Prevalence and clinical correlates of explosive outbursts in Tourette Syndrome

Abstract

The aim of this study was to examine the prevalence and clinical correlates of explosive outbursts in two large samples of individuals with TS, including one collected primarily from non-clinical sources. Participants included 218 TS-affected individuals who were part of a genetic study (N=104 from Costa Rica (CR) and N=114 from the US). The relationship between explosive outbursts and comorbid attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), tic severity, and prenatal and perinatal complications were examined using regression analyses. Twenty percent of participants had explosive outbursts, with no significant differences in prevalence between the CR (non-clinical) and the US (primarily clinical) samples. In the overall sample, ADHD, greater tic severity, and lower age of tic onset were strongly associated with explosive outbursts. ADHD, prenatal exposure to tobacco, and male gender were significantly associated with explosive outbursts in the US sample. Lower age of onset and greater severity of tics were significantly associated with explosive outbursts in the CR sample. This study confirms previous studies that suggest that clinically significant explosive outbursts are common in TS and associated with ADHD and tic severity. An additional potential risk factor, prenatal exposure to tobacco, was also identified.

An initial study of family accommodation in children and adolescents with chronic tic disorders

“…Similarly, the increased distress may result in poor emotion regulation and anger outbursts, coercing relatives to engage in higher levels of family accommodation [29,31,42,62]. Notably, various studies have elucidated the prevalence of aggressive, disruptive, and/or explosive outbursts in TS [8,11,12,63,64]. In response to these outbursts, family members may feel pressured to provide accommodations due to the child's tics, preventing them from learning more adaptive appraisals and reactions and compounding their tic-related impairment.…”

“…Prevalence rates suggest that approximately 4-16 in every 1000 youth experience TS [2, 3], with the severity of tics exhibiting a fluctuating course that reaches its greatest severity during adolescence [4,5]. In addition to tics, individuals with TS commonly experience co-occurring anxiety/obsessive-compulsive disorders [6, 7], disruptive behavior disorders [8,9], attention deficit/hyperactivity disorder [10] and mood disturbances [11,12]. Collectively, TS and its accompanying morbidity can confer significant impairment on the affected child and his/her family [13,14] and contribute to a poor quality of life [14].…”

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

“…Co-morbid psychiatric disorders are reported by the vast majority (90%) of patients with GTS, especially attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) (2) . GTS is also associated with anxiety and affective disorders, rage attacks, impulsivity and self-injurious behaviours (5)(6)(7) .…”

The premonitory urge revisited: An individualized premonitory urge for tics scale

“…Although highlighting consistent associations between the PUTS total score and internalizing symptoms, there is a need to expand evaluations to include related constructs that may contribute to urge phenomenology. Indeed, rage (Chen et al 2013; Storch et al 2012), dysregulation (McGuire et al 2013), distress tolerance (Cougle et al 2011), and emotional lability (Rizzo et al 2014; Rosen et al 2015) have been found to be important in TD and related conditions and may provide clarifying information on clinical construct associated with premonitory urges.…”