Tics are sudden movements or sounds that appear nigh-involuntarily and are difficult to control. Tic disorders mainly appear in childhood and were found to be linked to conditions of stress and anxiety. Since the “Swords of Iron” war broke out, pediatricians throughout Israel report an increase in children and teenagers presenting for treatment due to the appearance of new tics. Why is this happening? Can this phenomenon be treated? And what does all this have to do with TikTok? These are the topics of this new article in our blog by researcher Rotem Siso.

What are Tics?

Tics are sudden, recurring movements or sounds that are difficult to control. In general, tics are classified into two groups: motor tics, which include physical movements (blinking, shrugging, head movements, etc.), and vocal tics, which include recurring sounds (clearing one’s throat, making noises, sniffling, etc.). While some tics are related to Tourette’s Syndrome, they can also appear as a transient, isolated disorder.

The physiological basis for tics is linked with a particular region of the brain which contains the basal ganglia. The purpose of the basal ganglia is to control motions and sounds and filter out undesired ones. Damage to pathways that connect the areas that plan motion or sound and the areas meant to filter and increase the accuracy of the actions to be executed leads to tics. Many patients report that before a tic occurs, they experience some manner of urge, which may be expressed as a localized tension, itch or burning sensation in a particular area, and in many cases, the tics lead to relief.

The Relationship Between Tic Disorders and Stress

The relationship between tic disorders and conditions of stress and anxiety has been heavily researched. Patients with Tourette’s Syndrome demonstrate an exacerbation in the quantity and frequency of tics in stressful situations – and in the other direction, there are many reports implicating stressful situations as the reason for the onset of various tic disorders.
Provisional tic disorder is a childhood disorder that lasts less than 12 months, typically first appears between the ages of 5-7, and is more common among boys. This disorder is often linked with stressful environmental changes, such as entering school, and resolves as one gets used to the new situation and the stress associated with it lessens.

Similarly, times of war, which generate a feeling of stress, can lead to the emergence of tic syndromes among children and teenagers. Since the “Swords of Iron” war broke out, and against the background of the tension that many children and teenagers are under, pediatricians throughout Israel report an increase in the rate of individuals presenting for treatment due to the onset of new tics.

An interesting example that proves the relationship between stressful situations and tics was observed during the COVID-19 pandemic, where reports of an increase in the incidence of tic disorders among children and teenagers accumulated worldwide. One study conducted in London reported that the number of inquiries to neurology clinics due to the onset of new tics doubled. The prevalent hypothesis was that the stressogenic state, the many changes that these children went through and quarantines during the pandemic were contributing factors to the rise in the incidence of this phenomenon.

Tics or TikTok?

During the year 2020, concurrently with the increase in the incidence of provisional tic disorders in children, there was an increase in reports of teenagers and young adults (ages 12-25)  who presented with a tic disorder with different characteristics to the classical characteristics of childhood provisional tic disorder. Among other things, it appeared that the new disorder was more prevalent at later ages, was more common among girls than among boys, and patients suffered from vocal tics (words, expressions, or swearwords) and specific motor tics of hand motions.

When researchers started investigating this phenomenon, they noticed that the change in patients and symptoms occurs in many places worldwide simultaneously. A more thorough study discovered that most patients were exposed to viral videos on the TikTok social network featuring web influencers that revealed their Tourette’s Syndrome and the tics that they experience. The phenomenon – professionally known as “Functional Tic Disorder” and nicknamed “TikTok Tics” – is still under investigation, and findings demonstrate that those who suffer from it present tics that are identical to those tics of those who suffer from it are identical to those spread online. Currently, this phenomenon is described as a mass sociogenic illness, which includes a number of patients which experience identical symptoms without a physical or biological factor responsible for these symptoms being identified.

Is Treatment Necessary?

To decide whether or not treatment is required, it is important to attain an accurate diagnosis – and therefore, when a new tic disorder is suspected, one should present for an organized diagnosis by a physician.
In 70% of cases of childhood provisional tic disorder, the phenomenon will resolve by itself without the need for intervention. In cases that are disruptive to the child’s functioning, emotional therapy or medication to reduce stress – which, as said, is a contributing factor to the appearance of tics – are incorporated.
Treatment of TikTok Tics is under investigation these days, where some studies indicate the efficacy of cognitive-behavioral therapy (CBT) and antidepressants.