The phenomenology of tic and tic-like behavior in TikTok

ABSTRACT

Objective: We aimed to evaluate the tic phenomenology portrayed in videos about Tourette syndrome (TS) posted on TikTok, a popular social media platform. Background: An increase in functional tic-like disorder (FTLD) has been seen during the COVID-19 pandemic. These patients often report increased viewing of TS videos and posting videos of their movements in TikTok.1 Methods: The 100 most viewed videos under #tourettes in TikTok up to 03/27/21 were reviewed. All reviewers were pediatric movement disorder specialists. Three primary reviewers (<2 years independent practice) and 4 senior reviewers participated. Atypical or rare tic phenomenology was predefined and videos were randomly assigned to 2 primary reviewers. Disagreements between primary reviewers were solved by consensus. If not resolved, a senior reviewer was the tiebreaker. In addition, 2 primary and 1 senior reviewer rated each video on a Likert scale from 1= All of the tics portrayed are typical of TS to 5= None of the tics portrayed are typical of TS. Spearman correlation between primary and senior reviewers was calculated. Results: Of the reviewed videos, 6 did not portray tics and 2 were removed from TikTok before all reviewers could assign a score. Coprolalia and copropraxia were depicted in 53.2% and 20.2% of the videos, respectively. Coprophenomena often had atypical characteristics. Frequently, tics appeared to be strongly influenced by the environment, for both motor (54.3% of videos) and phonic tics (54.3%). Aggression was seen in 19.1%, throwing objects in 22.3%, self-injurious behaviors in 27.7%, and long phrases (>3 words) in 45.7% of videos. [table1] The primary reviewers' median Likert score was 4.5 (IQR4-5) and senior reviewers' median score was 5 (IQR 3-5). Spearman correlation coefficient was 0.46 (p < 0.001). [figure1]. Conclusion: We found a high frequency of atypical or rare tic phenomenology portrayed in TikTok videos. Most of the videos were rated as poorly consistent with TS. Recent FTLD patients present with similar events to those in the videos. 'Social contagion' has been postulated as a mechanism for the recent increase in FTLD.1 This modeling has been previously described in mass functional illness.2 Alternatively, echophenomena in susceptible patients has also been suggested. More research is needed to define the relationship between social media and FTLD.