A preliminary examination of self-concept in older adolescents and young adults with Gilles de la Tourette syndrome

Abstract

Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterised by multiple tics and often associated with behavioural problems. Although there is evidence of significantly reduced self-esteem in children and adolescents with GTS, little is known about perceived self-concept and its clinical determinants at the transition age between adolescence and adulthood. We therefore set out to investigate self-concept in a clinical sample of young patients with GTS at this crucial age for personal development. In addition to standard demographic and clinical data, we collected self-ratings using a standardised battery of psychometric instruments, as well as the Multidimensional Self Concept Scale, a comprehensive questionnaire developed to assess self-concept in subjects aged 9 to 19 years, tapping into the social, competence, affect, academic, family, and physical domains. We found that patients diagnosed with at least one comorbid psychiatric disorder ("GTS-plus" phenotype) reported significantly lower self-concept than patients with "pure GTS", whereas tic-related variables had no impact on self-concept. Anxiety symptoms were the main determinants of self-concept, especially trait anxiety with regard to social and affective domains. Affective symptoms could also have a negative impact on the physical, affective, competence, and social domains of self-concept. Routine screening for these co-morbid conditions should be recommended in all patients with GTS seen at transition clinics from paediatric to adult care, in order to implement effective treatment interventions whenever possible.

Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity, treatment, and comorbidity

“…Specifically, those with TS/CTD alone did not differ from published national norms for self-esteem in adults, whereas adults with TS/CTD who had at least one current comorbid diagnosis had distinctly lower self-esteem compared to published national norms. This finding is consistent with the existing, smaller studies that accounted for comorbidity [12, 14, 17, 20], lending reliability to our understanding that only people with TS/CTD and an additional current psychiatric comorbidity have, on average, lower than normative levels of self-esteem.…”

“…On the other hand, two studies failed to find significantly lower self-esteem in children with TS/CTD compared to normative means or clinical comparisons [6, 16]. Of note, self-concept is a closely related construct to self-esteem, and refers to one’s view of him or herself based on past success and failure experiences [17]. Three studies also examined the association between self-esteem or self-concept and tic severity in children, adolescents, and emerging adults [12, 14, 17]; two studies documented non-significant associations between self-esteem or self-concept and tic severity [14, 17], whereas the other study documented a significant relationship [12].…”

“…However, the authors did not examine whether self-concept differed among those with CTD alone and normative means. Likewise, Silvestri and colleagues [17] documented significantly lower self-concepts among adolescents and emerging adults with TS and a comorbid psychiatric diagnosis, compared to those with TS alone. More severe anxiety and depression symptoms were associated with lower self-concept scores [17].…”

“…Likewise, Silvestri and colleagues [17] documented significantly lower self-concepts among adolescents and emerging adults with TS and a comorbid psychiatric diagnosis, compared to those with TS alone. More severe anxiety and depression symptoms were associated with lower self-concept scores [17]. As with Hanks et al [12], however, the authors did not compare self-concept among those with TS alone to normative means.…”

Self-concept and self-esteem in patients with chronic tic disorders: A systematic literature review

“…Tic severity accounted for 17% of the variance in depressive symptom severity and self-concept appeared to mediate the relationship between tic severity and depressive symptom severity in adolescence but not in childhood. Silvestri et al 17 explored self-concept and its determinants in adolescents and young adults with GTS. Levels of selfconcept of patients with co-morbid psychiatric disorders were significantly lower than those reported by patients with GTS only, especially in the competence, academic, affect, and social domains.…”