(PS12-100) Tic Disorder Symptomatology and Self-identification Perceptions Following Behavioral Treatment for Tics

Involuntary, abrupt, repetitive movements or vocalizations characterize tic disorders.  It is unclear the extent to which persons with tics view them as part of their self-identity. Research has been mixed, with some studies showing that individuals with tic disorders consider their tics to be a part of their self-identity (Conelea et al., 2011; Reeve et al., 2009), and other research showing that individuals view their tics as foreign or not a part of themselves (Brandt et al., 2015; Eddy et al., 2011). This project aims to add to the current research by examining if individuals with tic disorders identify with their tics after going through behavioral treatment for tics.

A long-term follow-up study of a randomized controlled trial (RCT) comparing CBIT to psychoeducation and supportive therapy (PST) provided the data (Piacentini et al, 2010). Participant recruitment and data collection took place between 2014 and 2019. 80 of the original 126 participants (M follow-up time = 11.2 years) completed the long-term follow-up assessment. 57 participants provided qualitative interview data as part of the follow-up. The interview contained an open-ended question asking, "Do you think your tics are a big part of who you are as a person?” Two independent coders recorded participant replies verbatim and then classified them. At the conclusion of the randomized controlled trial, treatment response was measured by a Clinical Global Impression of Improvement score of "very much improve" or "much improved."

Chi-square tests were used to assess differences in response to this question by treatment group in the original RCT (i.e., CBIT vs. PST) and treatment response (responder vs. non-responder). 54.4% identified with their tics, whereas 45.6% stated that tics were not a part of their identity. The CBIT and PST groups did not differ in their responses to this question (X2 (1, N = 57) =1.85, p = 0.18). Likewise, posttreatment responders did not differ from nonresponders on their answer to this question (X2 (3, N = 55) = 2.92, p = 0.40)

Results indicate that a small majority of people in this sample identify with their tics post treatment, regardless of treatment group they were assigned to or whether they responded to treatment. Chronic disorders and illnesses are known to profoundly shape an individual's identity, leading to the concept of illness identity, where individuals attribute worth and significance to their symptoms (Charmaz, 1983; 1991). Distinct states of illness identity, associated with adaptive or maladaptive tendencies, have been explored in various populations, including cancer patients (Palmer-Wackerly et al., 2018), individuals with type one diabetes (Oris et al., 2016), and more recently, those with OCD (Fox, 2019). Additionally, no research has yet examined individuals with tics through the lens of narrative personality, a theory proposing that individuals construct their identity by integrating life experiences into an evolving self-story, offering a sense of unity and purpose in life. Future research on the extent to which patients with tics identify with their symptoms and the implications of doing so should be studied in future research.