Hilary Weingarden1, Lawrence Scahill2, Susanne Hoeppner3, Alan L Peterson4, Douglas W Woods5, John T Walkup6, John Piacentini7, Sabine Wilhelm8. 1. Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA. Electronic address: hilary_weingarden@mgh.harvard.edu. 2. Department of Pediatrics, Emory University School of Medicine, Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA. Electronic address: lawrence.scahill@emory.edu. 3. Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA. Electronic address: shoeppner@mgh.harvard.edu. 4. Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7550 IH-10 West, Suite 1325, San Antonio, TX 78229, USA; Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA. Electronic address: petersona3@uthscsa.edu. 5. Department of Psychology, Cramer Hall 317, Marquette University, Milwaukee, WI 53233, USA. Electronic address: douglas.woods@marquette.edu. 6. Department of Psychiatry, Anne and Robert H. Lurie Children's Hospital, 225 E. Chicago Ave., Chicago, IL 60611, USA; Department of Psychiatry, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: jwalkup@luriechildrens.org. 7. Department of Psychiatry and Biobehavioral Sciences, University of California Los Angles, 760 Westwood Plaza, Los Angeles, CA 90095-1759, USA. Electronic address: jpiacentini@mednet.ucla.edu. 8. Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA. Electronic address: swilhelm@mgh.harvard.edu.
Abstract
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.
RCT Entities:
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.
Authors: Sabine Wilhelm; Alan L Peterson; John Piacentini; Douglas W Woods; Thilo Deckersbach; Denis G Sukhodolsky; Susanna Chang; Haibei Liu; James Dziura; John T Walkup; Lawrence Scahill Journal: Arch Gen Psychiatry Date: 2012-08