How Teens Recovered From the ‘TikTok Tics’ - The New York Times
▻https://www.nytimes.com/2023/02/13/health/tiktok-tics-gender-tourettes.html
Over the next year, doctors across the world treated thousands of young people for sudden, explosive tics. Many of the patients had watched popular TikTok videos of teenagers claiming to have Tourette’s syndrome. A spate of alarming headlines about “TikTok tics” followed.
But similar outbreaks have happened for centuries. Mysterious symptoms can spread rapidly in a close-knit community, especially one that has endured a shared stress. The TikTok tics are one of the largest modern examples of this phenomenon. They arrived at a unique moment in history, when a once-in-a-century pandemic spurred pervasive anxiety and isolation, and social media was at times the only way to connect and commiserate.
Now, experts are trying to tease apart the many possible factors — internal and external — that made these teenagers so sensitive to what they watched online.
Four out of five of the adolescents were diagnosed with a psychiatric disorder, and one-third reported past traumatic experiences, according to a study from the University of Calgary that analyzed nearly 300 cases from eight countries. In new research that has not yet been published, the Canadian team has also found a link to gender: The adolescents were overwhelmingly girls, or were transgender or nonbinary — though no one knows why.
Perhaps as striking as the wave of TikTok tics is how quickly it has receded. As teenagers have resumed their prepandemic social lives, new cases of the tics have petered out. And doctors said that most of their tic patients had now recovered, illustrating the expansive potential for adolescent resilience.
Historians looking back thousands of years have come across stories of patients — most often women — with tremors, seizures, paralysis and even blindness that could not be explained. The ancient Greeks called it “hysteria” and blamed a wandering uterus. Sigmund Freud deemed the condition “conversion” and theorized that it was caused by suppressed traumatic experiences.
In more recent decades, scientists have gained a greater understanding of how anxiety, trauma and social stress can spur the brain to produce very real physical symptoms, even if body scans or blood tests show no trace of them. When these illnesses interfere with day-to-day life, they are now called “functional disorders.”
“We all recognize that the mind can make the body do things,” said Dr. Isobel Heyman, a child and adolescent psychiatrist at the UCL Great Ormond Street Institute of Child Health in London, who published the first report on the pandemic tics. Most people, after all, have experienced fear that makes their heart race or anxiety that ties their stomach in knots.
“But when the symptoms are quite bizarre and quite intense — like a seizure, or not being able to walk, or ticlike movements — we think, ‘How on earth can the brain generate symptoms like this?’” Dr. Heyman said. “It just can.”
Around the time Aidan started to tic, Dr. Pringsheim and Dr. Davide Martino, movement specialists at the University of Calgary, saw a message in an online forum for the American Academy of Neurology.
“My practice has seen an unprecedented increase in young adolescent women with what appears to be acute explosive motor and vocal tics,” wrote a doctor in Kansas City, Mo.
The Canadian neurologists had seen the same thing. Most of these new patients did not fit the mold of a typical case of Tourette’s, which generally affects boys and begins in early childhood. Tourette’s tics tend to be simple movements — like blinking or coughing — and they wax and wane over time. In contrast, the new patients were often rushed to the emergency room with tics that had appeared seemingly overnight. They were relentless, elaborate movements, often accompanied by emotionally charged insults or funny phrases.
The matching accounts from physicians across the world made the neurologists suspect a shared source. They searched on YouTube but found little. Dr. Pringsheim’s teenage daughter suggested that they look at TikTok, an app used by more than two-thirds of American teenagers.
When they searched for the word “tic” and hundreds of videos popped up, Dr. Pringsheim was stunned.
“This is the person that I saw in my clinic today,” she recalled thinking.
The TikTok influencers were saying the same words — like “beans” and “beetroot” — and making the same motions, like thumping their fists on their chests.
Over the next few months, the influx of patients made the pediatric movement disorder clinic’s waiting list swell from three months to a year. “It was an avalanche,” Dr. Pringsheim said.
TikTok videos labeled #Tourettes have been viewed 7.7 billion times.
By last summer, Dr. Martino and Dr. Pringsheim had compiled a detailed registry of 294 tic cases from clinics in Australia, Britain, Canada, France, Germany, Hungary, Italy and the United States. They wanted to know: What made these adolescents so vulnerable to the tic videos, while others scrolled past?
An overwhelming number of patients had a history of mental health conditions. Two-thirds were diagnosed with anxiety and one-quarter had depression. One-quarter had autism or attention deficit hyperactivity disorder. Roughly one in five had a prior history of tics.
Eighty-seven percent of the patients were female, a sex skew that was also found in previous outbreaks of mass psychogenic illness. No one knows why girls are more susceptible to this kind of social influence. One theory is that women may seek out belonging more than men do, and may empathize more strongly with others’ suffering. Women also experience higher rates of depression, anxiety and sexual trauma than men.
At a conference on tic disorders last summer in Lausanne, Switzerland, doctors from several countries shared another observation: A surprising percentage of their patients with the TikTok tics identified as transgender or nonbinary. But without hard data in hand, multiple attendees said, the doctors worried about publicly linking transgender identity and mental illness.
“These kids have a tough enough life already, and we don’t want to inadvertently somehow make things even worse for them,” said Dr. Donald Gilbert, a neurologist at Cincinnati Children’s Hospital, whose adult daughter is transgender.
Though the data is limited, some studies have suggested that transgender people have higher rates of functional disorders, which may be related to experiencing higher rates of discrimination, stigma and bias, said Dr. Z Paige L’Erario, a neurologist in New York City who collaborated on the unpublished study.
These adolescents were “at an already difficult time of their life, going through this pandemic,” said Dr. L’Erario, who is nonbinary. The tics were “a manifestation of their hardship.”
Other doctors suspect that a small subset of adolescents with serious mental health issues may be more susceptible to social influences. And during the pandemic, adolescents spent more time online, engaging with increasingly popular content related to mental health and gender, Dr. Hnatowich said.
Shortly after finishing the rehab program, Aidan returned to school. They wrote and directed their first play, and graduated on time, with honors.
Aidan hasn’t had a tic in a year. They no longer use TikTok — not because they’re afraid of getting sick, but because they find it boring. They still go on Instagram.
Aidan has learned to better identify and manage their anxiety. With the support of their psychiatrist, the teenager is planning to wean themselves off antidepressants early next year. Their stress about gender has also faded. They now believe that the tics were an unfortunate byproduct of an earnest, if futile search for definitive answers about their mental health and identity.
“After a year of therapy, I came to the conclusion that labels are stupid,” Aidan said. “I’m just out here.”
Neurologists said that a majority of the adolescents who developed tics during the pandemic — even those who did not have intensive treatment like Aidan — have stopped twitching. Those who did not get better have often refused to accept the functional diagnosis. Others have struggled to resolve the stressors underlying the tics. Some have developed other symptoms, like seizures or paralysis.
