Altered Interoceptive Sensibility in Adults With Chronic Tic Disorder

Abstract

BackgroundInteroception refers to the sensing, interpretation, integration, and regulation of signals about the body’s internal physiological state. Interoceptive sensibility is the subjective evaluation of interoceptive experience, as assessed by self-report measures, and is abnormal in numerous neuropsychiatric disorders. Research examining interoceptive sensibility in individuals with chronic tic disorders (CTDs), however, has yielded conflicting results, likely due to methodologic differences between studies and small sample sizes.ObjectiveWe sought to compare interoceptive sensibility between adults with CTD and healthy controls, adjusting for co-occurring psychiatric symptoms, and to examine the relationship of interoceptive sensibility with other CTD clinical features, in particular, premonitory urge.MethodsWe recruited adults with CTDs and sex- and age-matched healthy controls to complete the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), as well as a battery of measures assessing psychiatric symptoms prevalent in CTD populations. CTD participants additionally completed scales quantifying tic severity, premonitory urge severity, and health-related quality of life. We conducted between-group contrasts (Wilcoxon rank-sum test) for each MAIA-2 subscale, analyzed the effect of psychiatric symptoms on identified between-group differences (multivariable linear regression), and examined within-group relationships between MAIA-2 subscales and other clinical measures (Spearman rank correlations, multivariable linear regression).ResultsBetween adults with CTD (n = 48) and healthy controls (n = 48), MAIA-2 Noticing and Not-Worrying subscale scores significantly differed. After adjusting for covariates, lower MAIA-2 Not-Worrying subscale scores were significantly associated with female sex (β = 0.42, p < 0.05) and greater severity of obsessive-compulsive symptoms (β = –0.028, p < 0.01), but not with CTD diagnosis. After adjusting for severity of tics and obsessive-compulsive symptoms, a composite of MAIA-2 Noticing, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, and Trusting subscales (β = 2.52, p < 0.01) was significantly associated with premonitory urge.ConclusionStudy results revealed three novel findings: adults with CTD experience increased anxiety-associated somatization and increased general body awareness relative to healthy controls; anxiety-associated somatization is more closely associated with sex and obsessive-compulsive symptoms than with CTD diagnosis; and increased general body awareness is associated with greater severity of premonitory urges.

Tourette syndrome research highlights from 2022

“…Across all three groups, SH was associated with OCD and attention deficit hyperactivity disorder (ADHD) symptoms but not with tic severity. The second report investigated interoception in adults with or without CTD using a published self-report measure ( Narapareddy et al . 2022 ).…”

When the interoceptive and conceptual clash: the case of oppositional phenomenal self-modelling in Tourette Syndrome

“…In Section 1, we claimed that TS is marked by hyperprecision weighting over (the likelihood of) interoceptive sensory data. This is strongly consonant with the findings of Rae et al (2019b), who found that participants with TS had an objectively lower interoceptive accuracy on a heartbeat tracking task, as well as an increased (self-reported) sensitivity to interoceptive signals (cf., Ganos et al, 2015;Narapareddy et al, 2022). However, these researchers did not investigate the mechanism underlying tics and the subsequent attenuation of the premonitory sensation.…”

Advancements in the phenomenology, assessment, and treatment of Tourette syndrome

“…with greater premonitory urge severity [20]. Uaeda et al theorize that premonitory urge phenomena in TS may represent enhanced or aberrant interoceptive sensations [21].…”

“…Some research suggests that dimensions of interoception have been found to predict premonitory urges and tic severity among individuals with TS [18], whereas other sources contend that interoceptive sensitivity is an independent, but clinically relevant, construct among populations with TS [19]. Relative to healthy adults, adults with TS experience greater general body awareness and anxiety-associated somatization [20]. Furthermore, evidence suggests that greater body awareness is significantly associated with greater premonitory urge severity [20].…”

“…Relative to healthy adults, adults with TS experience greater general body awareness and anxiety-associated somatization [20]. Furthermore, evidence suggests that greater body awareness is significantly associated with greater premonitory urge severity [20]. Uaeda et al theorize that premonitory urge phenomena in TS may represent enhanced or aberrant interoceptive sensations [21].…”