Meta-Cognitions in Tourette Syndrome, Tic Disorders, and Body-Focused Repetitive Disorder

Abstract

ObjectiveTo explore if self-reported presence of thinking about tics or body-focused repetitive behaviours (BFRBs; gests) are direct triggers of tic or gest onset in 3 groups: Tourette syndrome (TS; n =18), persistent chronic tic disorders (TDs; n = 42), and a comparison group with BFRB (n = 36).Method:The 3 groups completed a thinking about tics inventory, listing 22 items derived from clinician consensus that asked whether thoughts always, sometimes, or never exclusively triggered tic onset. Other questionnaires measured mood, perfectionism, impulsivity, premonitory urge, and self-rated tension. Sixty-three participants completed the inventory twice, and the inventory was completed pre- and post-behavioural intervention by a further 54.Results:The ranking of the thoughts reported as likely to trigger tics or gests was positively correlated across TD and BFRB groups. Exploratory principal components analysis of a reduced 12-item set (the thinking about tics inventory) in TS and TD groups revealed that such thoughts could be grouped into 3 separate subscales: thoughts about the interference of tics or gests, thoughts anticipating tics or gests, and thoughts about whether the person has permission to perform the tic or the gest. The 3 sets of subscales showed good and acceptable internal consistency and overall score showed good test–retest reliability, suggesting thoughts about tics or gests are robust and measurable. The subscales correlated with impulsivity, tic or behaviour severity, and ratings of frequency decreased post-behavioural treatment.Conclusions:Thinking about tics or gests is reported as triggering tics or gests in both TD and BFRB, and meta-cognition seems independent of premonitory sensations and relates to distinct clinical characteristics in each clinical group.

Clinical Features That Evoke the Concept of Disinhibition in Tourette Syndrome

“…There is little doubt that the debate is fueled by evidence partly supporting and partly refuting a unitary conceptualization of tics and related repetitive behaviors as the result of insufficient capacity to 'hold in' unwanted actions. Moreover, recent work within the field of cognitive neuropsychology proposed alternative conceptualizations of tic genesis, among which are the formation of pathologically reinforced stimulus-response associations or sensorimotor programs (103)(104)(105), the generation of physiological motor commands to match abnormal sensorimotor priors (106), or the release of motor output that results from excessive body-focused metacognitions (107). None of these alternative conceptualizations is either based on defective inhibition, or categorically excludes the contribution of defective inhibition to the genesis of tics.…”

“…A system with these critical alterations in its basic sensorimotor circuitry may also be fraught in the relative weighing of information processing and monitoring (109). In turn this could lead to the presence of abnormal metacognitions for sensorimotor events (107,110), including changes in the experience of interoceptive signals (41) and voluntary actions (111,112).…”

P300 Source Localization Contrasts in Body-Focused Repetitive Behaviors and Tic Disorders

“…Tic disorders (TD) and body-focused repetitive behaviors (BFRB) are two motor-related neuropsychiatric afflictions that can be difficult to distinguish in clinical settings because they often co-occur and because their symptoms can easily be confounded [ 1 , 2 ]. Indeed, large proportions of TD patients present comorbid disorders such as BFRB, but also depression, anxiety, and obsessive-compulsive disorder (OCD) [ 3 , 4 , 5 ].…”

“…Thus, TD and BFRB patients report an urge or impulse to perform the motor act (i.e., the tic or the repetitive behavior) and both experience relief after it has occurred [ 10 , 11 , 12 , 13 ]. In both conditions, chronic symptoms wax and wane, follow the same loop of negative reinforcement, and can be accentuated by stress, fatigue, or boredom [ 1 , 14 , 15 ]. To our knowledge, no study has reported the comorbidity rates between tic disorders and BFRB as a whole.…”

Cognitive psychophysiological treatment of bodily‐focused repetitive behaviors in adults: An open trial

“…BFRBs have been considered as part of a continuum with obsessive‐compulsive disorder (OCD; APA, ), but BFRBs are also similar to tic and Tourette disorder and could be part of the tic disorder spectrum: both actions are semivoluntary, show similar trigger profiles, bring relief from sensations, and involve sensory stimulation; and in both disorders there is sensori‐motor activation and organizational perfectionism (O'Connor et al., ) and similar metacognitive trigger profiles (O'Connor et al. ).…”