Mass Social Media Illness with Tourette-Like Behavior Tics vs. Tourette Syndrome: What Are the Differences? (2023 Study)

In recent years, the medical community has observed a perplexing surge in cases of functional Tourette-like behaviors (FTB), attributed significantly to the influence of social media.

Dubbed Mass Social Media-Induced Illness (MSMI), this phenomenon marks a departure from traditional understandings of mass sociogenic illness, leveraging virtual platforms to spread across global populations.

Highlights:

1. Surge Since 2019: There has been a notable increase in FTB cases globally, strongly associated with social media content, particularly from influencers on platforms like YouTube and TikTok.
2. Distinct Clinical Profile: Compared to traditional TS/CTD, MSMI-FTB presents with a higher age at onset, a higher proportion of females, and a unique set of symptoms including a significant prevalence of obscene and socially inappropriate behaviors.
3. Influence of Virtual Index Cases: Influential social media personalities, like the host of “Gewitter im Kopf,” have been identified as catalysts for this new form of mass sociogenic illness, highlighting the power of virtual platforms in shaping health phenomena.
4. Challenges in Differentiation & Treatment: Despite some clinical overlap, key differences exist between MSMI-FTB and TS/CTD, necessitating nuanced approaches to diagnosis and treatment.

Source: European Archives of Psychiatry & Clinical Neuroscience (2023)

Functional Tourette-Like Behavior (FTB) (Overview)

Functional Tourette-like behavior (FTB) represents a complex, emergent phenomenon characterized by symptoms resembling those of traditional Tourette Syndrome (TS) and chronic tic disorders (CTD), yet distinct in its etiology, presentation, and potential underlying causes.

This condition has garnered increased attention due to its rising prevalence and unique relationship with social media exposure.

History

The concept of functional movement disorders, including FTB, has been recognized for many years, yet the specific categorization and understanding of FTB as a distinct entity have evolved more recently.

Historically, conditions resembling FTB might have been classified under broader categories of psychogenic or functional movement disorders.

However, the surge in cases observed since around 2019 has prompted a reevaluation of these behaviors, particularly in relation to mass media’s influence.

What is Functional Tourette-Like Behavior?

FTB involves the presentation of tic-like movements and vocalizations that are not attributable to the neurobiological mechanisms typically associated with TS or CTD.

Unlike tics in TS, which are often rapid, repetitive, non-rhythmic movements or vocalizations, FTB symptoms might mimic these characteristics but arise from different psychogenic or functional origins.

Importantly, these behaviors often include complex vocalizations and movements, including socially inappropriate or obscene language and gestures, which can significantly impact social interactions and quality of life.

Prevalence

Precise prevalence rates of FTB are challenging to determine due to its relatively recent recognition and diagnostic complexities.

Initial observations suggest that cases have become more common since the late 2010s, coinciding with an increase in social media usage and the dissemination of tic-related content.

The condition has been reported in various countries, indicating a global phenomenon, yet comprehensive epidemiological studies are needed to accurately quantify its prevalence.

Reasons for Increasing Prevalence

Several factors may contribute to the rising prevalence of FTB, including:

• Social Media Exposure: The proliferation of videos showcasing individuals with tic disorders on platforms like YouTube, TikTok, and Instagram has been linked to the emergence of FTB. Notably, content creators sharing their experiences with TS or tic disorders can inadvertently influence susceptible viewers, leading to the development of tic-like behaviors.
• Mass Sociogenic Illness: FTB aligns with the concept of mass sociogenic illness, where the rapid spread of illness symptoms occurs within a community or group, largely due to psychological factors. The unique aspect of FTB is its spread via virtual interactions, without the need for face-to-face contact.
• Psychological Stress: The increasing rates of FTB may also reflect broader societal trends, including heightened psychological stress and mental health challenges, especially among adolescents and young adults. The onset of FTB symptoms may be triggered or exacerbated by stress, anxiety, and other psychological factors.
• Diagnostic Awareness: Growing awareness and recognition of FTB among healthcare professionals may also contribute to an apparent increase in cases. As clinicians become more familiar with the condition, diagnoses may become more frequent, contributing to higher reported prevalence rates.

Major Findings: Tourette-Like Behavior in Social Media-Induced Illness (2023)

Fremer et al. evaluated the clinical characteristics of mass social media-induced illness presenting with functional Tourette-like behavior (MSMI-FTB) compared to traditional Tourette syndrome (TS) and chronic tic disorders (CTD) – below are the findings.

1. Age at Onset & Sex Distribution

Higher Age at Onset for MSMI-FTB: A significant finding was the later age of symptom onset in individuals with MSMI-FTB (average age 19.2 years) compared to those with TS/CTD (average age 7.0 years). This indicates that MSMI-FTB typically emerges during teenage years or early adulthood, significantly later than the preschool age onset typical of TS.

Increased Female Representation: There was a notably higher rate of females in the MSMI-FTB group, with a 1:1 male-to-female ratio, contrasting the male-dominant 3.4:1 ratio observed in TS/CTD. This sex distribution suggests a particular vulnerability or exposure among females to the conditions associated with MSMI-FTB.

2. Clinical Characteristics

Socially Inappropriate Symptoms: MSMI-FTB patients displayed a significantly higher rate of obscene words and other socially inappropriate symptoms. Such symptoms were reported in 96.9% of the MSMI-FTB group compared to only 28.1% in the TS/CTD group, highlighting a distinct clinical feature of MSMI-FTB.

Similarity in Premonitory Urges and Suppressibility: No significant differences were observed in the reported frequencies of premonitory urges/sensations and the suppressibility of symptoms between the two groups. This similarity suggests that while MSMI-FTB and TS/CTD might manifest differently in terms of symptom type and onset age, some core tic-related experiences like premonitory urges are shared.

3. Psychiatric Comorbidities

Lower Rates of ADHD & OCD/OCB in MSMI-FTB: The study found significantly lower rates of ADHD and OCD/OCB among patients with MSMI-FTB. Only 9% of MSMI-FTB patients had comorbid ADHD, and 46.9% had OCD/OCB, compared to 44.9% and 71.8%, respectively, in the TS/CTD group. This distinction in comorbidities is crucial for diagnostic and treatment considerations.

Similar Rates of Anxiety and Depression: There were no significant differences in the prevalence of comorbid anxiety and depression between MSMI-FTB and TS/CTD patients. This finding suggests that despite the differences in symptomatology and comorbid conditions like ADHD and OCD/OCB, both groups share a similar burden of anxiety and depression.

MSMI-FTB vs. Tourette Syndrome (TS) & Chronic Tic Disorders (CTD) (2023 Study)

The primary objective of this investigation was to understand the clinical characteristics of a sample of patients diagnosed with MSMI-FTB and to compare these characteristics with those of patients diagnosed with Tourette syndrome (TS) and other chronic tic disorders (CTD).

The study aimed to identify clinical factors that could help distinguish between tics in TS/CTD and MSMI-FTB, enhancing the diagnostic and treatment processes for affected individuals.

Methods

• Between May 2019 and September 2021, 32 patients diagnosed with MSMI-FTB at a Tourette outpatient clinic were included in the study.
• These patients underwent thorough neuropsychiatric examinations by experienced specialists and participated in detailed interviews that covered demographic data, symptom onset, and the nature of their symptoms, including premonitory sensations and suppressibility.
• The MSMI-FTB patients’ data were compared to a large sample of 1032 patients diagnosed with TS or CTD.
• This comparison aimed to discern differences in clinical presentations between those influenced by social media and traditional patients.
• The study employed quantitative methods to analyze data, utilizing t-tests for interval-scaled dependent variables and Fisher’s exact tests for dichotomous variables.
• Bonferroni correction was applied to adjust for multiple comparisons, ensuring the reliability of the findings.

Findings

The study revealed several significant differences between patients with MSMI-FTB and those with traditional TS/CTD.

1. Higher Age at Onset: MSMI-FTB patients had a significantly higher age at onset compared to traditional TS/CTD patients, indicating a deviation from the typical early childhood onset of tics.
2. Higher Rate of Females: The sex distribution in MSMI-FTB cases showed a significantly higher rate of females, contrasting with the male predominance observed in traditional TS/CTD cases.
3. Increased Socially Inappropriate Symptoms: Patients with MSMI-FTB exhibited a significantly higher rate of obscene and socially inappropriate symptoms.
4. Lower Rate of Comorbid ADHD & OCD/OCB: The study found a significantly lower rate of ADHD and OCD/OCB comorbidities among MSMI-FTB patients compared to those with TS/CTD.
5. Similar Rates of Anxiety and Depression: The prevalence of anxiety and depression did not significantly differ between the two groups, suggesting these comorbidities are common across both conditions.

Limitations

Despite its insights, the study acknowledges several limitations:

• Selection Bias: There may be a selection bias as the study likely attracted patients with more severe symptoms.
• Sample Size: The relatively small sample size of MSMI-FTB patients could limit the generalizability of the findings.
• Historical Data Comparison: The large TS/CTD sample was collected over many years and was not originally intended as a control group for this study, potentially affecting the comparability of the data.
• Lack of Detailed OCD/OCB Distinction: The study did not separately categorize OCD and OCB in the MSMI-FTB sample, which might have nuanced the findings regarding comorbidities.

What Causes Functional Tourette-Like Behavior (FTB)? (Possible Mechanisms)

Functional Tourette-like Behavior (FTB), understood within the broader context of Mass Social Media-Induced Illness (MSMI), is a multifaceted phenomenon with complex underpinnings.

FTB is not considered an intentionally faked condition; rather, it emerges from genuine psychological processes that individuals do not consciously control.

Psychological Stress & Vulnerability

Psychological stress and vulnerability play significant roles in the onset of FTB. Individuals experiencing high levels of stress, anxiety, or emotional distress may be more susceptible to developing FTB.

This psychological state can create a fertile ground for the manifestation of physical symptoms as a form of coping mechanism or expression of distress.

Social Learning & Mimicry

One of the primary mechanisms by which FTB develops is through social learning and mimicry.

Exposure to tic-like behaviors via social media can lead individuals to unconsciously emulate these behaviors.

This process is amplified by the repetitive nature of social media content consumption, where users may repeatedly view content depicting tic-like behaviors, reinforcing the learned behavior.

Mass Sociogenic Illness

FTB can also be understood through the lens of mass sociogenic illness, where symptoms spread among a group despite the absence of a physical or environmental cause.

The digital age has transformed this phenomenon, allowing for the rapid spread of symptoms across global networks without direct physical contact.

Social media platforms serve as a conduit for the spread, where the visibility and virality of content can influence collective behavior and symptom manifestation.

Identity & Belonging

For some individuals, engaging with communities on social media that share and discuss symptoms can offer a sense of belonging and identity.

This dynamic can inadvertently reinforce the adoption and maintenance of symptoms as individuals align their experiences with those of the community.

The validation and support found in these communities, while beneficial in fostering connections, may also contribute to the persistence of symptoms.

Neurological Sensitization

The constant exposure to tic-related content and the subsequent stress and anxiety can lead to a psychosomatic response, where the body manifests physical symptoms in response to psychological stimuli.

This mechanism highlights the powerful connection between the mind and body, where psychological factors can lead to real, physical symptoms that are not intentionally produced.

Attention & Reinforcement

While FTB is not an intentionally faked condition for attention, the mechanisms by which it is reinforced can include the role of attention and social feedback.

Positive or negative reinforcement can occur when symptoms lead to increased attention or support from others, inadvertently encouraging the persistence of the behavior.

This aspect underscores the importance of understanding and addressing the condition compassionately, without assuming manipulation or deceit.

Treatment for Functional Tourette-Like Behavior & Social Media-Induced Illness

Treating Functional Tourette-like Behavior (FTB), particularly when considered within the framework of Mass Social Media-Induced Illness (MSMI), requires a multifaceted and personalized approach.

Given the psychogenic nature of FTB, treatment strategies often prioritize psychological interventions alongside supportive measures tailored to the individual’s specific symptoms, triggers, and psychosocial context.

1. Psychological Therapy

• Cognitive-Behavioral Therapy (CBT): CBT is a cornerstone in treating FTB, focusing on identifying and modifying negative thought patterns and behaviors that contribute to symptom manifestation. It can help patients develop coping strategies to manage stress and anxiety, which are often underlying triggers for FTB symptoms.
• Exposure & Response Prevention (ERP): Particularly useful for individuals with tic-like behaviors, ERP involves gradually exposing the patient to the urge to perform a tic without allowing them to complete it, thereby reducing the tic’s frequency over time.
• Habit Reversal Training (HRT): A component of Comprehensive Behavioral Intervention for Tics (CBIT), HRT teaches patients to recognize the onset of tics and to perform a competing response that is physically incompatible with the tic, helping to reduce tic severity.

2. Educational Interventions

• Awareness & Understanding: Educating patients and their families about FTB and its distinction from neurological tic disorders is crucial. Understanding the role of social media and psychological factors in symptom development can empower individuals to adopt healthier media consumption habits.

3. Stress Management & Coping Skills

• Relaxation Techniques: Techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing exercises can help manage stress levels, potentially reducing the frequency and severity of FTB symptoms.
• Lifestyle Changes: Encouraging regular exercise, a healthy diet, and sufficient sleep can improve overall mental health, thereby indirectly impacting the severity of FTB symptoms.

4. Limiting Social Media Exposure

• Digital Hygiene: Patients are often advised to reduce or modify their social media use to decrease exposure to triggering content. This may involve taking periodic breaks from social media, unfollowing or blocking certain content sources, and setting limits on daily social media usage.

5. Family & Community Support

• Support Networks: Building a strong support system, including family, friends, and support groups, can provide emotional support and understanding, which is vital for individuals dealing with FTB. Community resources and therapy groups offer shared experiences and coping strategies.

6. Medication

• Psychopharmacological Treatment: While not a primary treatment for FTB, medications may be prescribed to address co-occurring conditions such as anxiety, depression, or ADHD, which could indirectly reduce the severity of FTB symptoms.

Conclusion: Functional Tourette-Like Behavior (FTB)

References

• Paper: What distinguishes patients with mass social media-induced illness presenting with Tourette-like behavior from those with Tourette syndrome? Results of a prospective cohort study (2023)
• Authors: Carolin Fremer et al.

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