.S192871.
Williams, B., Jalilianhasanpour, R., Matin, N., Fricchione, G. L., Sepulcre, J., Keshavan, M. S., LaFrance, W. C. Jr., Dickerson, B. C., & Perez, D. L. (2018). Individual differences in corticolimbic structural profiles linked to insecure attachment and coping styles in motor functional neurological disorders. Journal of Psychiatric Research, 102, 230–237. https://doi.org/10.1016/j.jpsychires.2018.04.006.
Williams, B., Ospina, J. P., Jalilianhasanpour, R., Fricchione, G. L., & Perez, D. L. (2019). Fearful attachment linked to childhood abuse, alexithymia, and depression in motor functional neurological disorders. Journal of Neuropsychiatry and Clinical Neurosciences, 31(1), 65–69. https://doi.org/10.1176/appi.neuropsych.18040095.
Yang, C. C., Holden, S. M., & Carter, M. D. K. (2018). Social media social comparison of ability (but not opinion) predicts lower identity clarity: Identity processing style as a mediator. Journal of Youth and Adolescence, 47(10), 2114–2128. https://doi.org/10.1007/s10964-017-0801-6.
Zanarini, M. C., Vujanovic, A. A., Parachini, E. A., Boulanger, J. L., Frankenburg, F. R., & Hennen, J. (2003). A screening measure for BPD: The Mclean screening instrument for borderline personality disorder (MSI-BPD). Journal of Personality Disorders, 17(6), 568–573. https://doi.org/10.1521/pedi.17.6.568.25355.
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Berg, L., Pringsheim, T.M., Lerario, M. et al. Psychological Factors Associated with Functional Tic-like Behaviours during the COVID-19 Pandemic. Res Child Adolesc Psychopathol (2024). https://doi.org/10.1007/s10802-024-01184-y
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DOI: https://doi.org/10.1007/s10802-024-01184-y