TikTok’s sick role subculture is causing children to take on the characteristics of rare psychiatric diagnoses, according to an article in Comprehensive Psychiatry. Children, especially teenage girls, have self-described Tourettes, eating disorders, autism, and dissociative identity disorder (DID), but suddenly and in a way that doesn’t match how these diagnoses were previously identified.
According to the researchers, identifying and glamorizing rare disorders has become a way for teenage girls to express extreme negative emotions in a way that, instead of stigmatizing them, they feel part of a community and even feel unique and special. Researchers call it psychosomatic social contagion.
They write that the purpose is to seek affirmation and/or draw attention to the self in order to gain social capital in online communities while maintaining an unconventional peripsychiatric identity that may mask feelings of anxiety, depression, and possibly lower self-esteem.
The authors of the paper were John D. Haltigan of the University of Toronto and the Department of Child and Adolescent Psychiatry at the Center for Addiction and Mental Health, Canada; Tamara M. Pringsheim, Program Leader for the Tourette’s and Pediatric Movement Disorders Clinic at the University of Calgary; and Gaiathiri 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 such as Tumblr and Instagram. But TikTok, with its short video content, has a more powerful impact. It has now become the most widely used social media site for children and teenagers.
A CNN article shows how mental illness content on social media can affect teenagers:
The [14-year-old girl] she began to identify with the creators, according to her mother, and became convinced that they had the same diagnoses, including attention deficit hyperactivity disorder (ADHD), depression, autism, mysophobia (extreme fear of dirt and germs) and agoraphobia (fear of going out from home).
Every week she would make a different 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 of content creators who self-identify as having these illnesses, often videos that include how the symptoms manifest during daily activities and how this is an important part of the creator’s identity unique. Then the children suddenly appear with outward symptoms, just as the content creator described.
For example, according to the researchers, tic disorders that appear in children after watching videos of content creators are called functional tic-like behaviors (FTLB). In classic Tourette syndrome, tics usually appear in early childhood, develop over time, and then improve in the teenage years, with complex gestures and verbalizations (such as swearing) being rare. Small spasm-like movements and throat-clearing sounds are much more common. However, the researchers write that FTLB has a sudden onset in the teenage years in children who never experienced it in early childhood; they have much larger, more noticeable and complex movements and almost always involve complex verbalizations such as saying offensive phrases.
DID is a particularly rare psychiatric diagnosis, almost unheard of in youth. Formerly known as multiple personality disorder, it involves different personalities, known as alters, who are often very different, such as different ages or genders and the idea that some alters do not remember actions taken when others are in control.
Despite being so rare, especially in children, social media has exploded with the DID community, including a so-called plural group that glamorizes and sexualizes the diagnosis, according to researchers. While DID in real life is associated with experiencing significant, long-term trauma, DID in the world of social media is not necessarily so. Rather, it seems to be a way for children to assert their uniqueness and experiment with different identities.
The researchers write that when someone self-diagnoses after viewing content on social media, they may express the illness as part of their online identity, receiving positive feedback from a community that romanticizes it as something that makes the person paradoxically special, just like everyone else. others in that community.
There has been recognition of a vast ecosystem of neurodivergence online in which classic symptoms and diagnoses of mental illness are viewed less as mental health problems that require professional attention, and more 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 disease, children incorporate it into how they see themselves and express it in online communities. Therefore, the psychiatric diagnosis is defined and spread without the need for a psychiatrist to make a diagnosis.
The researchers write:
The increasingly algorithmic and audiovisual immersive environment of social media is a scopic medium in which various neurodivergent or diseased identities or personas can be claimed at will, at any time, without prior biological basis or attachment to empirical reality, with positive social and emotional reinforcement and resonance from the connected online community (eg using hashtags; sharing between users and amplifying content). This social and emotional resonance can reinforce and strengthen identification with the person and can even predict subsequent behaviors in accordance with it.
What does this mean for the idea that mental illness is stigmatized and that we need to raise awareness and normalize it?
Haltigan, JD, Pringsheim, TM, and Rajkumar, G. (2023). Social media as an incubator of personality and behavioral psychopathology: authenticity of symptoms and disorders or psychosomatic social contagion? Comprehensive psychiatry, 121, 152362. https://doi.org/10.1016/j.comppsich.2022.152362 (Link)
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