Monday, October 18, 2021

TikTok tics

Doctors around the globe have reported seeing a baffling surge in the number of teenage girls seeking medical attention for tics since the start of the pandemic—a trend that many of them have linked to TikTok videos, the Wall Street Journal reports. Doctors were reportedly left scratching their heads at the influx of teenage girls experiencing the “physical jerking movements and verbal outbursts,” as men have traditionally been far more likely to develop the movement-disorder. But as doctors in the U.S., Canada, Australia, and the United Kingdom began comparing notes, they realized that all the teens shared a fondness for TikTok videos. They had also reportedly been watching videos of influencers sharing their experience with Tourette’s syndrome, a nervous-system disorder that causes people to make involuntary movements or sounds. Doctors say that the teens who’ve recently experienced such behaviors are likely to have pre-existing diagnoses like depression or anxiety. “There are some kids who watch social media and develop tics and some who don’t have any access to social media and develop tics,” Dr. McGuire, an associate professor at John Hopkins University’s Department of Psychiatry and Behavioral Sciences, was quoted saying. “I think there are a lot of contributing factors, including anxiety, depression, and stress.” 

In June 2019, psychiatrist Dr. Kirsten Müller-Vahl from the medical school in Hanover, Germany, encountered a strange mystery. The Tourette’s ward she was responsible for was flooded with patients with symptoms she couldn’t explain. There were dozens of teens and people in their 20s who were never diagnosed with Tourette's syndrome, but suddenly began to suffer from the "tics" that characterize it. 

Dr. Müller-vahl has treated Tourette's for 25 years. She says the syndrome is most often diagnosed at a very young age, usually around age six, and is more common in boys. 

In addition, the "tics" that characterize the disease are usually unique to each person. 

In this case, more young women and girls came to the ward, and all the new patients, who as mentioned had never been diagnosed with the syndrome, suffered from the exact same "tics.” They mainly shouted “flying shark,” “you’re ugly” or “heil Hitler.” 

Her ward soon discovered that the new patients were mimicking the "tics" of a young German named Jan Zimmerman, who runs a popular YouTube page where he shares how he copes with Tourette's disease. Over the past two years, Zimmerman has managed to become a beloved YouTube star, with two million subscribers to his page. 

In a study published by Dr. Muller-Vahl in the journal Brain of Oxford Academic publishing, she emphasizes that this isn’t Tourettes, but a completely different problem known in free translation as Functional Movement Disorder (FMD). 

According to her, while Tourette's syndrome develops as a result of neurological damage, people can also develop “tics” from psychological or environmental causes. 

When she explained this to new patients who were admitted to the clinic, some of them stopped suffering from these symptoms. Others needed psychotherapy to stop the problem, but the fact that so many young people suffered from exactly the same symptoms fascinated the specialist and the rest of her staff, who wanted to understand exactly why this was happening - and why now. 

Mental disorders can spread like a plague. 

Throughout history, many psychological phenomena have been recorded that spread in a manner similar to the outbreak of a contagious epidemic. A similar case occurred in 2011 in Le Roy, a small town in northern New York, when a group of girls began to develop "tics" that included facial distortions and verbal outbursts. The really weird thing about the story was that people who read about the case or were exposed to it on social media started to develop these same symptoms. 

In the past, experts called such occurrences "mass hysteria." Today it’s referred to by a more politically correct term, Mass Psychogenic Illness.

Robert Bartholomew, a clinical sociologist, was the first to state in a published study that social networks contribute to the accelerated spread of these symptoms. According to him, throughout history, these outbreaks have in fact been an expression of the most common fears of the period. 

"In the 17th century we had witches, today it's technology," he said. 

Today, TikTok is a platform that allows people with Tourette’s to better cope with the challenges they face, and to win the love of the public and hugs from those who weren’t aware of their challenges. The hashtag #tourettes is extremely popular, with 4.6 billion views as of this writing. Experts emphasize that this is a welcome phenomenon, but there may be consequences we’re just beginning to understand. 

Recently, many articles have been published by experts warning against this situation, which now has a very catchy name: "TikTok Tics.” 

In an article published in the March 2021 edition of the British Medical Journal, a significant increase was reported of women and girls suffering from "tics.” In a more recent study from April 2021, a group of doctors from Texas reported a 60% increase in the number of patients who came to the clinic with tics, compared to the days before coronavirus. 

“I have never seen such an increase in distress " 

Tamara Pringstein and Davide Martino are neurologists at the University of Calgary in Canada. In 2008, the two opened their Tourette’s treatment clinic, and have since treated an average of 200 new cases a year. Between May 2020 and May 2021, this figure increased to about 300 cases per month on average. 

According to them, they first noticed this increase in the summer of 2020, as they treated a large wave of young people who suffered from "tics" without ever being diagnosed with Tourette’s. 

Martino said that since then the rate of cases has only risen, until at Christmas he topped out at "astronomical proportions." Here, too, many patients showed exactly the same symptoms, with "tics" that were more or less the same. The two believe that the reason for this increase is partly due to the anxiety created by COVID-19, as well as the fact that many children have increased screen time, especially with Tiktok and other social networks.

 Pringstein stressed that "throughout my career, I have never seen such an increase in distress in young people and teens, it’s frightening." 

The data show that in the last decade there has indeed been a continuous and gradual increase in the proportion of young people suffering from tics not related to Tourette’s but many researchers believe that coronavirus has contributed to an even greater acceleration of this strange phenomenon. 

The good news is that this is not really neurological damage and that these problems can be treated relatively easily. But the strange story highlights the need for every parent to pay attention to emotional changes in their children, especially during this period, even if on the surface everything seems to be normal. 

Müller-Vahl KR, Pisarenko A, Jakubovski E, Fremer C. Stop that! It's not Tourette's but a new type of mass sociogenic illness. Brain. 2021 Aug 23:awab316. doi: 10.1093/brain/awab316. Epub ahead of print. PMID: 34424292. 


We report the first outbreak of a new type of mass sociogenic illness (MSI) that in contrast to all previously reported episodes is spread solely via social media. Accordingly, we suggest the more specific term "mass social media-induced illness" (MSMI). In Germany, current outbreak of MSMI is initiated by a "virtual" index case, who is the second most successful YouTube creator in Germany and enjoys enormous popularity among young people. Affected teenagers present with similar or identical functional "Tourette-like" behaviours, which can be clearly differentiated from tics in Tourette syndrome. Functional "Tourette-like" symptoms can be regarded as the "modern" form of the well-known motor variant of MSI. Moreover, they can be viewed as the 21th century expression of a culture-bound stress reaction of our post-modern society emphasizing the uniqueness of individuals and valuing their alleged exceptionality, thus promoting attention-seeking behaviours and aggravating the permanent identity crisis of modern man. We wish to raise awareness of the current global "Tourette-like" MSMI outbreak. A large number of young people across different countries are affected, with considerable impact on health care systems and society as a whole, since spread via social media is no longer restricted to specific locations such as local communities or school environments.spread via social media is no longer restricted to specific locations such as schools or towns. 

Heyman I, Liang H, Hedderly T. COVID-19 related increase in childhood tics and tic-like attacks. Arch Dis Child. 2021 Mar 6:archdischild-2021-321748. doi: 10.1136/archdischild-2021-321748. Epub ahead of print. PMID: 33677431.

From the article: 

Since the onset of the COVID-19 pandemic, paediatricians and child mental health practitioners have noticed an increase in tic symptoms in some children and adolescents already diagnosed with tic disorders. Interestingly, clinicians have also seen a marked increase in presentations of sudden and new onset of severe tics and ‘tic-like’ attacks. 

There is an urgent need to collate systematic data on this group as this is a rare and unusual subtype of tics and Tourette syndrome, differing in age and type of onset and expected patterns of tics. Typically, childhood tics start around 5–7 years and show a waxing and waning course of predominantly motor tics, more commonly affecting boys in a ratio of 4:1. The new surge of referrals consists of adolescent girls with sudden onset of motor and phonic tics of a complex and bizarre nature. In London, UK specialist tic clinics at each of the two children’s hospitals, each centre received four to six referrals per year (out of a total of approximately 200 in 2019/2020), which were acute onset tics in teenage girls. In the last 3 months (end of 2020–January 2021), both centres have been receiving three to four referrals per week of this nature which, if it continues, would amount to 150–200 cases per year and effectively double the referral rate.  

Initial impressions are that these adolescent girls fall into two groups: the first present with explosive functional tic-like movements on a background of diagnosis of, or vulnerability to, motor and phonic tics. The second group comprises florid, completely new onset tic-like disorder that appears functional in nature. Both groups may have undiagnosed neurodevelopmental impairment, autism spectrum disorder (ASD), specific learning difficulties and attention deficit hyperactivity disorder (ADHD). Distinguishing these two subtypes can be challenging; however, the likelihood is that in either case the precipitating factor for symptomatology and impairment is anxiety (probably in part COVID-19 related), and importantly, the same management strategies are suggested for both of these groups.

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