FND

CBIT Therapy for Tics, FND, and BFRB

Functional Neurological Disorder (FND)

Functional Neurological Disorder (FND) is an emotional regulation related disability with physical or sensory symptoms and no known medical cause. FND can present in drastic ways such as blindness, falls, catatonic states, numbness, paralysis, seizures, hearing loss, limb injuries, migraines, and tic-like behaviors.

FND symptoms are typically distressing to the patient and often impact overall quality of life for their entire family. Online OTs provides support for tic-like behaviors related to FND with occupational therapy strategies and training in Comprehensive Behavioral Intervention for Tics, also known as CBIT. Patients learn to shift attention away from their disabling symptoms to reduce the frequency and intensity through their own actions and abilities. FND often improves following a proper diagnosis of the disorder, reassurance that symptoms are not caused by an underlying medical problem, and validation that the symptoms are real. It is also important to recognize situations in which symptoms become more intense and to learn how to support their own wellbeing.

FND TikTok Tics

TikTok Tics is a highly complex and unusual form of FND that emerged in 2020 during the pandemic shutdown. Patients with TikTok Tics have a sudden onset of numerous and noticeable tic-like behaviors which are identical to other patients. In fact, patients with TikTok Tics blurt out many of the same words and have extremely similar movements of their hands, neck, and face. Common actions include swearing, hitting their heads or chests, throwing objects, whistling, clicking their tongues, head jerks, gesturing with the middle finger, and saying words such as "whoa," "uh oh." and "beans" repeatedly.

TikTok Tics is considered a mass sociogenic illness because the symptoms are spread on a large scale from one person to another through observation instead of a viral or bacterial cause. Following repetitive watching of TikTok and YouTube videos with false and exaggerated tic content, distressed patients believing that they too have developed tics due to Tourette Syndrome. People with TikTok Tics DO NOT have Tourette Syndrome.

TikTok Tics occurs almost exclusively in middle to upper-class white girls and non-binary youth ages 10 to 22. Many have a significant history of social anxiety, ADHD, and OCD. Most are not accustomed to pursuing leisure activities without adult intervention and have few chores and responsibilities at home. Sleep disturbance related to being on screens late at night may be related to this disorder. Associating with other youth who have TikTok Tics quickly exacerbates the symptoms, while also bringing a sense of belonging and community.

Social media use is frequently kept hidden from parents and medical providers, even after symptoms have spiraled out of control. It seems that this secrecy is in part out of fear of losing phone privileges and concern of no longer belonging to the online and in-person community of others with TikTok Tics.

Due to the complexity of TikTok Tics, this Functional Neurological Disorder is best treated with a team approach. Pediatricians, nurses, neurologists, psychiatrists, psychologists, educators, social workers, occupational therapists, and families are often involved. Major concerns include self-harm, further isolation, an escalation of tic-like behaviors, and bullying.

With no guidebook available to spell out how to proceed with treatment, Comprehensive Behavioral Intervention for Tics (CBIT) has been successfully adapted to manage the physical symptoms.

Teenager using a CBIT strategy called a competing response to prevent an arm tic.

TiKTok Tics Research

Patients with a sudden onset of multiple tic-like behaviors often erroneously believe they have Tourette Syndrome. This is because their movements and vocalizations are similar to misleading social media influencers. People with TikTok Tics tend to feel attached to the influencers and develop a sense of belonging with their other followers. Upon realization that the videos are mostly theatrical, some people with TikTok Tics feel duped. They wonder how they were misled so easily and become angry that they were hurt in the process.

If you or your child seems to have TikTok Tics, know that there is help and this condition is treatable. A good place to begin is with your pediatrician and a neurologist. You can also learn more is this broadcast by WBUR called Can you really get tics from Tik Tok?

Below are articles guiding the way to understand and treat this Functional Neurological Disorder.

On 10/17/21 The Wall Street Journal published an article on sudden onset tics related to social media.

The Verge followed up with an important article called TikTokTics Are A Symptom of A much Bigger Problem.

Also of interest is The Guardian's article 'The unknown is scary': why young women on social media are developing Tourette's - like tics.

Another important read is How TikTok has become a dangerous breeding ground for mental disorders.

Sudden onset tic-like behaviors related to social media has also been explored by the Tourette Association of America in the article Rising Incidence of Functional Tic-Like Behaviors. What's happening? Why now? Please also view the research articles below and be on the lookout for our upcoming report in collaboration with specialists from Boston Children's Hospital.

Social media Concerns

According to Statista Digital Economy Compass, the 2021 global average daily time spent on social media per internet user is 142 minutes. Algorithms control much of what is being seen and causes users to be flooded with messages that normalize serious health concerns. Take charge by deleting social media accounts, cancelling alerts, setting screen time limits, and finding something more hands on and productive to do with your time. Social media has some benefits, but over use and misuse is associated with greater isolation, depression, jealousy, anger, anxiety, and other emotional and physical concerns.

In 2020 the Calgary Tic Disorders Clinical Registry referred to TikTok Tics as Functional Tic-Like Behaviors (FTLBs) and is tracking the trend closely. The condition, which is related to both extreme anxiety and exposure to erroneous tic content is extremely disabling and even life threatening. Misdiagnosis leads to further complications related to medications and recovery.

Parasocial relationships

TikTok Tics and Parasocial Relationships

TikTok Tics is associated with a psychological condition called a parasocial relationship

Binge-watching videos created by social media influencers can lead to a false sense of knowing them intimately. This fascination with the influencer may be due to social isolation and loneliness. The bond occurs even though the relationship is entirely one-sided and will always be that way. The influencer does not watch videos made by you or know anything at all about you, even though she may share intimate and sometimes embarrassing details about her life. You may also feel like part of the influencer's family or friendship group if they are also introduced in some of the videos.

Some people in parasocial relationships may adopt their influencers fashion, hairstyle, beliefs, room decorations, and even what seems like a disabling condition. Others may be tempted to support their influencer financially by donating money to help them continue turning out more videos.

Learn more about parasocial relationships here.

Girl on social media on cell phone