TikTok Tourette’s: Are We Witnessing a Rise in Functional Tic-Like Behavior Driven by Adolescent Social Media Use?

Jessica Frey,1 Kevin J Black,2 Irene A Malaty3 1Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA; 2Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO, USA; 3Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USACorrespondence: Jessica Frey, Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26505, USA, Tel +1 304-298-6127, Fax +1 304 598 6442, Email jess.el.frey@gmail.comAbstract: Perceptions of Tourette syndrome (TS) and tic disorders are often driven by social media. During the COVID-19 pandemic, social media consumption greatly increased, particularly in the adolescent population. In parallel with increased social media consumption, there has also been an increase in tic severity and functional tic-like behavior (FTLB). Given that many of the tic videos posted on social media are misleading, perpetuate false beliefs about TS, or reinforce tic-like behaviors, there is increasing concern that these videos are driving the rapid increase in FTLBs. Several studies have reviewed newly presenting cases of FTLB and have found shared characteristics, including that a higher proportion of affected individuals are female, there is a low proportion with a history of childhood or family tics, and symptom onset is typically acute and develops in the teenage years. In addition, the quality of the tics seen in association with FTLB mirrors many of the tics seen on popular social media channels, with higher rates of coprophenomena, tic attacks, and involvement of the trunk and extremities than is seen with typical tics. FTLBs are likely a specific subgroup of functional tics largely influenced by the portrayal of and growing popularity of functional tics posted on social media during the COVID-19 pandemic. However, several factors, including increased anxiety, social isolation, and social media use in general during the pandemic are likely also contributing factors to the surge of FTLBs seen recently. In this era of increased social media consumption, it will become increasingly important for clinicians to educate patients about where and how medical information is spread, to ensure the best possible diagnosis, treatment, and outcomes for patients.Keywords: functional tics, social media, functional tic-like behavior, COVID-19 pandemic, Tourette syndrom