Tourette syndrome patients at risk of assault or exhibition of criminal behavior: JAMA
Sweden: Patients with Tourette syndrome (TS) or chronic tic disorder (CTD) diagnosed in specialist settings are more likely to experience assault or perpetrate a crime, reveals new research. The study appears in the journal JAMA Neurology.
The study showed that patients with TS were twice as likely to be assaulted and three times more likely to commit a crime compared to the general population.
Tourette syndrome and chronic tic disorder often co-occur with other neuropsychiatric conditions, such as attention-deficit/hyperactivity disorder (ADHD), and is tied to multiple social adversities, including school failure, social rejection, stigma, suicidality, and difficulty establishing relationships. However, not much is known about the experience of violent assault (including sexual assault) and criminality in this group.
To fill the knowledge gap, David Mataix-Cols, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden, and colleagues aimed to establish if TS and CTD are associated with an increased risk of experiencing violent assault and criminal convictions in a cohort study.
For this purpose, the researchers identified all individuals living in Sweden at any time between January 1, 1973, and December 31, 2013, from nationwide health and administrative registers. The risk of violent assault and criminal convictions was estimated among people with TS or CTD, compared with the general population and unaffected full siblings. Data analysis was performed between September 1 and October 22, 2021.
The study cohort included 13 819 284 individuals living in Sweden between 1973 and 2013. 7791 individuals with TS or CTD were identified.
The findings of the study are as follows:
- Compared with unaffected individuals from the general population, people with TS or CTD had a 2-fold increased risk of experiencing any violent assault (sexual and nonsexual) (adjusted hazard ratio [aHR], 2.21), a 3-fold increased risk of violent convictions (aHR, 3.13), and a 1.6-fold increased risk of nonviolent crime convictions (aHR, 1.62).
- Among people with TS or CTD, 37.0% (114 of 308) of individuals who had experienced violent assault also had a violent crime conviction, compared with 17.9% (16 067 of 89 920) in the general population.Exclusion of individuals with attention-deficit/hyperactivity disorder and substance use disorders partially attenuated the associations. Similarly, within-sibling models attenuated but did not eliminate the associations (any violent assault: aHR, 1.32; violent crime: aHR, 2.23; nonviolent crime: aHR, 1.34).
"Our results suggets that people with TS or CTD diagnosed in specialist settings were more likely to both experience violent assault and be perpetrators of violence," the authors wrote. "In individuals with comorbid ADHD and substance use disorders, the risk was highest."
"Future studies should focus on understanding the etiology of such serious outcomes in an effort to prevent the experience of assault or criminal convictions in individuals with TS or CTD," they concluded.
Reference:
Mataix-Cols D, Virtanen S, Sidorchuk A, et al. Association of Tourette Syndrome and Chronic Tic Disorder With Violent Assault and Criminal Convictions. JAMA Neurol. Published online March 21, 2022. doi:10.1001/jamaneurol.2022.0167
KEYWORDS: JAMA, Tourette syndrome, chronic tic disorder, violent assault, crime, criminal conviction, David Mataix-Cols, sexual assault, neuropsychiatric conditions, attention-deficit/hyperactivity disorder, ADHD
