Self-injurious behavior in Tourette syndrome

J Neurol. 2022 May;269(5):2453-2459. doi: 10.1007/s00415-021-10822-0. Epub 2021 Oct 1.


Introduction: Tourette syndrome (TS) is characterized by the presence of motor and phonic tics, as well as a variety of behavioral co-morbidities. Self-injurious behavior (SIB) is one of the most serious manifestations of TS, but its pathophysiology is poorly understood.

Methods: Consecutive patients with TS studied in a tertiary care center.

Results: We identified a total of 34 patients (16.9%) with SIB from a cohort of 201 patients with TS. Most of these patients (n = 23, 11.4%) experienced self-directed damage; while others had outward-directed (n = 7, 3.5%) or tic-related SIB (n = 4, 2%). Compared to other patients with TS, those who manifested SIB (self- and outward-directed damage) were more likely to have tics involving shoulder (P = 0.046), trunk (P = 0.006), and arm (P = 0.017); as well as dystonic tics (P = 0.016); complex motor tics (P < 0.001), copropraxia (P = 0.045), complex phonic tics (P = 0.003), higher number of phonic tics (P = 0.001), verbalizations (P = 0.001), coprolalia (P = 0.006) and obsessive compulsive disorder (OCD) (P < 0.001) as determined by bivariate analysis. In the multivariate analysis only complex motor tics (P = 0.006), obsessive-compulsive behavior (P = 0.025) and greater severity of tics (P = 0.002) showed a statistically significant association with SIB. Patients with SIB had a greater probability of being selected for deep brain stimulation (DBS) therapy by the treating clinician (P = 0.01).

Conclusions: SIB is observed in about 17% of patients with TS. The presence of complex motor tics, OCD and greater severity of tics was related to the presence of SIB.

Keywords: Deep brain stimulation; Obssesive-compulsive disorder; Self-injurious behavior; Tourette syndrome, tics.

MeSH terms

  • Compulsive Behavior
  • Humans
  • Obsessive-Compulsive Disorder* / complications
  • Obsessive-Compulsive Disorder* / epidemiology
  • Self-Injurious Behavior* / epidemiology
  • Tics* / epidemiology
  • Tourette Syndrome* / complications
  • Tourette Syndrome* / epidemiology