4 ms·
> So apparently when a doctor in a white coat tells these people they definitely don't have Tourettes, the behavior stops? I don't know if there's a general te
by derefr 5y ago
> So apparently when a doctor in a white coat tells these people they definitely don't have Tourettes, the behavior stops?
I don't know if there's a general term for this, but there seem to be a category of syndromes where if you're high-functioning with the syndrome, then it's possible to suppress the symptoms, and whether you're expected to suppress the symptoms depends on whether a doctor "grants you the privilege" of a diagnosis of having the disease.
For example, Hikikomori in Japan—these people almost certainly have Social Anxiety Disorder, but it's their parents/caregivers that enable them to live as recluses, and they only tend to do this if they believe their child has some sort of clear mental illness. If they take their child to a psychiatrist and the psychiatrist says "nope, no social anxiety, they just like staying home to play video games", then the parents would likely stop enabling the child to stay in their room all the time, and instead would force them to go out. Even if it turns out that the child really just has high-functioning Social Anxiety Disorder, to the point where it's "masked" from a signs-and-symptoms based diagnosis; and so is still markedly suffering when made to go out in public. Without the diagnosis, they're no longer allowed to be free from social approbation when they avoid people.
I would think a similar thing could be at play in "high-functioning", able-to-be-suppressed-with-constant-effort Tourettes cases: without the diagnosis (or rather, with a negative diagnosis), nobody around you will tolerate a Tourettes outburst from you, so you just have to "suck it up" and mask it as hard as you can. Also, given the negative diagnosis, your supporters will likely no longer associate the more subtle symptoms with Tourettes, as they now "know" you don't have it; so they'll mentally categorize those tics, if they do show up, as being something else.
In such cases, you'd also expect that if someone had always known such symptoms were socially-unacceptable and so had always been actively suppressing them, then finding out that there's a disease they might have where presenting these symptoms would be considered socially-acceptable in the context of having that disease, would mean they'd suddenly be willing to start 1. claiming they have the disease, and 2. presenting the symptoms—but only after people know and understand their claim to have the disease, as the whole point is to be able to finally "let out" the symptoms while avoiding social approbation for them.
> So a sudden swing in the sex ratio for a disease that's long been presumed to have some kind of male-associated underlying genetic basis that lines up with a prominent female influence seems like pretty strong evidence for their theory.
Charitable interpretation: women are underdiagnosed with Tourettes, because some combination of hormonal and social factors generally leads to them generally being higher-functioning — i.e. "leaking" the symptoms less. But actually, they're still being impacted, just silently (i.e. their dopamine is being drained faster by having to "fight the urge", much like someone with OCD.)
This is the current hypothesis for the gender disparity in diagnosis of childhood ADHD. It's very underdiagnosed in girls (which we know because a lot of these undiagnosed girls become adult women who go to a psychiatrist and find out they have adult ADHD, and then think back and realize they've always had the internal experience of ADHD but were never diagnosed.) We think this is because girls are more trait-conscientious, which leads to them being more motivated to not let (socially-unacceptable) hyperactivity symptoms "leak", while still internally suffering from those symptoms, and visibly suffering from the more socially-acceptable symptoms (which alone aren't usually enough for people to put two and two together and send them to a psychiatrist for diagnosis.)
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All that being said, yeah, I don't think this is really "high-functioning Tourettes." That isn't quite how Tourettes works; there's a lot of involuntary stuff in Tourettes that absolutely cannot be suppressed no matter how much you might want to, and
But there are a number of etiologies with related symptom profiles. My guess about what actual "property" these girls are actually noticing about themselves, is that they're high-functioning on the autistic spectrum (another thing underdiagnosed in women!) and so find that stimming behaviors — which can look a lot like Tourettes motor tics, but are actually voluntary, just highly preferred to be executed when possible — help to calm certain sensory processing problems they have.
- larsiusprime 5y ago> I would think a similar thing could be at play in "high-functioning", able-to-be-suppressed-with-constant-effort Tourettes cases: without the diagnosis (or rather, with a negative diagnosis), nobody around you will tolerate a Tourettes outburst from you, so you just have to "suck it up" and mask it as hard as you can. Tourette's can't really be suppressed consistently, it comes out eventually, and suppressing it now just makes it worse later. It is very hard to hide -- believe me, I've tried. Also, see the comment in the above thread -- one pretty strong giveaway is an entire lack of facial tics and other classic tells. I have a ton of the "famous" Tourette's symptoms -- coprolalia, echolalia, palilalia, even a small touch of the dreaded copropraxia, not to mention at times extremely exaggerated arm movements (beating my chest like a gorilla is the most common). However, my first tics, and which continue as a constant background noise, are small facial grimaces, nose wrinkles, blinks, making tiny grunts, etc. It is extremely anomalous to see someone present with "Tourette's" and not have any of those low level tics, but all the "fancy" ones. > Charitable interpretation: women are underdiagnosed with Tourettes, because some combination of hormonal and social factors generally leads to them generally being higher-functioning — i.e. "leaking" the symptoms less. But actually, they're still being impacted, just silently (i.e. their dopamine is being drained faster by having to "fight the urge", much like someone with OCD.) I'm more than willing to keep an open mind, but look at the effect size. Swinging from 1:4.3 to 9:1 is a change of 38X. That is RIDICULOUSLY huge. I'm happy to postulate that women are undiagnosed to some degree, but a swing of that size, that is that sudden, and which lines up so closely with a specific group and a specific female influencer, based primarily on observed novel physical symptoms, charitably speaking at least merits a little scrutiny, wouldn't you think? A mere 1.5X change would be enormous, 38X is astronomical.
- derefr 5y ago> Swinging from 1:4.3 to 9:1 is a change of 38X. That is RIDICULOUSLY huge. Those numbers would not be as bad if one postulates that there's a subset of men who also have the right factors to lead to underdiagnosis, such that the right influencer with a male audience would make men's numbers shoot up as well; and that such a mens' influencer just happened to have not shown up yet. > It is extremely anomalous to see someone present with "Tourette's" and not have any of those low level tics, but all the "fancy" ones. Is it possible that there is an undiscovered "diagnostic spectrum" on which Tourettes is the endpoint? Like how, at some point, we knew low-functioning autism was a thing, but only later figured out that high-functioning autism (e.g. Asperger's) was a thing? ---- (That being said, I do think I agree with you that this probably isn't Tourettes of any kind; see the postscript in my previous comment. I just like to ask these Devil's Advocate kind of questions to see where they go, in case there's interesting science down one of these unwalked paths.)