The prevalence and clinical correlates of body-focused repetitive behaviors in pediatric Tourette Syndrome

Abstract

The association between Tourette Syndrome (TS) and body-focused repetitive behaviors (BFRBs), including skin picking disorder (SPD), hair pulling disorder (HPD) and pathological nail biting (PNB) is rarely studied, especially in TS pediatric samples, even though TS and BFRBs share many characteristics. This study therefore sought to determine the prevalence rates and predictors of SPD, HPD and PNB in a pediatric TS sample. Data from 739 child and adolescent participants who completed validated instruments to assess for tic severity and various other comorbidities were used to calculate prevalence rates for each of the BFRBs. Clinical and demographic predictors were determined via regression modelling. The prevalence rates for SPD, HPD and PNB were 5.8%, 2.4% and 6.0%, respectively. The presence of PNB and worst ever tic severity predicted the presence of SPD. Worst ever tic severity and the presence of SPD were the only significant predictors of HPD and PNB, respectively. When distress was dropped as a diagnostic requirement for the BFRBs, the prevalence for SPD, HPD and PNB increased to 18.4%, 7.6% and 11.8%, respectively, while the predictors were generally the same. The prevalence rates for SPD, HPD and PNB were similar to estimated rates in the general population. However, their association with tic severity suggests a relationship between BFRBs and TS. These findings suggest that more research is needed to further elucidate the nature of the relationship between TS and BFRBs, especially in pediatric populations.