Mass social media-induced illness presenting with Tourette-like behavior
Open accessAbstract
Currently, we are facing a new manifestation of functional neurological disorder presenting with functional Tourette-like behavior (FTB). This study aimed to show characteristics of this phenotype presenting as an outbreak of “mass social media-induced illness” (MSMI) and to explore predisposing factors. Between 5–9/2021, we prospectively investigated 32 patients (mean/median age: 20.1/18 years, range: 11–53 years, n = 16 females) with MSMI-FTB using a neuro-psychiatric examination, a comprehensive semi-structured interview and aspects of the Operationalized Psychodynamic Diagnostic System. In contrast to tics, numbers of complex movements and vocalizations were nine times greater than of “simple” symptoms, and of vocalizations one and a half times greater than of movements. In line with our hypothesis of MSMI, symptoms largely overlapped with those presented by German YouTuber Jan Zimmermann justifying his role as “virtual” index case in current outbreak. Typically, symptoms started abruptly at a mean age of 19 years and deteriorated gradually with no differences between males and females. In all patients, we identified timely-related psychological stressors, unconscious intrapsychic conflicts, and/or structural deficits. Nearly all patients (94%) suffered from further psychiatric symptoms including abnormalities in social behavior (81%), obsessive-compulsive behavior (OCB) (47%), Tourette syndrome (TS) (47%), anxiety (41%), and depression (31%), about half (47%) had experienced bullying, and 75% suffered from coexisting somatic diseases. Our data suggest that pre-existing abnormalities in social behavior and psychiatric symptoms (OCB, anxiety, and depression), but also TS in combination with timely-related psychological stressors, unconscious intrapsychic conflicts, and structural deficits predispose to contagion with MSMI-FTB.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
More recent reports emphasize the role of anxiety in complex tic presentations and note that FTLBs often co-exist alongside neurodevelopmental tics.
“More recent reports emphasize the role of anxiety in complex tic presentations, noting that FTLBs often co-exist alongside neurodevelopmental tics and that this dual diagnosis has increased in recent years and/or been previously underestimated (20, 22, 23).”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [23]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Experimental evidence of massive-scale emotional contagion through social networks
Kramer, A. D. I., Guillory, J. E., & Hancock, J. T. (2014) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1320040111 · Cited by 3,687 · see citing works
The yale global tic severity scale: initial testing of a clinician-rated scale of tic severity
LECKMAN, J. F., RIDDLE, M. A., HARDIN, M. T., ORT, S. I., SWARTZ, K. L., STEVENSON, J., & COHEN, D. J. (1989) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-198907000-00015 · Cited by 2,146 · see citing works
Mayring, P. (2010) · Handbuch Qualitative Forschung in der Psychologie · doi:10.1007/978-3-531-92052-8_42 · Cited by 1,752 · see citing works
Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., LaFaver, K., LaFrance, W. C., Lang, A. E., Nicholson, T., et al. (2018) · JAMA Neurology · doi:10.1001/jamaneurol.2018.1264 · Cited by 786 · see citing works
The behavioral spectrum of Gilles de la Tourette syndrome
Cavanna, A. E., Servo, S., Monaco, F., & Robertson, M. M. (2009) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.2009.21.1.13 · Cited by 297 · see citing works
The influence of contextual factors on tic expression in Tourette's syndrome: A review
Conelea, C. A., & Woods, D. W. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.04.010 · Cited by 250 · see citing works
Emotional contagion: a brief overview and future directions
Herrando, C., & Constantinides, E. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.712606 · Cited by 249 · cited 1× · see citing works
“Since emotional contagion also spreads via social media (34, 35) channel-hosts’ sex may have an impact on sex ratios.”
Coprophenomena in Tourette syndrome
Fréeman, R. D., Zinner, S. H., Müller‐Vahl, K., Fast, D. K., Burd, L. J., Kano, Y., Rothenberger, A., Roessner, V., Kerbeshian, J., & Stern, J. S. (2009) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.2008.03135.x · Cited by 173 · see citing works
Management of functional neurological disorder
Gilmour, G. S., Nielsen, G., Teodoro, T., Yogarajah, M., Coebergh, J. A., Dilley, M. D., Martino, D., & Edwards, M. J. (2020) · Journal of Neurology · doi:10.1007/s00415-020-09772-w · Cited by 169 · see citing works
<scp>TikTok</scp> Tics: A Pandemic Within a Pandemic
Olvera, C., Stebbins, G. T., Goetz, C. G., & Kompoliti, K. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13316 · Cited by 158 · see citing works
Rapid Onset Functional Tic‐Like Behaviors in Young Females During the <scp>COVID</scp>‐19 Pandemic
Pringsheim, T., Ganos, C., McGuire, J. F., Hedderly, T., Woods, D., Gilbert, D. L., Piacentini, J., Dale, R. C., & Martino, D. (2021) · Movement Disorders · doi:10.1002/mds.28778 · Cited by 133 · see citing works
The clinical features of psychogenic movement disorders resembling tics
Baizabal-Carvallo, J. F., & Jankovic, J. (2014) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2013-305594 · Cited by 125 · see citing works
COVID-19 related increase in childhood tics and tic-like attacks
Heyman, I., Liang, H., & Hedderly, T. J. (2021) · Archives of Disease in Childhood · doi:10.1136/archdischild-2021-321748 · Cited by 120 · see citing works
Stop that! It’s not Tourette’s but a new type of mass sociogenic illness.
Müller-Vahl, K. R., Pisarenko, A., Jakubovski, E., & Fremer, C. (2022) · Brain · doi:10.1093/brain/awab316 · Cited by 114 · see citing works
Tics and <scp>TikTok</scp> : Functional Tics Spread Through Social Media
Hull, M., & Parnes, M. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13267 · Cited by 108 · see citing works
Hull, M., Parnes, M., & Jankovic, J. J. (2021) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000001082 · Cited by 98 · see citing works
Pandemic Tic‐like Behaviors Following Social Media Consumption
Paulus, T., Bäumer, T., Verrel, J., Weißbach, A., Roessner, V., Beste, C., & Münchau, A. M. (2021) · Movement Disorders · doi:10.1002/mds.28800 · Cited by 73 · see citing works
Mass psychogenic illness and the social network: is it changing the pattern of outbreaks?
Bartholomew, R. E., Wessely, S. C., & Rubin, G. J. (2012) · Journal of the Royal Society of Medicine · doi:10.1258/jrsm.2012.120053 · Cited by 71 · see citing works
Rapid onset of functional tic‐like behaviours in young adults during the COVID‐19 pandemic
Pringsheim, T. M., & Martino, D. (2021) · European Journal of Neurology · doi:10.1111/ene.15034 · Cited by 71 · see citing works
Eddy, C. M., & Cavanna, A. E. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.05.019 · Cited by 69 · see citing works
Paediatric tic-like presentations during the COVID-19 pandemic
Buts, S., Duncan, M., Owen, T., Martino, D., Pringsheim, T., Byrne, S., McWilliams, A., Murphy, T., Malik, O., Liang, H., et al. (2022) · Archives of Disease in Childhood · doi:10.1136/archdischild-2021-323002 · Cited by 60 · see citing works
‘It's a curse!’: coprolalia in T ourette syndrome
Eddy, C. M., & Cavanna, A. E. (2013) · European Journal of Neurology · doi:10.1111/ene.12207 · Cited by 56 · see citing works
What Does Neuroscience Tell Us About the Conversion Model of Functional Neurological Disorders?
Cretton, A., Brown, R. J., LaFrance, W. C., Jr., & Aybek, S. (2019) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.19040089 · Cited by 53 · see citing works
Pseudo-tics in Tourette Syndrome
Dooley, J. M., Stokes, A., & Gordon, K. (1994) · Journal of Child Neurology · doi:10.1177/088307389400900112 · Cited by 49 · see citing works
Recognizing Uncommon Presentations of Psychogenic (Functional) Movement Disorders
Baizabal-Carvallo, J., & Fekete, R. (2015) · Tremor and Other Hyperkinetic Movements · doi:10.7916/d8vm4b13 · Cited by 42 · see citing works
Canna, M., & Seligman, R. A. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112725 · Cited by 40 · see citing works
Recognizing Uncommon Presentations of Psychogenic (Functional) Movement Disorders
Baizabal‐Carvallo, J. F., & Fekete, R. (2015) · Tremor and Other Hyperkinetic Movements · doi:10.5334/tohm.266 · Cited by 37 · see citing works
Essing, J., Jakubovski, E., Psathakis, N., Cevirme, S., Leckman, J. F., & Müller‐Vahl, K. (2022) · Journal of Movement Disorders · doi:10.14802/jmd.21045 · Cited by 34 · see citing works
Prognosis of rapid onset functional tic‐like behaviors: Prospective follow‐up over 6 months
Howlett, M., Martino, D., Nilles, C., & Pringsheim, T. M. (2022) · Brain and Behavior · doi:10.1002/brb3.2606 · Cited by 33 · see citing works
Kessler, H., Stasch, M., & Cierpka, M. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00718 · Cited by 29 · see citing works
Erikson's Stages of Psychosocial Development
Gross, Y. (2020) · The Wiley Encyclopedia of Personality and Individual Differences · doi:10.1002/9781119547143.ch31 · Cited by 27 · see citing works
Inter-individual differences in urge-tic associations in Tourette syndrome
Schubert, L., Verrel, J., Behm, A., Bäumer, T., Beste, C., & Münchau, A. M. (2021) · Cortex · doi:10.1016/j.cortex.2021.06.017 · Cited by 26 · see citing works
Belgian Coca-Cola-related Outbreak: Intoxication, Mass Sociogenic Illness, or Both?
Gallay, A. (2002) · American Journal of Epidemiology · doi:10.1093/aje/155.2.140 · Cited by 24 · see citing works
Outbreak of Mass Sociogenic Illness in a School Feeding Program in Northwest Bangladesh, 2010
Haque, F., Kundu, S. K., Islam, M. S., Hasan, S. M. M., Khatun, A., Gope, P. S., Mahmud, Z. H., Alamgir, A. S. M., Islam, M. S., Rahman, M., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0080420 · Cited by 16 · see citing works
Diagnosespezifische Strukturdefizite
Seiffge‐Krenke, I., Fliedl, R., & Katzenschläger, P. (2013) · Psychotherapeut · doi:10.1007/s00278-012-0955-3 · Cited by 16 · see citing works
[Psychogenic tics: clinical characteristics and prevalence].
Janik, P., Milanowski, Ł., & Szejko, N. (2014) · PubMed · Cited by 13 · see citing works
Epidemic hysteria. A study of high risk factors.
Chan, M., & Wc, K. (1983) · PubMed · Cited by 10 · see citing works
Touched by Le Roy: Teens, Tourette’s, and YouTube in the Twilight of Neoliberalism
Sammond, N. (2015) · Women's studies quarterly · doi:10.1353/wsq.2015.0010 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Functional Tic‐Like Behaviors: A Common Comorbidity in Patients with Tourette Syndrome
Müller‐Vahl, K., Pisarenko, A., Fremer, C., Haas, M., Jakubovski, E., & Szejko, N. (2023) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13932 · Cited by 30 · see citing works
Cavanna, A. E., Purpura, G., Riva, A., Nacinovich, R., & Seri, S. (2023) · European Journal of Neurology · doi:10.1111/ene.15867 · Cited by 23 · see citing works
Nilles, C., Szejko, N., Martino, D., & Pringsheim, T. M. (2023) · European Journal of Neurology · doi:10.1111/ene.16051 · Cited by 20 · see citing works
Maxwell, A., Zouki, J.-J., & Eapen, V. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1265123 · Cited by 18 · see citing works
“More recent reports emphasize the role of anxiety in complex tic presentations, noting that FTLBs often co-exist alongside neurodevelopmental tics and that this dual diagnosis has increased in recent years and/or been previously underestimated (20, 22, 23).”
BackgroundFremer, C., Szejko, N., Pisarenko, A., Haas, M., Laudenbach, L., Wegener, C., & Müller‐Vahl, K. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01603-z · Cited by 17 · see citing works
Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era
Cavanna, A. E., Spini, L., Ferrari, S., Purpura, G., Riva, A., Nacinovich, R., & Seri, S. (2024) · Healthcare · doi:10.3390/healthcare12111106 · Cited by 16 · see citing works
Premonitory Urge in Patients with Tics and Functional Tic‐like Behaviors
Szejko, N., Fletcher, J., Martino, D., & Pringsheim, T. M. (2023) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13951 · Cited by 14 · see citing works
Hartung, K., Klages, C. S., Fremer, C., Pisarenko, A., Haas, M., Jakubovski, E., Szejko, N., Brandt, V. C., & Müller‐Vahl, K. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.07.011 · Cited by 14 · see citing works
Cavanna, A. E., Caimi, V., Capriolo, E., Marinoni, M., Arienti, G., Riva, A., Nacinovich, R., & Seri, S. (2025) · Brain Sciences · doi:10.3390/brainsci15050435 · Cited by 10 · see citing works
Sandra, D. A., Segal, Z. V., Majoo, S., Sistanis, A., Burke, M. J., & Inzlicht, M. (2025) · Psychological Medicine · doi:10.1017/s0033291725101979 · Cited by 9 · see citing works
Tourette Syndrome with Functional Overlay: A Case Series
Cavanna, A. E., Damodaran, L., Purpura, G., & Nacinovich, R. (2022) · Archives of Medicine and Health Sciences · doi:10.4103/amhs.amhs_247_22 · Cited by 7 · see citing works
Tourette syndrome research highlights from 2022
Hartmann, A., Andrén, P., Atkinson-Clément, C., Czernecki, V., Delorme, C., Debes, N. M., Müller‐Vahl, K., Paschou, P., Szejko, N., Topaloudi, A., et al. (2023) · F1000Research · doi:10.12688/f1000research.135702.1 · Cited by 6 · see citing works
Tourette syndrome research highlights from 2023
Hartmann, A., Andrén, P., Atkinson-Clément, C., Czernecki, V., Delorme, C., Debes, N. M., Morand‐Beaulieu, S., Müller‐Vahl, K., Paschou, P., Szejko, N., et al. (2024) · F1000Research · doi:10.12688/f1000research.150931.2 · Cited by 5 · see citing works
Hartung, L. K., Schmitt, S., Fremer, C., Klages, C. S., Szejko, N., & Müller‐Vahl, K. (2025) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.70384 · Cited by 5 · see citing works
Call for action: misinformation about Tourette syndrome from major media network
Müller-Vahl, K. R., Szejko, N., Hartmann, A., Debes, N. M., Hedderly, T. J., Parnes, M., Abi‐Jaoude, E., Śmiłowska, K., Nilles, C., Coffman, K. A., et al. (2026) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-025-02939-8 · Cited by 4 · see citing works
The psychological consequences of mental health awareness efforts
Foulkes, L., Winterburn, I., Sandra, D. A., Inzlicht, M., Andrews, J. L., & Holst, C. G. (2026) · Nature Reviews Psychology · doi:10.1038/s44159-026-00532-7 · Cited by 4 · see citing works
Salzberg, M. R., Kim, H. H., Basnayake, C., Holt, D. Q., & Kamm, M. A. (2024) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.16698 · Cited by 4 · see citing works
Tourette syndrome research highlights from 2022
Hartmann, A., Andrén, P., Atkinson-Clément, C., Czernecki, V., Delorme, C., Debes, N. M., Müller‐Vahl, K., Paschou, P., Szejko, N., Topaloudi, A., et al. (2023) · F1000Research · doi:10.12688/f1000research.135702.2 · Cited by 3 · see citing works
What Do We Currently Know About Functional Tic-Like Behaviors: A Topical Review
Andersen, K., Szejko, N., Müller‐Vahl, K., Cavanna, A. E., Hedderly, T. J., Greenberg, E., & Debes, N. M. (2026) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2026.02.007 · Cited by 1 · see citing works
“How do I explain something I don’t understand?”: Young people’s experiences of functional tics
Oates, N., Hedderly, T. J., French, N., Owen, T., & Ludlow, A. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2640284 · Cited by 1 · see citing works
Tochen, L. S., & Singer, H. S. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-10944-7.00118-9
“I swear it’s not Tourette’s!” - it is time to rethink coprolalia in Tourette syndrome
Müller‐Vahl, K., Nilles, C., Debes, N. M., Szejko, N., & Hedderly, T. J. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1948442
A systematic review to characterize functional tic-like behaviors
Gary, J. B., Shaw, J. S., & Mcguire, J. F. (2026) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2026.1936806
- Authors
- Fremer, C., Szejko, N., Pisarenko, A., Haas, M., Laudenbach, L., Wegener, C., & Müller-Vahl, K. R.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- Medical University of Warsaw (PL)
- Filmuniversität Babelsberg KONRAD WOLF (DE)
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2022-09-20
- Volume
- 13
- Pages
- 963769-963769
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC9530444
- OpenAlex
- W4297906064
- Cited by
- 24
- References
- 38
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 5 · 2023: 8 · 2022: 1
- FWCI
- 2.93
- Type
- journal article
- Language
- en
- Update notices
- correction (2025-09-15)
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Keywords
- conversion disorder, Tourette syndrome, psychological stressors, bullying, obsessive-compulsive behavior, anxiety, depression, contagion, psychodynamic diagnosis, structural deficit, tics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
