TikTok’s “sick-role subculture” leads to children taking on the characteristics of rare psychiatric diagnoses, according to an article in Comprehensive Psychiatry. Kids—especially teenage girls—are presenting with self-described Tourette’s, eating disorders, autism, and dissociative identity disorder (DID)—but suddenly, and in a way that doesn’t match how these diagnoses have previously been identified.
According to the researchers, identifying with and glamorizing rare disorders has become a way for teenage girls to express extreme negative emotions in a way that, rather than stigmatizing them, makes them feel part of a community and even feel unique and special. The researchers call it “psychosomatic social contagion.”
They write that the purpose “is to seek affirmation and/or draw attention to oneself to acquire social capital in online communities while simultaneously maintaining an unconventional peri-psychiatric identity that may mask feelings of anxiety, depression, and possibly lower self-esteem.”
The authors of the paper were John D. Haltigan at the University of Toronto and the Child and Youth Psychiatry Department at the Centre for Addiction and Mental Health, Canada; Tamara M. Pringsheim, Program Lead for the Tourette and Pediatric Movement Disorders Clinic at the University of Calgary; and Gayathiri Rajkumar at Western University.
They note that in the early 2010s, content promoting eating disorders, self-harm, and suicide became popular on social media sites like Tumblr and Instagram. But TikTok, with its short-form video content, has a more powerful impact. It has now become the most widely used social media site for children and teens.
An article by CNN shows how social media “mental illness” content can affect teens:
“The [14-year-old girl] started to self-identify with the creators, according to her mother, and became convinced she had the same diagnoses, including attention-deficit hyperactivity disorder (ADHD), depression, autism, mysophobia (an extreme fear of dirt and germs) and agoraphobia (a fear of leaving the house).”
“’Every week, she would come up with another diagnosis,’ Coleman told CNN. ‘If she sees a hint of herself in someone, she thinks she has it, too.’”
According to Haltigan, Pringsheim, and Rajkumar, the pattern is this: young girls watch videos by content creators who self-identify as having these “illnesses,” often videos that involve how the symptoms manifest during everyday activities and how it is an important part of the creator’s identity that makes them unique. Then, kids suddenly present with the outward symptoms, just as described by the content creator.
For instance, according to the researchers, the tic disorders that appear in kids after watching content creators’ videos are termed “functional tic-like behaviors (FTLBs).” In classic Tourette’s syndrome, tics usually appear in early childhood, develop over time, and then improve in the teenage years, with complex gestures and verbalizations (such as curse words) being rare. Much more common are small spasm-like movements and throat-clearing sounds. However, the researchers write that FTLBs have a sudden onset in the teenage years in kids who never experienced them in early childhood; they feature much larger, more noticeable, and complex movements, and they almost always include complex verbalizations like saying offensive phrases.
DID is an especially rare psychiatric diagnosis, almost unheard of in youth. Previously known as “multiple personality disorder,” it involves various personalities, known as “alters,” that are often very different—such as being different ages or genders—and the notion that some alters don’t remember actions taken when other alters are in control.
Despite being so rare, though, especially in kids, social media has exploded with a DID community, including a group called “plurals” who glamorize and sexualize the diagnosis, according to the researchers. While DID in real life is associated with the experience of significant, long-lasting trauma, DID in the social media world is not necessarily so. Instead, it seems to be a way for kids to claim uniqueness and experiment with different identities.
The researchers write that once someone self-diagnoses after viewing social media content, they can then express that “illness” as part of their identity online, receiving positive feedback from a community who romanticize it as something that makes the person—paradoxically—special, just like everyone else in that community.
“There has been a recognition of vast online ‘neurodivergence’ ecosystem in which classical mental illness symptoms and diagnoses are viewed less as mental health concerns that require professional attention, but rather as consumer identities or character traits that make individuals sharper and more interesting than others around them,” the researchers write.
Over time, despite never actually meeting the criteria for the “illness,” kids incorporate it into part of how they see themselves and express it themselves in online communities. Thus, the psychiatric diagnosis is reified and spread without even needing a psychiatrist to give the diagnosis.
The researchers write:
“The increasingly algorithmic and audiovisually immersive social media environment is a scopic medium in which various ‘neurodivergent’ or sick role identities or personas can be claimed at will, at any given moment—with no antecedent biological basis or tether to empirical reality—with positive social and emotional reinforcement and resonance from the associated online community (e.g., via the use of hashtags; user-to-user sharing and amplification of content). This social and emotional resonance may amplify and reinforce identification with the persona and may even predict later behaviors in line with it.”
What does this mean for the notion that “mental illness” is “stigmatized,” and we need to “raise awareness” and “normalize” it?
Haltigan, J. D., Pringsheim, T. M., & Rajkumar, G. (2023). Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion? Comprehensive Psychiatry, 121, 152362. https://doi.org/10.1016/j.comppsych.2022.152362 (Link)