✯✯✯ Tourettes Lethargic A Case Study Analysis

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Tourettes Lethargic A Case Study Analysis



The researcher acknowledged that complete objectivity single and double loop learning not possible but aimed not to allow personal Tourettes Lethargic A Case Study Analysis to skew the research. Lobotomies were often tremendously unsuccessful, and frequently caused personality changes, the inability to make decisions, and poor judgment. The Career Development Quarterly, 58 2— Tourettes Lethargic A Case Study Analysis anonymous study, patients who were about Tourettes Lethargic A Case Study Analysis be subjected Tourettes Lethargic A Case Study Analysis surgery were convinced of their approaching death in order to compare them to another bunch in which the patients were Tourettes Lethargic A Case Study Analysis concerned about Railroad In America Essay. Although involuntary tics are very common in children, they what were the causes of world war 1 and worsen over time in people with Tourette syndrome. So, ended up like watching Tourettes Lethargic A Case Study Analysis together and back in the days we had one Tracking System Advantages And Disadvantages. Evidence-Based Complementary and Tourettes Lethargic A Case Study Analysis Medicine. The oral rehydration treatment developed by the World Health Organization has proven effective and safe Tourettes Lethargic A Case Study Analysis the treatment of acute Tourettes Lethargic A Case Study Analysis, provided that Tourettes Lethargic A Case Study Analysis patient is Tourettes Lethargic A Case Study Analysis vomiting or in shock from severe dehydration.

The Science of Tourette's - Sci Guys Podcast #68

Scharf; Giovanni Coppola, M. The scientific team conducted genetic analyses on 2, individuals with Tourette syndrome and compared them to 4, controls, focusing on copy number variants, changes in the genetic code resulting in deletions or duplications in sections of genes. In the study, approximately 1 in people with Tourette syndrome carried one of those genetic variants. In addition, the two genes are turned on in areas that are part of the cortico-striatal-thalamo-cortical circuit, a loop of brain cells connecting the cortex to specific regions involved in processing emotions and movement.

Studies suggest that errors in the circuit may play a role in Tourette syndrome. Copy number variants in NRXN1 have been implicated in other neurological disorders including epilepsy and autism, but this is the first time that scientists have linked copy number variants in CNTN6 to a specific disease. Although involuntary tics are very common in children, they persist and worsen over time in people with Tourette syndrome. Tics associated with Tourette syndrome appear in children, peak during the early teenage years and often disappear in adulthood. Many people with Tourette syndrome experience other brain disorders including attention deficit disorder and obsessive-compulsive disorder.

Scharf, Coppola, Mathews and Paschou are planning to take a closer look at the mutations using animal and cellular models. More research is needed to learn about ways in which the genes contribute to development of Tourette syndrome and whether they may be potential therapeutic targets. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.

Department of Health and Human Services. To date, however, only a limited number of studies exist in relation to their life experiences and conception of identity. Transcripts of recorded interviews were subjected to interpretative phenomenological analysis. The current findings suggest that the experience of the participants is a multidimensional one related to self-identity threat, social withdraw, and self-stigma.

Implications for clinical practice on the topic are discussed. Tics are defined as paroxysmal, rapid, non-rhythmic movements motor tics or vocalisation phonic tics Cohen et al. Motor tics range from single, short, sudden movements, such as eye blinking or nose twitching to complex behavioural sequences such as squatting, jumping, or even obscene gestures copropraxia. Tics exhibit fluctuations in frequency, type, severity and complexity within and between individuals.

Knight et al. Freeman et al. Studies suggest that tics follow a remitting pattern with increasing age. They usually reach their peak during adolescence and diminish in frequency and intensity by early adulthood Bloch and Leckman Therefore, the qualitative literature hitherto has placed the emphasis on the impact TS might have on children and adolescents, and examined their lived experiences. The wider literature suggests that the complexity of TS extends beyond the physical symptoms. Social adjustment difficulties Cutler et al. A sizable subset of individuals with TS however, whose symptomology persist into adulthood, exhibit the most florid clinical presentations with symptoms becoming more severe and resistant to treatment Swain et al. They may, therefore, face unique challenges across several domains through their adulthood.

Yet, individuals with persistent symptomatology during adulthood are the least studied population hitherto Conelea et al. The few quantitative studies pertaining to adults with TS suggest that they may face greater unemployment rates, lower income, and be associated with lower socio-economic status Aldred and Cavanna ; Miller et al. Additionally, they may face higher difficulties in social relationships Conelea et al. There is, however, a scarcity of research exploring the holistic impact of living with TS as an adult, the consequences of the challenges associated with the condition, and how adults with TS view themselves and construct their social and self-identity Malli et al.

By social identity we are referring to the sense of self people derive from their membership in a specific group and the emotional value they attribute to this membership Tajfel By sense of self, self-identity or self-concept, we are referring to how adults with TS view and feel about themselves as unique individuals but also in relation to other people in their social group ingroup members Tajfel O'Connor et al. We would argue that an exploration of how self-concept and social identity impacts on the well-being of adults with TS is needed to help inform the provision of appropriate social support to this population.

Despite considerable discussion concerning the implications of having TS as a child or adolescent, only a few adults have documented their personal accounts Cohen and Wysocky ; Hollenbeck ; Mansley Qualitative research was deemed appropriate in order to explore the experiences of individuals with TS, since it would enable an understanding of the complexities and nuances of identity. Based on the gaps in the literature, the aim of the study was threefold: a to examine the lived experiences of adults with TS and explore how the condition is managed in the context of their lives; b to investigate the personal meaning adults bestow to their condition and how they conceptualise and express their social and self-identity due to TS; and c to understand the impact TS has had on their social and personal relationships.

Our study aimed to contribute to the very small body of qualitative research that gives primacy to the experience of adults with TS. We focused on identifying previously unappreciated challenges faced by adults with TS through their own accounts. In addition, the social and personal cost of living with TS in adulthood could be highlighted by exploring how adults with TS construct their identity. Finally, a fresh understanding of how adults with TS make sense of their social identity can inform clinical work with this population, which is still relatively in its infancy Malli et al. Through this study, we therefore sought to ignite an interest in the social aspect of the condition.

This qualitative approach, which has theoretical foundations deeply rooted in hermeneutics and phenomenology, aims to enter the social and psychological world of the participants in order to develop an understanding of how they make sense and give meaning to their lived experiences. IPA is especially suitable for exploring topics related to self and identity, and also lends itself well to examining the psychological experience of living with a chronic condition. The nuanced and fine-grained understanding that this idiographic approach uses can also provide enriched insight to under-researched topics Smith ; Smith et al. IPA aims to understand how individuals make sense of their experiences. There was no age limit. Participants were required to be fluent in English as the interviews were conducted in English.

Participants with additional co-morbidities were included in the sample except for individuals with learning disabilities, as this study was a part of a larger one investigating the social care needs of adults with TS. Individuals with learning disabilities were excluded to avoid bias in the results of the study, since they may have social care needs that might not necessarily be related to having TS.

Smith et al. To this end, the sample of this study encompassed sixteen adults with TS. Many in-depth IPA studies have employed a similar number of participants and succeeded in retaining an idiographic focus on the individual voice Colton and Pistrang ; McCarthy et al. The sample included four females and twelve males. Thirteen of the participants reported being white British, two identified as other white ethnic group and one as Pakistani.

The mean age of symptomology onset was 8. Two of the participants reported to have experienced the onset of TS symptomology after the age of 18, three reported that their symptomology had exacerbated during adulthood, while eleven reported that their tics had stayed the same since childhood. Three participants characterised their symptoms as mild, eleven as moderate and two as severe and debilitating. Five participants had children ranging from one to two , one of which was diagnosed or displayed the symptomology of TS.

Table 1 outlines the demographic information of all included participants. The sample was not assumed to be representative of the broader population of adults with TS. Informed consent in writing was obtained from all individual participants included in the study. After taking part in an online survey, all eligible participants were asked to contact the researchers if they wanted to take part in a one-to-one interview, which resulted in a self-selected sample.

All potential participants were sent an information sheet giving the details of the study and were asked to choose the most convenient medium to conduct the interview: video call, phone or in person. A mutually convenient time to conduct the interviews was organised with the first author. No participant withdrew from the study and no stress was conveyed or reported to the researchers during or after the interview.

The participants were encouraged to seek clarification, raise any potential concerns and ask questions about the study and the research process. Data were collected over a period of seven months by the first author. Interviews lasted between 20 to 70 min, they were audio recorded and transcribed with any identifiable information removed. The voucher was intended to compensate the participants for their time and effort, and to reduce non-response bias in order to achieve a sample that is more representative of the population being studied Grady The interview schedule was constructed using a range of previously published interview schedules relating to chronic conditions and disabilities though no specific interviews in relation to TS were found and their impact on social identity Monteleone and Forrester- Jones ; Shinebourne and Smith ; Smith and Osborn Additionally, specific questions that had previously not been asked were included and the interview schedule was guided by the advisory group who helped to identify lines of inquiry not previously considered.

Such techniques in constructing interviews have been advocated by Flowers et al. The interview included topics about the emotional, social and practical implications of having TS in adulthood but also the perceived impact of TS on self and future self. Following Smith et al. The interview schedule was piloted with two adults with TS that were part of the advisory group for this study to ensure the validity. At the start of each interview, it was pointed out to all participants that they were not obliged to answer all the questions, that they were free to stop the interview at any time, and could request their data to be excluded from the analysis up until the point at which the study was completed. As with all qualitative research, there was variability in the depth and richness of the data collected within the interviews.

Furthermore, extensive interpretative notes regarding how the experiences had been described by the participants and why they had been described in that way were made. These initial codes, as well as a reflective diary kept by the researcher, enabled themes to emerge. Subordinate themes were developed by scrutinising and clustering the emergent themes. In turn, the subordinate themes were clustered into superordinate themes through a process of abstraction and subsumption. In the subsumption process, an emergent theme acquired a superordinate status and there appeared to be a series of other themes that fitted accordingly as subordinate themes.

This procedure was repeated successively for each interview transcript to ensure each interview was analysed on its own merit, and to allow personal experience and insight to emerge Smith et al. During the cross-case analysis stage, the superordinate and subordinate themes from each of the transcripts were examined to detect patterns across cases, with attention paid to both convergent and divergent themes. NVivo 11, a qualitative analysis software, was used to manage the data.

Although the authors acknowledge that alternative interpretations of the data are possible, special care was taken to ensure the validity of this research. Smith suggests that we should not evaluate qualitative research with quantitative criteria; rather, different criteria are advocated which entail internal coherence and presentation of evidence.

Internal coherence refers to whether the research is internally consistent and whether it deals with contradictions and ambiguities, and if it offers alternative readings. Presentation of evidence dictates that ample raw data should be available so that the reader can interrogate interpretations being made. In this article, the transcript extracts allow the reader to evaluate the interpretation made by the researcher. Furthermore, Lincoln and Guba suggest reflexivity as an indicator of validity.

The researcher acknowledged that complete objectivity was not possible but aimed not to allow personal values to skew the research. This was achieved through a reflective journal that was kept during the interviews, transcriptions and data analysis Rossman and Rallis Guba and Lincoln propose member checks as a method to enhance the credibility of a qualitative study. This method was used to assess the accuracy of the data. Finally, half of the transcripts were independently coded by the second author to ensure validity.

Any disagreements about interpretations were discussed until an agreement was reached. In line with the IPA guidelines, inter-rater reliability coding did not aim to produce a categorical analysis but rather to verify that the analysis had been systematically conducted and was supported by the data. The quotes selected were evaluated as the most representative, and the ones that articulated and exemplified the core essence of the themes. They were also picked based on their efficiency to demonstrate both the variation and depth of a theme. Identifying information is replaced within square brackets. Each of the superordinate themes comprised of at least two subordinate themes. All of the subordinate themes were evidenced with data from at least half of the participants in line with the recommendations of Smith et al.

The recurrence of subordinate themes in at least half of cases was a way to enhance the validity of the findings. Two distinct and divergent groups were generated in relation to incorporating TS into self: individuals that had accepted their condition as part of their own identity and life, and were willing to work with it as opposed to against it; and those that felt inferior due to TS and were grieving the loss of normalcy. The latter group felt restricted by TS and were incapacitated by the stigma that the condition attracted, and were dissatisfied with their existence. TS had become an indispensable part of the life and reality of this group. They had grown to accept and reconcile with their differences.

Thus, although the underlying awareness of TS remained, they were determined to live meaningful lives. I don't know if embracing is the correct word Simultaneously, it was acknowledged that homogeneity was untenable and that every individual possesses attributes that renders them unique. Participant 8 characteristically mentioned:. Participant 13 expressed a greater level of acceptance and presented TS as an attribute that did not fully define his identity or his life.

He still viewed himself as a unique multidimensional person and was able to distinguish between his impairment and self-identity:. This is a small part of what you are. As much as, say, someone who picks their nose and then hides it behind the sofa or something. It is as much as that as one hobby. Humans can't be defined by just one aspect…a part, there are a lot of things about you. The condition was never who one was but only something that a person had.

This was achieved by making social downward comparison, through focusing on other people with TS who were worse off than themselves Festinger The comparison was usually done on dimensions of tic severity and achieving life goals. They were therefore inclined to see themselves in a positive light through a self-enhancing social comparison. This could be interpreted as an identity management strategy adopted in response to the stigma attached to TS. Some participants also believed that the condition had afforded them an opportunity for self-development and felt that it let them evoke a search for a greater meaning in their lives. By facing adversity, they had managed to become emotionally stronger and TS allowed them personal integration and growth.

But, also, it also kind of helped me get into support work to deal with people with learning disabilities. Individuals in this group talked at length about how TS had taken things away from them, assumed centrality in their lives, and defined their sense of self. A discourse of loss, disadvantage and anger was communicated by these adults who viewed TS as being in charge of their being. Most importantly however, TS deprived them of their normalcy. TS was an identity that they had not embraced and there was a clear dissonance between their preferred social identity and the persona that TS imposed on them.

And I have so much to offer. But unfortunately, I can't do what I need to do because of my Tourette's. Participant 15 vividly described how TS had deprived him of normalcy while also revealing an underlying anxiety about how the condition left him vulnerable to external hostile judgement. And it's not even just things that people can see on me when they first meet me. They are the things that happen behind closed doors that no one sees and only I see, or sometimes don't see.

The rejection of the TS-categorisation may also be due to the fact that participants belong to other significant groups to which they draw positive self-esteem from. It's really not something I would like to have. I have a diagnosis for autism spectrum disorder and I'm quite…not proud of that, but I embraced it. But the tics, I do not like them.

I feel very, very uncomfortable a lot of the time, I feel like I can't relax and the sensation just before, it makes me very, very uncomfortable. It drives me crazy. And I find it very embarrassing and I don't want the attention Participant 3. In response to the TS stigma, many participants tried to conceal their spoiled identity Goffman by trying to control their tics. This helped them maintain a socially desirable identity. In other words, due to their ability to control their symptomology, the boundaries of the TS group were viewed as permeable:. Medication usually antipsychotic drugs also used to treat schizophrenia was reported by participants as an effective means of concealing their tics.

Nevertheless, most participants reported that the side effects of medication were distressing and deprived them of their personality:. Like haloperidol I am naturally like a very lively, active person and they just make you feel like you've got no energy and you feel like In response to their spoiled identity, the participants also tried to overcompensate for their tics by bolstering other socially desirable aspects of themselves. This is a common strategy among members of stigmatised groups in order to maintain a positive self-image and disprove stereotypes that are commonly linked to their social identity Miller et al.

I am the one that does the most work, so The sense of loss was even more pertinent to the minority of participants who developed their symptoms at an older age over 18 years old. These adults had to go through the process of biographical disruption and reconstruction Bury as opposed to individuals who developed TS from an early age and therefore were socialised to their role from quite early on. The latter was infused with altered social relationships and altered visions for the future. They described their lives as going through a qualitative shift and their past happiness, normalcy, self-sufficiency was contradicted to their current situation:.

If less severe, that would be difficult at times but at least I could still do things. So, I did have a busy life back then, working hard but also having lots of fun, travelling all over the world. In their accounts, the participants made extensive reference to social interactions they had throughout their lives and the subsequent impact these had on their self-esteem. Both negative and positive relationships were described. Most of the interviewees described how their symptomology was discredited, commenting on the negative feedback from their parents, teachers and siblings as a regular occurrence since childhood. Their tics were dismissed as simply behavioural problems in the past, which led to negative judgement by others. Nearly all of the participants in the study reported some form of rejection or victimisation as a response to their condition and described the subsequent effect that had on their self-esteem.

For some, victimisation and marginalisation was not only encountered within the realm of the public arena but also within their homes growing up. Family conflict and poor communication was narrated by many participants who felt criticised for their condition. They reported on how their families attributed blame to them, as well as a lack of parental understanding and acceptance. For some, this resulted in parents placing unreasonable demands on individuals with TS:.

They thought by telling me off or slapping me or whatever, punishment, you know, name calling…they thought that I would stop doing it. They thought it was something, you know, that could be stopped. So, ended up like watching television together and back in the days we had one television. So, I would have to sit behind the family, so they wouldn't get distracted. And they would humiliate me in public, you know, they would say stop being a monkey and then my sisters obviously because they were Thus, they taught their children that their tics represented an undesired differentness or a moral weight they had to carry.

They solely focused on the restrictions faced by people with tics and coached them to conceal their condition from others. Similar to parents of people with intellectual disabilities, close family members of our participants were the key people in shaping their identities and providing them with the social meaning that the condition bears Todd and Shearn Discrimination did not always manifest overtly but the participants also described subtle behaviours of the stigmatisers. They reported that people may respond to them with either superiority or excessive politeness. It has been attributed to less public tolerance of overt displays of prejudice.

Thus, it is a form of subtle, unconscious and mostly unintentional degradation of a group in everyday interaction. Because they often occur outside the level of conscious awareness, well-intentioned individuals can engage in these biased acts without guilt or knowledge of their discriminatory actions Sue Furthermore, the subtle tone of these interactions means that they are difficult to document and often dismissed and glossed over as being innocent and innocuous. Low self-confidence, poor self-esteem stemmed from these interactions and restricted them in their everyday life:.

They made me feel it was my fault, that I was doing something wrong and it also kind of made me feel segregated, always Interviewees also indicated through their narratives how the aftermath of being victimised still manifested in their social relations. Participant 15 described a lingering internal fear of becoming a victim again. It was a bad experience and I'm dead scared of that happening again. The negative social interactions that the participants may have experienced could have a detrimental impact on the self-consciousness. Therefore, receiving negative feedback could give rise to intense emotions of shame.

Some participants described a supportive social network that provided a buffer against the outside world Forrester-Jones and Grant Indeed, a non-judgemental and empathic group of friends was depicted that shielded them from negative experiences, discrimination and stigmatisation. Participants described finding acceptance in spite of a limiting condition, and they subsequently deepened relationships with those who provided such understanding.

This social support advocated on their behalf when necessary. Other participants also described the moral, financial, practical and ethical support their significant others provided. And then I don't do it alone. These intimates represented the wise, the normal who could relate to the stigmatised individuals. This theme encapsulates the deeply isolating consequences of having TS as an adult. The participants described a feeling of loneliness that stemmed from being segregated from the normal, and a lack of understanding in society, but also emerged from self-isolation and social withdrawal to cope with enacted stigma.

I was hidden in the cupboards and the rooms. I was never taken out into public. The excerpt above indicates the social invisibility that this group might endure and a resulted feeling of isolation. Segregation for people with TS was also implemented through excluding them from the workforce and therefore depriving them of the opportunity for full participation in the labour market. Participants described how, from their viewpoint, employees failed or refused to make reasonable adjustments which in turn inhibited them from becoming employed or sustaining a job.

It's just a big blow down, it really is. Most interviewees expressed a concern about being devalued and discriminated against because of their tics, and being judged through the lens of a negative group stereotype. This fear, which may have been triggered by past incidents of stigma or even by anticipation or suspicion of prejudice, may lead to social identity threat Steele et al. Participant 15 explains:.

In response to social identity threat, individuals in the study appeared to avoid situations that would expose them to the prejudice of others. Indeed, the majority of the participants believed that they would be devalued and rejected by others, causing them to withdraw socially:. Well, to socialise at all or to seek out friends, cause I was worried about being the joke Participant 3. Social avoidance may be viewed as a protective strategy to tackle social exclusion and feelings of rejection.

Some of the participants described the discomfort they felt when in the presence of others. In response to social identity threat, the participants preferred to retreat into the company of a few selected friends who understood their condition. There was a clear avoidance of disclosure, anxiety about exposure and vigilance to others behaviour. As participant 10 explains, it appeared easier for her to withdraw from the public view than to rely on the understanding of others:. So I don't really integrate with people very well. It's embarrassing It's just I'll go for avoidance rather than, you know, tackle it head on. This is in accordance with Goffman , who argued that stigmatised individuals begin to self-isolate because society fails to grant them the respect they anticipate.

Like for instance cinema I would get the back seat. Although they maintained that social and emotional support was available for children with TS and their parents, resources for adults were limited and could not be easily accessed. Whilst TS is not a condition restricted to childhood, the participants asserted that there was no continuity of care and that individuals with TS were at a high risk of failing to transition successfully to adult services.

I've not had any inquiries or contact from anyone regarding it…since the age of That was it. In addition, participants felt that their social support needs were not adequately addressed. They did not have access to support groups that were specifically for adults with TS, and subsequently, rarely had the chance to meet and befriend other adults with the same condition who might have lived through similar experiences and might be able to provide them with information about the condition. Participant 9 clearly pointed out:. And there was not much for adults, so I have to say Many of the participants maintained that access to an adult group would decrease their sense of isolation, would allow them to be part of a community, and give them a sense of belonging, a sense of safety and unconditional acceptance.

Furthermore, it would give them a platform where they could freely discuss their condition, their feelings and strategies to cope with TS. I'm part of something almost. Qualitative methodologies and, more specifically IPA, enable stories to be told directly from the people who have had the experiences and gain insights into some of their perceptions, something that has previously been lacking in this particular field. In relation to exploring the lived experience of adults with TS, our study indicated that the participants encountered both supportive and unsupportive social relationships as a response to their condition.

However, the participants felt that the social stigma linked to the condition isolated them. In addition, the fear of being discriminated against caused them to withdraw from social interaction. Our study suggests that individuals with TS tend to incorporate the condition into their identity in two ways: by trying to work with it and minimise its influence in their lives, or by working against it. The former group had accepted TS and had learned to live with it; it was inconsequential to their self-identity and not central to their self-concept.

This was mainly due to the fact that these participants perceived the differences between other people with TS and themselves as more salient than the differences to individuals who did not have TS and were members of other groups. Indeed, as is evident from the findings, participants with TS that had accepted their status were keen to make self-enhancing downward comparison to other individuals that had TS Wills ; Monteleone and Forrester- Jones They compared themselves to individuals that had more pronounced or severe symptomology and therefore viewed themselves as occupying a more favourable position than less fortunate others with TS.

The group working against the condition described feelings of difference as being central to their understanding of TS and wanted to distance themselves from the condition. With little or no positive representations of individuals with TS, it is not surprising that many participants reported emotional difficulties in their identity construction. In both groups, the participants did not view TS as a dominant identity characteristic. As is clear from the data, the participants did not embrace TS as a positive social identity and distinguish themselves from other people with the same condition.

They refused to view TS as a valid identity mainly due to the stigma associated with the condition. Rejecting or denying group membership is a common mechanism for people that belong to stigmatised groups in order to avoid prejudice Finlay and Lyons ; Meisenback In many descriptions, the home was a key site, where rejection or the fear of bullying was a regular part of life. These findings resonate with previous literature in which parents of individuals with TS tried to discipline their children, sometimes even by using violence due to their lack of understanding about the condition Khoury It is therefore important for professionals not to solely concentrate on ameliorating the tics of the affected person but also to provide support for the whole family.

Frictions with parents and siblings of an individual with TS suggests that the impact of TS extend beyond the individual and may affect family functioning. Apart from overt discrimination, a subtle demeaning message was communicated to people with TS due to less public tolerance of overt displays of prejudice. Because of its convert nature, it can be misrecognised as an innocent and trivial act. Nevertheless, it is common towards stigmatised groups and it can lead to a sense of heightened helplessness for these individuals, denying them their privacy, identity or disability experience Sue Future research should therefore further explore how microaggression is applied to individuals with TS and how it could be ameliorated through relevant interventions.

The findings of the study indicate that the participants may be vulnerable to experiencing social identity threat. Thus, due to being aware that TS is a culturally devalued condition, adults with TS may anticipate discrimination. This fear could arise in response to previously experienced incidents of stigma but also from the anticipation of being devalued. This is considered a defensive behavioural coping strategy and it may serve as an adaptive mechanism insofar as it reduces distress and limits exposure to discrimination Ilic et al. However, social withdraw also means one may have to rely less on their dwindling social resources and limit the diversity of their social network.

It also prevents adapting to stigma stressors and bolsters the feeling of inferiority. Indeed, the study indicated that most of the participants had a small, core network comprising of relatives, close friends or romantic partners that provided social support and were very involved in their everyday life. They provided a social safety net, helped them manage TS and reduce its fallout. However, their social networks were mostly lacking of peripheral weak ties due to stigmatisation and social withdraw. Weak ties are unstable and sparse but nevertheless enhance the quality of life of an individual, help their social integration, and mitigate loneliness Fingerman Furthermore, they can provide a diverse viewpoint, useful information and offer greater objectivity resulting from less emotional attachment between the members.

Another defensive behavioural strategy that the participants used in order to avoid the stigma experience is overcompensating. To enhance their social desirability, they excerpted more effort than non-stigmatised individuals and believed that they had to work harder in order to receive the same evaluations as them and strive to be successful. Many adults with TS in this study wanted to maintain a socially desirable identity by suppressing the tics and concealing their group membership, or by avoiding social interaction.

It is common for members of stigmatised groups to disidentify with their counterparts and align their behaviour with the non-devalued community as a means of coping with stigma Tajfel and Turner For example, the study of Crabtree et al. However, tic suppression has been reported to be a distracting, demanding and attention-consuming task that can create post-suppression discomfort and it is often of limited duration Cutler et al. A substantive amount of literature also suggests that identity-concealment may lead to worse mental health outcomes, including greater levels of anxiety, depression and lower self-esteem see Quinn et al.

As is evident, the techniques the participants used to tackle stigma were non-assertive, in the sense that that they did not directly address discrimination but avoided it, were overcompensatory in order to escape from it, or were geared to concealment of identity Chung et al. Individuals were internally coping with prejudice and, as they identified the problem within themselves, were apologetic about it. Defensive and self-directed strategies to avoid or mitigate the impact of discrimination is common among stigmatised groups Major and Schmader This is done by stigmatised individuals accepting the devaluation directed at them and finding ways to carry on without affecting the mainstream culture.

Nevertheless, future studies need to assess the effects of these strategies on the well-being and self-concept of adults with TS. The defensive mechanisms that the participants adopted also reveal self-stigma. Indeed, common expressions of self-stigma include feelings of shame, which reveal that the participants endorsed cultural stereotypes in relation to TS, considered that these applied to them, and believed that they would be devalued. Therefore, more interventions need to be developed to eliminate self-stigma among adults with TS. None of the participants in the group tried to counteract the discrimination of TS by increasing identification with the TS group. According to the rejection-identification model, stigmatised individuals can attenuate the negative effects of discrimination and maintain their psychological well-being and self-esteem by enhancing their group identity Branscombe et al.

Thus, participants had no group-based buffer against the negative effects of belonging to a stigmatised group, which a support group could potentially offer. Indeed, support groups could help increase group identification and cohesion, help build a sense of pride for individuals with TS and help them engage in collective action against discrimination. They also maintained that their sense of isolation and rejection could be ameliorated in a TS community for adults that would foster feelings of belonging among their members. Previous research on the benefits of support groups in coping with stigmatised conditions highlight the importance of providing a safe space where individuals could express their fears, and receive support and advice Crabtree et al.

Support groups have also been acknowledged as sites of unique reciprocity and mutuality that could facilitate expansion of social networks and understanding of self. The fact that a collective voice has not been formed also has implications for the self-advocacy movement. Indeed, there appears to be a lack of self-advocacy groups in relation to TS, and protest against discrimination is still individual and disorganised. Research suggests that membership of these groups can provide an opportunity for empowerment, counterbalance some of the negativity derived from stigma and ultimately can promote changes in society as a whole Anderson and Bigby The findings of this study must be considered in the light of a number of methodological limitations.

The majority of the interviews were conducted over the telephone or by email. Previous literature has pointed out the methodological limitations of conducting semi-structured qualitative interviews by telephone e. Nonetheless, in comparison to face-to-face interviews, telephone interviews are less intrusive for participants with TS, allowing increased privacy, that could result in a more enhanced interviewer-interviewee relationship — both elements important to generating rich qualitative data. They are also more pragmatic and allow participants that live far away and those with mobility difficulties to take part in research Holt Finally, they have been used successfully in IPA research in the past Reilly et al.

Respectively, the use of e-mail interviews has been found to be a particularly effective method of including persons with disabilities in the research process who might not otherwise be willing to participate Murray and Sixsmith The sample of adults with TS were a heterogeneous group. IPA aims to recruit a homogeneous sample and, although this was our initial intention, there was a variation of years of lived experiences and severity of symptomology as well as co-morbidities. Participants had been living with the condition for varying amounts of years and two individuals had developed tics after entering into adulthood. This suggests that the female population in this study was under-represented. Nevertheless, the experiences of women appeared to be in alignment with the male ones.

Yet, her previous interaction with people with TS might have also helped her find nuances and enabled in-depth understanding that may have been impossible in the absence of these experiences. Nevertheless, none of the researchers experienced TS themselves and this realisation made them more diligent in the data analysis process and heightened their awareness of potential biases Pillow with steps taken to resolve these risks. The themes that were generated highlight the multidimensional experience of having TS as an adult for the participants of this study.

In addition, the social and personal cost of Tourettes Lethargic A Case Study Analysis with TS in adulthood could be highlighted by exploring how adults with TS construct their identity. However, the participants felt that the social stigma linked to the condition isolated them. This is done by stigmatised individuals Tourettes Lethargic A Case Study Analysis the devaluation Tourettes Lethargic A Case Study Analysis at them and The Underage Drinking Problem ways Tourettes Lethargic A Case Study Analysis carry on without affecting the mainstream culture.

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