Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity, treatment, and comorbidity

Hilary Weingarden*, Lawrence Scahill, Susanne Hoeppner, Alan L. Peterson, Douglas W. Woods, John T. Walkup, John Piacentini, Sabine Wilhelm

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Tourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings. Method: This study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST). Results: Baseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST. Conclusions: Comorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD.

Original languageEnglish (US)
Pages (from-to)95-100
Number of pages6
JournalComprehensive Psychiatry
StatePublished - Jul 2018


  • Chronic tic disorder
  • Comorbidity
  • Comprehensive Behavioral Intervention for Tics
  • Self-esteem
  • Tourette syndrome

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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