TikTok Tourette's: Mass Hysteria and Social Contagion in a Connected World

While working in an adolescent partial-hospitalization program during the year of 2021, the therapists, nurses, and psychiatrists on staff were witness to a peculiar phenomenon. For those not privy to the strange trends of social media, the unusual behavior of a growing number of our patients was baffling. But mostly, it was frustrating. I sort of knew what was going on, being a fan of internet rabbit holes myself. Voyeuristic interest in TikTok trends is one thing, though. We were having to deal with the internet, in real life, in the therapy room.

In every age group at the facility, kids were faking Tourette’s. By that I mean, kids were claiming to suffer from “tics,” verbal and physical, and were performing them in group therapy. The physical tics looked like neck-jerks, twitches, the occasional slapping of oneself. The verbal ones could be anything. Slurs, full sentences, anime sound effects, cute sayings. The patients claimed they could “catch” a tic. An anime sound would echo throughout the group, like a game of hot potato. Typically, it was limited to a handful of female patients (AFAB, at least; gender non-conforming identities abounded amongst this particular subset).

How did we, the mental health professionals, deal with it? Being an adolescent therapist is a tightrope between empathetic validation and gentle confrontation. Applying this mixture when the kids in your group are yelling slurs and defensively calling them “tics” is an unusual challenge. Mostly we would ignore the behavior, removing the attention that was potentially the unconscious goal of the behaviors. Sometimes we had to set limits, due to disruption of the group process. Usually when I stated the consequences clearly (being escorted from the room for a break), the behavior stopped soundlessly.

Parents had to learn how to navigate it, as well. Some just told their kids, plainly, to stop. Some did stop.

60 Minutes Australia recently released an episode on the phenomenon. They followed the stories of three female adolescents who began experiencing “tics” during the pandemic. One of these adolescents had ceased the behavior after “intensive therapy.” The other two adolescents continued. In the interviews of the still-afflicted girls, they displayed the same behavior as the kids in my group, while their mothers laughed and warmly regarded them. One mother had joined her daughter in becoming a TikTok influencer, crafting fun videos about the “tics.”

Where did it all start?

When I began seeing the phenomenon in my groups, I thought about the streamer Sweet Anita and the compilation videos of her cutest “tics.” I thought of Billie Eilish’s recent disclosure of her own diagnosis of Tourette Syndrome. Sweet Anita’s tics looked like the ones in my group (cute sounds, twitches, random funny phrases, and in at least one case, a slur, which almost got her banned from Twitch). Billie Eilish’s tics, when seen in interviews, were extremely subtle and in line with a layperson’s understanding of Tourette’s.

But these potential influences were quickly superseded by teenagers making TikToks of their own “tics.” It seemed like Tourette Syndrome had potentially usurped Dissociate Identity Disorder as the new mental illness du jour for the perpetually online.

The “tics” waned over the next few months at the hospital. If a new patient joined the group, still “ticking,” they did not necessarily find a group to belong to, like they would’ve previously. I no longer work at the hospital, and cannot speak to whether or not the trend has continued. I went on to work in public schools, and the students were mysteriously tic-less. According to a recent New York Times article, the phenomenon is waning.

The 60 Minutes Australia episode brought new reflections for me. I felt bad that our American neuroses had spread to a country across the globe. Reasonably, it was happening in other countries, too.

I also reflected on the parallels to the Salem Witch Trials. I had been viewing the faking of Tourette’s as a case of Fictitious Disorder (the rechristened Munchausen’s), or Conversion Disorder (psychosomatic in origin, essentially). But this wasn’t one person, it was global.

Was this mass hysteria?

Mass hysteria, also known as mass psychogenic illness, or mass sociogenic illness, is defined as:

the rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss or alteration of function, whereby physical complaints that are exhibited unconsciously have no corresponding organic aetiology.

These cases, listed on the mass hysteria Wikipedia, stood out to me in particular:

1400’s: a nun who lived in a German convent began to bite her companions, and the behavior soon spread through other convents in Germany, Holland and Italy.

The Middle Ages: a nun who lived in a French convent inexplicably began to meow like a cat, shortly leading the other nuns in the convent to meow as well. Eventually, all of the nuns in the convent would meow together for a certain period, leaving the surrounding community astonished. This did not stop until the police threatened to whip the nuns.

The Salem Witch Trials (1692-1693): In colonial Massachusetts, adolescent girls began to have fits that were described by a minister as “beyond the power of epileptic fits or natural disease to effect.” The events resulted in the Salem witch trials, a series of hearing which resulted in the execution of 20 citizens and the death of five other citizens.

1749: Germany, an outbreak of screaming, squirming, and trance in a nunnery led to the execution of a suspected witch.

1894: Montreal, 60 students at a ladies’ seminary had an outbreak of fits and seizures, some for as long as 2 months.

1962: Louisiana, with students’ sexual activity under close scrutiny by school officials, and following rumors of mandatory pregnancy tests, 21 girls and 1 boy in grades six to eleven were affected by seizures and other symptoms over six months.

1965: England, several girls at a girls’ school complained of dizziness. Some fainted. Within a couple of hours, 85 girls from the school were rushed by ambulance to a nearby hospital after fainting. Symptoms included swooning, moaning, chattering of teeth, hyperpnea, and tetany. A medical analysis of the event about one year later found that outbreaks began among the 14-year-olds, but that the heaviest incidence moved to the youngest age groups. The younger girls proved more susceptible, but disturbance was more severe and lasted longer in the older girls. It was considered that the epidemic was hysterical, that a previous polio epidemic had rendered the population emotionally vulnerable, and that a three-hour parade, producing 20 faints on the day before the first outbreak, had been the specific trigger.

1976: Mississippi, school officials suspected drug use after 15 students fell to the ground writhing, but no drugs were found and hysteria is assumed to be the culprit.

1970’s-1980’s: Malaysia, mass hysteria affected school-aged girls and young women working in factories. The locals have explained this outbreak as “spirits” having possessed the girls and young women.

1983: Palestine, a series of incidents wherein 943 Palestinian teenage girls and a small number of women soldiers fainted or complained of feeling nauseous in the West Bank. Conclusion that 20% of the early cases may have been caused by the inhalation of some kind of gas, the remaining 80% were psychosomatic.

2002: North Carolina, ten girls developed seizures and other symptoms at a rural high school. Symptoms persisted for five months across various grade levels. Incidents tended to happen outside of class, with half of all incidents estimated to have occurred around lunch hour. Half of the affected were cheerleaders or former cheerleaders.

2006-2007: Mexico City, mass hysteria resulted in an outbreak of unusual symptoms experienced by more than 500 adolescent female students at Children’s Village School, a Catholic boarding-school. The affected students had difficulty walking and were feverish and nauseated, some becoming partially paralyzed.

2007: Virginia, an outbreak of twitching, headaches and dizziness affected t least nine girls and one teacher at William Byrd High School. The episode lasted for months amid other local public health scares.

2008: Tanzania, 20 girls at a school in Tabora started fainting while taking their final year exams.

2010: Brunei, incidents of mass hysteria occurred at two all-girls secondary schools. The phenomenon caused a wave of panic. Some of the students affected claimed to have been possessed by spirits, displaying histrionic symptoms such as screaming, shaking, fainting and crying.

2011-2012: New York, 12 high school girls developed Tourette-like symptoms. In 2012, several more students and a 36-year-old adult female came forward with similar symptoms. They were all diagnosed with conversion disorder.

This last incident stood out to me most, given the recency and the symptoms. In this New York Times article, it said that the symptoms began with the cheerleaders, then spread to other groups of girls, one boy, and one female teacher. When a neurologist diagnosed the group with Conversion Disorder and labeled it a mass psychogenic illness, one guardian of an affected girl said: “It’s a very hard pill for me to swallow — what are we, living in the 1600s?”

Parents pushed back and demanded environmental testing, which had already been done, showing that no toxin would have resulted in these symptoms. Treating physicians pointed to stress and trauma as possible common factors in the originating cases.

Former Faker Friday

Curious to see if this brand of mass hysteria had been discussed in any communities of people formally diagnosed with Tourette’s, I turned to Reddit. My cursory search did not find a subreddit for Tourette’s, though. Instead, I mostly got results from r/fakedisordercringe, a subreddit I’m very familiar with. Browsing it while I worked at the hospital helped contextualize what I was seeing in the therapy room.

This post caught my eye: “I Used to fake Tourettes.” It had been posted just 8 hours prior. The post read:

“I'd like to start off by saying I didn't fake on purpose. I was just really deep into Tourettes TikTok and I don't know if you've heard of this but there was a craze of people suddenly presenting with ticks during the pandemic because of TikTok. The people who had these 'tics' didn't actually have tics, it was a psychological thing that would go away if you stopped the exposure. And sure enough, when I deleted TikTok my 'tics' stopped. It happened for a few months maybe. I was in a really rough patch of my life at that point but I'm still really ashamed of it. It wasn't that bad, I didn't go around telling everyone I had Tourettes but it's still awful. I was 12 when I was faking it, and I'm about to turn 15 now.”

Another user replied empathically, saying: “As someone diagnosed with an actual tic disorder […] I can understand why people fake it. It certainly does give you attention, which is something I understand wanting at a time as vulnerable as puberty.”

Another user replied anxiously, wondering if they might be faking, as well. They said they developed “tics” at the age of 15.

The post was flaired as “Former Faker Friday.” In sorting through the posts, there were individuals admitting to faking Dissociative Identity Disorder (not the subject of this post, but another faked illness that was on the outs in 2021 while I worked at the hospital).

Another poster admitted to faking schizophrenia for 2 years. The user apologized to those “actually struggling with schizophrenia.”

A post titled “I used to fake Tourette’s, very ashamed of this now” had been posted 11 hours ago. It read:

"Okay so, I am making this post today on a Friday night to confess and to get it out of my system, I used to fake Tourette's when I was a child, let's say 11, I genuinely believed that I had Tourette's syndrome because I would tic a lot. I always had unrestricted internet access growing up, and because of that I was way more mature then kids my age. I started to tic around February because I wanted to fit in with my friend who has diagnosed Tourette's, I fit the criteria for Tourette's at the time, I now do not. I thought that my Tourette's were very real and intense. I was alone in my room most of the time when I would tic, and it used to happen when I was at school, but that was only verbal tics and a few motor(?) tics, but when I got home that was when the real chaos started. I eventually moved to my dads house as I was living at my mums at the time, I realised I stopped ticing because I was in a public space, I eventually grew out of this Tourette's phase and I am so thankful for that, looking back on it now it was very embarrassing for me even though I was alone. Thank you for taking the time to read this, I am sorry for believing I had Tourette's Syndrome.”

The thing about analyzing this phenomenon as a mental health professional is that you feel slightly cruel. As a therapist, you want to validate your client's self-reports. Especially with adolescent clients, who sometimes need validation the most. I assumed something about the ticking did feel involuntary, like a compulsion. Many of these kids were already diagnosed with Attention-Deficit/Hyperactivity Disorder, which is marked by impulsive behavior. I also felt that some of them were worried they could indeed be faking, which led to further defensiveness on their part.

While my generation took part in various trends in our teenage years related to mental health (self-harm and anorexia, namely), I am a little happy I won’t have to look back as an adult and think, “remember that time I faked Tourette’s?” It is difficult to admit that one may have deluded oneself, and attempted to convince everyone else of the delusion.

If the pseudo-Tourette’s phenomenon is the newest case of mass hysteria, it is unique in its potentially global reach. Given that many of these teens are exposed to the faking of Tourette Syndrome primarily through the internet, the spread is not limited to one boarding school, or one nunnery.

Another user posted on r/fakedisordercringe saying “I keep expecting to see myself here.” The post read:

“I'm ashamed I use to fake mental illnesses, but I also need to admit and realize that faking was easier than admitting the truth behind my trauma. I wouldn't even believe my diagnoses if I didn't have my doctors and repeatedly looking up my meds to make sure they aren't placebos. Nothing feels real and I feel like I'm trapped in a never-ending dream/nightmare.”

As definitions of mental illness morph and shift, with false narratives spreading like wildfire amongst the masses (adults and adolescents alike), it is a bit like a never-ending nightmare. As always, I recommend internet literacy and intellectual boundaries as the solution to the spread.

Lauren Crowley Taylor is a Licensed Professional Counselor and Licensed Marriage and Family Therapist. These are her personal and clinical opinions based on an amalgamation of cases.

Sources and tidbits:

Bartholomew, Robert; Wessely, Simon (2002). "Protean nature of mass sociogenic illness" (PDF). The British Journal of Psychiatry. 180 (4): 300–306.

“Conversion disorder is two to three times more common in females” DSM-V p. 320.

“The essential feature of factitious disorder is the falsification of medical or psychological signs and symptoms in oneself or others that are associated with the identified deceptions.” DSM-V, p. 325.

The Rise of Mental Health Misinformation: Autism Edition

If you’ve used social media at all these past few years (particularly, Instagram and TikTok), you are probably privy to the explosion of content focused on mental health and psychology.

As these platforms have transitioned from showing you content from your friends and family (that you chose to follow), to algorithm-based recommendations, people are left wondering “why is this app trying to diagnose me?”

And I am left wondering, “why are non-licensed individuals clogging up the airwaves with inaccurate information, while amassing large followings?”

Usually their professed profession is either “life coach” or “mental health advocate.” These titles, of course, are not regulated in any way. There are life coaches who do indeed help others, and plenty of advocates for these topics that altruistically try to inform the public. These might not be the ones showing up in your feed, however.

Occasionally licensed therapists and psychologists create content on these platforms – for better or worse. It’s been a toss up for me, personally, on whether or not these professionals are making content aligned with clinical practice, or with new narratives not grounded in evidence-based practice.

Why would a layperson devote their time to creating content about mental health conditions, despite not having training in that area? Of course, giving them the benefit of the doubt, perhaps they are seeking an outlet, or connection, or wanting to raise awareness.

But we must acknowledge another important element: brand endorsement. We could also discuss the need for attention, a universal need, as a potential motivator.

What do we make of social media content, knowing that the creator is potentially motivated by money, and has no regulatory body enforcing an ethical code upon them?

Licensed mental health professionals must navigate ethical laws around dual relationships and product endorsement. For instance, in the Licensed Professional Counselor code for my state of Texas, they say:

“A licensee may promote the licensee's personal or business activities to a client if such activities, services or products are to facilitate the counseling process or help achieve the client's counseling goals. Prior to engaging in any such activities, services or product sales with the client, the licensee must first inform the client of the licensee's personal and/or business interest therein. A licensee must not exert undue influence in promoting such activities, services or products.”

I would be hard pressed to find an ethically-minded therapist who would be okay with pushing products on potential clients and strangers over the internet as part of a sponsored post. But I’m sure it happens!

And for those trying to forge a new career in influencing, there really are no rules.

I’m sure I don’t have to spell it out, but in order to get these brand deals, a wannabe influencer must amass a following. We’ve seen that polarizing content seems to rise to the top. And when it comes to content about mental health conditions, the more general and relatable, the better. We don’t often see influencers posting about the DSM-V-TR criteria for disorders. They tend to post about insignificant, normal, everyday human experiences. Things so called “neurotypicals” experience regularly. I do come across content that accurately speaks to certain conditions, but often, it speaks to everyone.

Which is much better when trying to gain a big following! Only speaking to 1-5% of the population just won’t do!

What are the topics we keep hearing about on social media? Gaslighting, “toxic” relationships, trauma, ADHD, and as of late, autism. “Sensory issues” seems to be a rising buzzword as well.

Why these topics? That could be a deep dive of its own. What inspired this post, though, is the rise of misinformation around Autism Spectrum Disorder (ASD).

Influencers and the influenced may not be aware, but the DSM-V was revised in March 2022. Various changes were made, including the criteria for Autism Spectrum Disorder becoming more strict, in order to clarify and maintain a high diagnostic threshold. Whereas it was not clearly laid out before how many of the social difficulty criteria were required to qualify, now all three must be met.

Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

The majority of the content I’ve been witness to around autism (often created by those that have opted to “self-diagnose”) focuses on sensory difficulties, and a general awkwardness when it comes to social relationships. Both of these can be explained by a myriad of different conditions (and everyday human experience). The move towards the pathologization of average human experience, once again, is a topic for a different deep dive.

A pattern I have noticed, as well, is the tendency for those already diagnosed with ADHD to tread into the waters of self-diagnosing themselves with autism. ADHD and ASD do have overlap in symptoms. Differential diagnosis by a professional is required to tease it apart.

Sensory sensitivity, difficulty with social interaction, and even “specific interests” can be associated with ADHD. “Specific interests” for those with ADHD may be more a result of an obsessive mind that goes through phases in terms of hobbies/interests, whereas in ASD, interests may be more persistent and singular, hence the word “restrictive.” You can compare an individual with ADHD who cycles through intense hobbies (one day learning everything about gardening, impulsively buying the tools, then moving on to astronomy) to an individual with ASD who has a lifelong, or decades-long, passion for certain subjects (airplanes, a certain historical period, etc.). In my personal and professional experience, individuals with ADHD may obsess over certain interests due to impulsivity, hyperactivity, and a lack of stimulation, whereas those with ASD may focus on their interests due to it being their comfort zone, in comparison to spontaneous conversation that may focus on a variety of topics. Their specific interest may be a source of social withdrawal and disengagement from reciprocal interaction.

Obviously, with the overlap, it makes sense that the public may get confused and fall down internet self-diagnosis rabbit holes.

My hope for laypeople is for them to practice internet literacy. To ask themselves: Who is creating this content? What are their credentials? What might motivate them in influencing others (money, likes, views, clout)? What's their angle? And to remind themselves that there is a difference between relating to certain traits or symptoms, and meeting diagnostic criteria for a disorder.

The “spectrum” of Autism Spectrum Disorder does not refer to a spectrum between people with autism and people without autism. Autism Spectrum Disorder is a collection of disorders that used to be separated out in the DSM: Asperger Disorder, Autism Disorder, and Pervasive Developmental Disorder, Not Otherwise Specified. The “spectrum” refers to the variability in these three disorders that have enough in common to now be grouped together. I surmise that lumping them together may have created a pathway for our current situation (self-diagnosis via social media). I have personally never seen any content about Asperger Disorder on Instagram, which was once known as the “milder” form of autism. Perhaps it would have been the buzzword if it was kept in the DSM. For now, we have essentially “neurotypical” people self-identifying as autistic, when they perhaps would not have even made the cut for Asperger Disorder a decade ago (it was lumped into ASD in 2013).

My hope for professionals is that they speak out against misinformation, while remaining professional and ethical. I do not dream of more therapist-influencers. I do dream of a world where social media provides a verification system for licensed mental health professionals, or adds a caveat to mental health posts letting the audience know when the creator is not a licensed professional. That probably won’t happen, but a therapist can dream.

Most internet trends crescendo and then fall away. In my clinical experience working with adolescents, Dissociative Identity Disorder and Tourette’s Disorder were popular to fake in 2020-2021. Assuming Autism Spectrum Disorder is the new disorder du jour, its heyday may end in the coming year. But where will that leave the accurately diagnosed? My hope is they get their online spaces back, and get to control their own narrative. It seems that just when autistic adults got to speak for themselves (rather than their parents, or ABA organizations, or vaccine-conspiracy pushers), a new rival arose to vie for their position: the self-diagnosed.

Self-diagnosis, for some, is a step towards professional diagnosis. For others, it’s a dead-end, reinforced by the echo chamber of other young people opting for self-diagnosis.

Some individuals with autism remain completely unaware of the condition until it is suggested by a professional. Some individuals without autism attach themselves to the disorder, and persist in this identification, even when another explanation is suggested by a professional.

Lastly, I would like to offer the Highly Sensitive Person concept as a potential explanation for these cases. Dr. Elaine Aron formulated this concept, and has demonstrated through fMRI that it is a distinct brain pattern, separate from autism. It is not a disorder, and not included in the DSM. It could be referred to as “functional sensory sensitivity.” I enjoy this framework, for it explains both emotional and sensory sensitivity, while not stepping on the toes of individuals who struggle socially in a way that “allistics” may never understand.

- Lauren Crowley Taylor is a Licensed Professional Counselor and Licensed Marriage and Family Therapist. She is the owner of Witch Hazel Therapy. This blog post is based on Lauren's professional and personal experience, and is not a substitute for mental health care.

Insights into Parapsychological Research: Anomalous Phenomena

What are anomalous experiences?

Experiences that depart from normative states of consciousness and/or consensus reality.

Experiences that remain unexplained by the Western scientific/medical model (or are believed to be at odds with it).

Cultures vary in their acceptance of these experiences. Some cultural narratives make space for anomalous phenomena, while others may deem them as delusional or pathological.

These experiences may be confusing, distressing, traumatic, awe-inspiring, transformative, ecstatic, and/or enriching.

For some, these experiences are wholly spontaneous and unexpected, shifting the experiencer’s conception of reality. Others seek out these experiences, fine-tuning their "sixth sense."

When an experiencer is unable to speak to others about what was perceived (due to stigma, fear of being “crazy,” self-censorship), integration of the experience into everyday life is more difficult.

Living a “double life”

I once worked at a bookstore where I was lucky to be in charge of the Metaphysical section. While organizing the shelf dedicated to Extra-Terrestrials, an older gentleman approached me and began to tell me about his experiences.

He told me he lived a “double life”: he was a Christian who had witnessed a UFO many years ago. He struggled to speak to others about his experience. When he first walked into the store, I had helped direct his wife to the Christian Living section. There's a chance this was something he did not speak to her about.

The concept of a “double life” can be thought of doubly:

• attempting to live a mainstream life, while keeping these experiences secret/private;

• or, alternately, the double life of consciously existing in both spiritual and material reality, post awakening.

Distinguishing between psychosis/pathology vs. non-pathological, valid experiences.

A topic deserving further exploration. A key controversy in exploring these phenomena is whether the experiencer is delusional, or very much in touch with reality – a reality that is mostly unseen, but knowable, and perceived by some.

Positive, strength-based, affirming model.

Experiencers of anomalous phenomena have the opportunity to integrate these experiences, shifting towards a more expansive definition of reality, meaning, and spirituality. Therapy for experiencers focuses on this potential while acknowledging the trauma, isolation, and confusion that can be reported as well.

Integration

Various spiritual, religious, and cultural traditions offer explanations for anomalous phenomena. Experiencers may be served by practicing discernment in their quest for explanations – endorsing information too readily from external sources may lead to attachment to figures that are positioning themselves as all-knowing gurus.

Experiencers can construct their own individual meaning when it comes to phenomena, or search for meaning in the various texts detailing mystical, non-ordinary reality. Finding others with similar experiences may lessen the isolation, and normalize their new sense of reality.

For some, extra-ordinary experiences and altered states may lend themselves to new purpose in life. Whether it’s individual life purpose, a sense of oneness leading to charity and kindness, or a dedication to the ecological health of our planet, experiencers are often given the gift of a higher calling.

Interested in therapy for anomalous experiences? Lauren Crowley Taylor, LPC, LMFT received her MA in Psychology at the Spirituality Mind Body Institute at Teachers College, Columbia University. Contact her here.