To examine how gender minority (GM) identity relates to etiological factors and health outcomes in functional tic like behaviours (FTLB).  

GM people experience stigma-related stressors which may result in gender dysphoria, a condition associated with higher rates of depression, anxiety, disability, and lowered quality of life. During the COVID-19 pandemic, we observed a rise in FTLB which appeared to occur disproportionately in GM people. 

Patients aged 11-25 years with FTLB (n= 34) were age and assigned sex-matched to Tourette Syndrome (TS [n= 21]), and healthy controls (HC [n=21]). Groups completed self-report measures and a clinical neuropsychiatric interview that investigated demographics, quality of life, disability, loneliness, neuropsychiatric disorders, social interaction anxiety, social phobia, vulnerable attachment, distress tolerance, pandemic experiences, suggestibility, family functioning, and social media use. Validated measures of gender dysphoria and GM stress and resilience were not included. 

41.2% of FTLB patients disclosed a GM identity as compared to 9.5% of TS and 14.3% of HC (p=.013). GM identity was significantly related to total disability (p=.017), anxiety (p=.033), depression (p=.005), social phobia (p=.037), social interaction anxiety (p=.028), lower psychological quality of life (p=.010) and self-reported worsening mental health during the pandemic (p=.022) across subgroups. An interaction between GM identity/diagnostic group indicated GM HC reported lower distress tolerance than cisgender HC (p=.027). All other relationships and interactions were non-significant. Regression analyses indicated the gender identity/disability and diagnostic group/disability relationships were strongly and nearly identically mediated by anxiety and depression (p<0.001).

Although validated measures of gender dysphoria were not included, our study results suggest greater disability from anxiety and depression  may have increased the clinical presentation of GM patients with FTLB during the COVID-19 pandemic, as compared to their cisgender peers and controls.