‘Outbreak’ of Sudden Tics Among Teen Girls Has Surprising Global Similarity

Physicians are reporting a global increase in the number of young people with functional tic-like behaviors, with symptoms that are severe, frequent, and highly disabling. The numbers have increased markedly during the past two years of the COVID-19 pandemic.

The tic-like behaviors come on rapidly and have been strikingly similar, and individuals have only a limited ability to suppress them, according to an article by Tamara Pringsheim, M.D., and colleagues. They published their findings from eight tourette syndrome clinics in five countries in the December 2021 Movement Disorders. Before the pandemic, referrals for functional tic-like behaviors as a primary problem accounted for only about 1% to 2% of caseloads, but now account for up to 35%.

What’s driving this increase? Researchers found that all patients developed their symptoms after watching influencers on social media, primarily TikTok and YouTube, with tics or Tourette syndrome. The pages are wildly popular: On TikTok alone, #tourettes had racked up 5.2 billion views by press time. These patients share other similarities: They were more than four times as likely to have an anxiety disorder and five times as likely to have a depressive disorder as those with primary tic disorders.

“The magnitude of functional disability and level of parental distress caused by the tic-like behaviors are extreme,” the authors wrote. They included large amplitude arm movements, hitting and punching self or family members, and blurting out obscenities or bizarre words or phrases. One teenager on YouTube, whose condition appeared abruptly 16 months ago, likened her symptoms to what happens “if you shake a can of [soda] and open the tab.”

“Functional tic-like behaviors have always been around, like other functional movement disorders, but until recently they were not common in clinical practice,” Alexander Münchau, M.D., professor and director of the Institute of Systems Motor Science in Lübeck, Germany, told Psychiatric News. He is a co-author of an article on the phenomena also published in the December 2021 Movement Disorders. “We know that this subconscious, automatic picking up of movements from others is not uncommon and has been referred to as echo-phenomena.”

Münchau pointed to similar “outbreaks” of functional movement disorders within communities, such as “jumping Frenchmen of Maine” syndrome, characterized by an extreme startle reaction and echolalia. It caught on among lumberjacks in a logging camp in the 19th century. “This usually happens when people meet others face to face. What is new is that such echo-phenomena can also occur through social media, without personal contact,” he added.

Tammy Hedderly, M.D., an acute pediatric neurologist who specializes in movement disorders at the Evelina London Children’s Hospital, told Psychiatric News that the brains of people affected are often highly suggestible. “Watching tics on social media may therefore be a perpetuating factor that makes symptoms worse.” Factors such as social isolation, pandemic stressors, and loss of routine in relation to the pandemic is also playing a role. “I was surprised at how many children and young adolescents were also engaging in self harm and the percentage that reported suicidality, which demonstrates the level of distress the children and families are experiencing,” she added.