Etiological factors associated with functional tic-like behaviours during the COVID-19 pandemic
Lindsay Berg1, Tamara Pringsheim2, Davide Martino3
1University of Calgary, 2Mathison Centre, 3Department of Clinical Neurosciences, University of Calgary
Objective:
To explore the hypothesized etiological factors affecting the functional tic like behaviour (FTLB) cohort that emerged since the onset of the pandemic.
Background:
FTLB are a form of functional movement disorder resembling Tourette Syndrome (TS) that surged in prevalence during the SARS-COV-2 pandemic. Exposure to tic-related social media content, pandemic stressors, and comorbid neuropsychiatric disorders are factors hypothesized to contribute to the sudden increase in FTLB.
Design/Methods:
FTLB patients (n= 34) age/sex matched with TS (n = 21), and healthy controls (HC) (n=21) completed self-report measures and a clinical neuropsychiatric interview that investigated social media use, suggestibility, distress tolerance, demographics, attachment style, SARS-COV-2 related experiences, family history, family functioning, loneliness, and neuropsychiatric comorbidities. Group differences were Bonferroni corrected.
Results:
FTLB had higher levels of depression (p <.001), suicidality (p <.001), panic disorder (p=.029), and were more likely to gender identify as trans/non-binary/genderfluid (p =.013) than TS and HC. Compared to HC, FTLB patients experienced higher levels of anxiety (p =.005), vulnerable attachment (p =.004), agoraphobia (p=.016), borderline personality traits (p =.004), psychotic symptoms (p =.049), ADHD (p =.035), neuropsychiatric family history (p <.001), pandemic related sleep disturbance (p=.002) and loneliness (p =.038). FTLB reported poorer pandemic school performance compared to TS (p=.043). FTLB and HC were more likely to first learn about tics through social media than TS. Suggestibility, distress tolerance, family functioning, exposure to tic-related content on social media, time spent online, social media integration and comparison, and most pandemic experiences tested were not significantly different. Distress tolerance posed the only significant interaction between group and gender identity in HC.
Conclusions:
Neuropsychiatric comorbidities emerged as the strongest etiological factor related to FTLB. The insignificant direct relationship between FTLB to tic-related content on social media may be due to ubiquitous exposure to tic-content suggesting the influence of social media is mediated by unexplored factors.