Researchers in several countries are reporting that the pandemic has triggered an increase in the number of teen girls with tic-like behaviors that are severe, frequent and disabling.

The tic-like behaviors come on rapidly and individuals have only a limited ability to suppress them, according to research from Tamara Pringsheim, M.D., and colleagues published in the December 2021 issue of Movement Disorders. They looked at data from eight Tourette syndrome clinics in five countries. Before the pandemic, referrals for functional tic-like behaviors as a primary problem accounted for about 1% to 5% of cases, but now account for 20-35% in these clinics. “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.”

Pringsheim and colleagues identified several potential contributing factors including the increased social isolation and stress and increased use of social media during the pandemic. The rise in cases coincided with an increase in the popularity of social media videos of people tics or tic-like behaviors. This social media “exposure to tics or tic-like behaviors is a plausible trigger for the behaviors observed in at least some of these patients,” the study authors write. These videos are very popular — on TikTok alone, #tourettes has more than 6 billion views.

“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.” This usually happens when people meet in person, Münchau added. “What is new is that such echo-phenomena can also occur through social media, without personal contact.”

“Adolescents present acutely, and they and their families are invariably distressed and frightened,” Isobel Hyman and colleagues wrote in a recent article in Archives of Disease in Childhood.  “There is increasing evidence that personal, family and professional anxiety serves to exacerbate and prolong episodes, while clear explanation, reassuring and calm management can reduce or even eliminate occurrences.”

While there are some similarities with Tourette syndrome, researchers point to several differences: Tourettes typically starts in childhood, begins gradually, involves simple movements, and impacts boys more than girls; this new tic-like concern typically begins in adolescence, starts suddenly, involves complex movement, and impacts girls more than boys. In addition, Tourettes is often associated with ADHD and obsessive-compulsive disorder, while the newer tic-like phenomenon is more often associated with anxiety and depressive disorders.

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.

Adapted from Psychiatric News May 23, 2022.

References

• Heyman, I., et al. COVID-19 related increase in childhood tics and tic-like attacks. (2021). Archives of Disease in Childhood, 106:420-421.b 
• Pringsheim, T., et al. (2021), Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic. Movement Disorders, 36: 2707-2713. 
• Paulus, T., et al. (2021). Pandemic Tic-like Behaviors Following Social Media Consumption. Mov Disord, 36: 2932-2935.