The Rise of Functional Tic-Like Behaviors: What Do the COVID-19 Pandemic and Social Media Have to Do With It? A Narrative Review

Abstract

BackgroundThere has been a rise in explosive onset of tic-like behaviors during the COVID-19 pandemic. Historically, this is an uncommon phenomenology of functional movement disorders across all ages. Both the psychological burden of the pandemic and social media usage have been implicated in the rise of these tic-like behaviors.MethodsThis paper provides a narrative review of the literature on chronic tic disorders, functional tics, and mass functional illness with particular focus on the key distinguishing features, role of social media, and the role of COVID-19.ResultsThe COVID-19 pandemic has profoundly affected the mental health of many individuals, including children, adolescents, and their caregivers. Implementation of lockdowns, lifestyle disruptions, school closures, and social distancing have driven a surge in social media and digital technology use. The combination of predisposing factors, the psychological burden of the COVID-19 pandemic, and social media are implicated in the rise and spread of tic-like behaviors; which may represent a modern-day form of mass functional illness. While many of the features overlap with functional tics, there are emerging distinctive features that are important to recognize. A more encompassing term, Functional Tic-Like Behaviors, is used to better reflect multiple contributing factors.ConclusionKnowledge of these differences is essential to mitigate downstream health effects and poor outcomes.

The spectrum of functional tic‐like behaviours: Data from an international registry

“…Overall, these differences suggest the existence of two possible subtypes of FTLB [16], one related and one unrelated to social modelling. Within the former, a minority of patients also reported in-person exposure to individuals, usually within their peers, experiencing tics or tic-like behaviours.…”

Sudden Onset Tic and Tic-Like Presentations in Older Adolescents and Adults

“…While there are clear differences between the disorders, TS and FTLB also share some common features. Both TS and FTLB are subject to suggestibility and distractibility [ 4 ••, 7 ••, 23 , 24 ••]: both categories of behaviors can be triggered or aggravated by directing the focus of communication toward the behaviors and by intercurrent stressors, and both can be alleviated by re-orienting attention toward other attention-demanding tasks (particularly tics) or simply away from the behaviors (particularly FTLB).…”

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

“…31 During the pandemic, there was an increased interest in TS via social media, leading to "#tourette" being viewed nearly 5 billion times on the TikTok platform alone. 3,49 Social media can, in fact, be a positive support system in which users have acknowledged that social media portrayals of tics have led to peer support and a sense of belonging. 24 However, there may be unintended consequences of viewing inaccurate portrayals of tics on social media, including reinforcement of maladaptive behaviors.…”

“…Although there was no significant worsening of symptoms in patients who have preexisting FMD, there was an increase in the number of people who newly presented to clinic with FMD during the pandemic. 19,49,51 At least one study reported a 60.1% increase in new patients diagnosed with FMD between March 1, 2020 and October 30, 2020. 19 The majority of these new presentations occurred in female patients (75.6%), and the most common type of functional movement disorder reported was tremor (53.3%) followed by dystonia (31.1%).…”

“…While there are many factors that have likely contributed to the increase in FTLB seen during the pandemic, there is no question that social media is one of these factors given the rapid rise across geographic and cultural borders and striking similarities between the tics on social media and the FTLB seen in clinic. 30,49,62,64,66 In a somewhat ironic cycle, the influence of social media on tics has gained popularity in news and media outlets, spreading the popularity of these videos to even wider audiences. However, the relationship between these social media posts and the onset of new FTLB is much more complex than a straightforward cause-and-effect relationship.…”