TikTok Tics: A Neuropsychiatric Phenomenon

Tourette’s syndrome (TS) is a neuropsychiatric disorder characterised by compulsive acts, echolalia and tics - involuntary movements and gestures that are minor, quick, and repetitious. These tics can be physical, such as blinking, shrugging and jumping, or vocal, such as grunting, whistling and tongue clicking. 

The exact anatomical reasoning for tics remains undetermined, however, tics are attributed to dysfunction in several regions of the brain that are associated with movement and speech. This includes the thalamus, a major sensory relay centre that influences mood and movement, the basal ganglia, which controls muscle activity and posture to inhibit unintentional movement, and the frontal cortex, which is responsible for voluntary movement and expressive language. Neuroanatomic models suggest that tics may be caused by failures in the cortico-striatal-thalamo-cortical (CSTC) circuits of the brain which control execution of movement and habit formation, which is interconnected with the brain’s reward system. Hyperactivity in specific domains or throughout the pathway is thought to underlie Tourette’s. Due to this physiology, people with Tourette’s are comorbid with neurodevelopmental, mental, and behavioural disorders such as autism spectrum disorder (ASD) attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), depression and anxiety. 

In 2020, according to the CDC, around 1.4 million people in the US are affected by tic disorders. Suddenly, a new kind of tic disorder, similar to Tourette’s, began to spread all over the world, particularly in teenage girls. Within a three-week period in March 2021, the month when the World Health Organisation declared COVID-19 a pandemic, the views of short-form content under the hashtags “tourettes” and “tics” increased by 7%, attaining 5.8 billion views. Just over 50% of these videos had teenagers stating that they had developed “new tics”. This medical phenomenon became known as “TikTok tics” (TTT).

Nevertheless, this functional movement disorder is different to Tourette’s syndrome. For instance, research showed that the frequency of tics associated with TTT was much greater than typical TS. To illustrate this, those with Tourette’s tend to tic 0 to 13 times per minute, whereas the number of tics is almost doubled with TTT, with an average number of 29 times per minute. Additionally, these TTT tics started completely overnight and can be overcome. In contrast, Tourette’s syndrome tends to appear in childhood between the ages of 2 and 14 and cannot be treated. One defining characteristic that set TikTok tics apart was the similarities of the tics between patients worldwide, unlike Tourette's tics which are unique to each individual. Researchers found similar vocal and physical tics, including phrases such as “woohoo” and “flying shark”, a large use of obscene language, as well as hitting and banging the body and other people. One very specific word was “beans”, in which 53% of videos on Tourette’s TikTok contained. These tics are very specific to the content creators found on the platform, which gave physicians their first clue as to the cause of this new type of mass sociogenic disorder.

Paediatric neurologist Dr Russell Dale witnessed this spectacle, seeing a rise in referrals for patients with tics between 2020 and 2021. During an interview on “60 Minutes Australia,” Dr Dale stated that “the stress of the pandemic, plus other stress factors in life, accumulated. And if you are chronically stressed, the body starts to fail and struggles to cope.” The movement disorder was made worse by the pandemic, which caused a rise in social isolation, conflict and sheer boredom, resulting in the increased use of social media. Girls tend to have depression and anxiety more than boys, hence they are more likely to be affected by the tic disorder that they see on their phone screens. This may also explain why these tics were so common in girls, with around 65% of the research cohort consisting of individuals who identified as female.

The phenomenon of social contagion refers to the spread of behaviours through a social network. During the Coronavirus outbreak in the United States, TikTok's user base grew by 180% among users between the ages of 15 and 25. By passive consumption, TikTok algorithmically curated an individual's ‘For You’ page with content that they engaged with. By looking at each feed, users were introduced to a new ‘side’ of TikTok’. Girls who began to tic could find a vast amount of content and connect with other girls going through a similar experience to them, introducing them to Tourette-related videos, which provided a support framework for girls experiencing TTT. For Dr Russell Dale, suggestibility was one of the factors that contributed to the tic disorder, causing girls to adopt the symptoms that they observe in others whilst strolling. 

In conclusion, the rise of TikTok tics in teenage girls highlights the influence of social media and the potential impact it can have on mental health. Despite resembling Tourette’s syndrome, it is a distinct disorder with its own unique characteristics. The stress of the pandemic, coupled with suggestibility, likely contributed to the worldwide spread of TTT among adolescent girls. While the exact anatomical cause of Tourette's syndrome and TikTok tics remains unclear, ongoing research and awareness-raising efforts can help improve understanding and provide support to those affected by these disorders.

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