Determinants of self-concept in patients with Gilles de la Tourette syndrome in late adolescence

Background: Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterized by multiple tics and often associated with behavioral problems. Although there is evidence of significantly reduced self-esteem in children and adolescents with GTS, little is known about perceived self-concept and its clinical determinants at the transition age between adolescence and adulthood, a crucial age for personal development. Objective: This original study aimed to investigate self-concept in a clinical sample of young patients with GTS at the transition age between adolescence and adulthood. Methods: In addition to standard demographic and clinical data, we collected self-ratings using a standardized battery of psychometric instruments, as well as the Multidimensional Self Concept Scale, a comprehensive questionnaire developed to assess self-concept in subjects aged 9 to 19 years, tapping into the social, competence, affect, academic, family, and physical domains. Results: We found that patients diagnosed with at least one comorbid psychiatric disorder (“GTS-plus” phenotype) reported significantly lower self-concept than patients with “pure GTS,” whereas tic-related variables had no impact on self-concept. Anxiety symptoms were the main determinants of self-concept, especially trait anxiety with regard to social and affective domains. Affective symptoms could also have a negative impact on the physical, affective, competence, and social domains of self-concept. Conclusion: Routine screening for comorbid conditions, especially anxiety and affective symptoms, should be recommended in all patients with GTS seen at transition clinics from pediatric to adult care, in order to implement effective treatment interventions to improve self-concept whenever possible.