Why are teen girls developing tics after watching Tourette Syndrome TikToks?

Sure, the Megan Knees Challenge might leave you with some lingering leg soreness, but most TikTok content is pretty harmless. What worries some mental health experts are the subtle effects the video app can have even after young people put away their phones. A Wall Street Journal story suggests that it makes not only challenges and dances go viral — but also behaviors typically associated with neuropsychiatric disorders. On Tuesday, the outlet reported that doctors have noticed an increase in teenage girls reaching out about twitching movements and vocal outbursts, known as tics. Most of them had watched TikToks of influencers who they said have Tourette syndrome, a nervous system disorder in which tics are the primary symptoms.

This rise seems to coincide with the start of the pandemic. The Wall Street Journal cited statistics from pediatric movement disorder centers around the country, including the Hopkins University Tourette’s Center, where 10% to 20% of pediatric patients reported acute tic-like behaviors, compared to only 2% to 3% a year prior to the pandemic.

Most of these teens were already diagnosed with anxiety or depression that the pandemic had prompted or worsened, like 17-year-old Kayla Johnsen, who’d previously received anxiety disorder and ADHD diagnoses. While turning to YouTube videos of students with ADHD for support, she came across TikTok compilations of teens with anxiety or ADHD experiencing tics. “I do think my tics may have been triggered by these videos and that it spiraled into its own beast,” she told the Wall Street Journal.

Probably not unlike many who read this story, I have questions: Were the girls who are part of this increase already experiencing tics, and these TikToks inspired them to seek help? Or did watching people with tics on TikTok trigger them, like Johnsen said happened to her? I asked mental health experts to walk me through what could be going on here.

Petros Levounis, professor and chair of the department of psychiatry at Rutgers New Jersey Medical School, thinks that the teen girls described in the Wall Street Journal report fall into three categories. One includes those who have Tourette syndrome or another tic disorder but don’t realize it. Only after watching a TikTok of someone else with a tic disorder showing similar symptoms do they realize that maybe they should see a doctor to get diagnosed.

A second group includes teen girls who also have undiagnosed tic disorder, Levounis notes, but for them, watching the TikToks of people experiencing tics influences them to exhibit those behaviors themselves. “When [people who live with tic disorders] observe a gesture or sound in another person, they may very well make similar gestures or sounds, which can be misinterpreted by others as purposeful,” he says. In other words, as easy as it might be to dismiss this mimicry as deceitful or attention-seeking, it’s actually totally involuntary.

Finally, a third group includes those who don’t have a tic disorder but mistakenly blame it for a gesture or other behavior they were reprimanded for in the past, Levounis explains. “It happens all the time,” he says. “People just look around, and they see something that may give an explanation to some trouble that they may have, and they latch on to it.” He points out that we see people misattributing their mental health problems to PTSD, bipolar disorder, and autism, too.

Levounis and Megan Moreno, a UW Health adolescent health expert and pediatrician, believe there might be a possibility of social contagion, a phenomenon in which attitudes, ideas, or behaviors — in this case, tics — spread through a population. Moreno points out that we’ve seen this with news coverage of suicides influencing adolescents to attempt suicide themselves. That’s why we now have media guidelines for reporting suicide, such as refraining from glorifying the victim or describing their methods, in order to discourage people from wanting to imitate them, and make it hard for them to do so. Studies have shown that eating disorder symptoms can also spread among friends.

The fact that TikToks are videos means they can play a powerful role in fueling social contagion, says Moreno, who researches the impact of social media on adolescent health. It’s much easier to imitate a video of a tic than, say, a verbal explanation of it. And while she believes some teens are subconsciously replicating what they see on TikTok, others “are really struggling with their mental health and see this as a venue to be able to get attention they need for other reasons.” Adolescents have really been struggling during the pandemic, she tells me — yet there just aren’t enough providers to meet the surge in their mental health needs.

“I think it’s important that for youth who are engaging in this behavior, that we try to view it as a call for help rather than viewing it as drama or trying to get attention,” Moreno says. “If it is a call for help, what’s underneath that?”

Teenage girls are way more complicated than we often give them credit for. (I know — I used to be one.) As experts point out, the factors that motivate a trip to the doctor for tics can vary from one girl to the next. Whatever might be underlying their symptoms, whether a tic disorder or something else entirely, they deserve our attention — and compassion.