Stigma and Social Avoidance in Adults with Essential Tremor

Abstract

BackgroundPeople with essential tremor (ET) can be subject to stigma, and some adopt avoidance behaviors. Characteristics associated with ET stigma and the relationship between perceived stigma and social dysfunction have not been studied.ObjectivesTo discern predictors of perceived stigma and social dysfunction in ET, and to identify potentially treatable psychological factors associated with social dysfunction.MethodsWe surveyed ET patients (n = 158) on recalled stigma incidents and social dysfunction related to tremor, as well as clinical and demographic characteristics including tremor severity, and psychological constructs including anxiety, depression, mindfulness, resilience, and narcissism.ResultsWorse tremor severity (Standardized beta [SB] 1.4, P < 0.001) especially among younger participants (interaction of age and tremor severity SB −0.9, P < 0.001) and presence of vocal tremor (SB 0.7, P = 0.002) predict perceived stigma. 53/157 (33.8%) participants met criteria for social dysfunction, employing maladaptive avoidance strategies. Scores for perceived stigma (Odds Ratio [OR] 1.2, P = 0.002), depression (OR 1.5, P = 0.004) and stigma psychological distress (OR 1.2, P = 0.001) as well as sex (OR 4.3 for females, P = 0.045) predicted social dysfunction.ConclusionsDepression and stigma psychological distress contribute to social dysfunction related to ET stigma. Treating these psychological factors may mitigate social avoidance behaviors prevalent among susceptible individuals: those who most perceive ET stigma, i.e. relatively younger patients with worse tremor or with vocal tremor, and in particular females who are more prone to social dysfunction than males with the same degree of perceived stigma.

Neuropsychiatric Approaches to Essential and Functional Tremor: A Comparative Study

“…This is particularly relevant, as psychometric evaluations could reveal underlying psychological factors that might not be immediately apparent through physical examinations alone [19][20][21][22]. The significant psychometric differences identified underline the necessity of incorporating comprehensive psychological assessments into the diagnostic process for tremors, potentially enhancing the accuracy of distinguishing between ET and FT [23][24][25]. By integrating detailed psychometric evaluations into the routine assessment of patients with tremors, clinicians could better understand the patient's condition, which is crucial for effective treatment planning.…”

Epidemiologic Disparities and Challenges in Non-parkinsonian Tremor Disorders Research: A Scoping Review Emphasizing the Indian Context

“…Findings were categorized under prevalence statistics (29 studies),[ 15 16 17 18 19 20 21 22 23 ] proposed pathophysiologic mechanisms (15 studies),[ 4 5 6 7 24 25 26 27 28 29 30 ] assessments of psychiatric comorbidities (nine studies),[ 31 32 33 34 35 36 37 38 39 40 ] the stigma associated with tremor disorder (two studies),[ 41 42 ] and evaluations of quality-of-life impact (five studies). [ 36 43 44 45 46 ]…”

“…[ 41 ] Assessments of stigma dimensions revealed that ET patients frequently conceal their diagnosis and feel uncomfortable in social situations due to their tremors. [ 42 ] However, no studies have comprehensively evaluated various dimensions of stigma and associated determinants, specifically among Indian patients with tremor disorders.…”