The latter earns enormous attention among young people with millions of subscribers and followers of the most popular influencers such as Jan Zimmermann with his German YouTube channel “Gewitter im Kopf” (“thunderstorm in the brain”) ( 15) 1, the English speaking Evie Meg under her TikTok name “thistrippyhippie” ( 16, 17) 2, 3, and the Danish speaking Stine Sara ( 18) 4 Interestingly, not only patients affected, but also these influencers show a remarkable symptom overlap.Īs outlined recently ( 1), in Germany we suggested that the YouTuber Jan Zimmermann acts as a “virtual” index case of an outbreak of MSMI-FTB. Several authors speculated that current increase in FTB is related to the COVID-19 pandemic, increased social media use, and/or “tic-like” presentations on social media ( 1, 5– 12). In line with older reports ( 13, 14), in a small number of patients, preexisting tics/Tourette syndrome (TS) have been described ( 6, 11). Even kind of symptoms show an astonishing similarity with complex, stereotyped movements at arms and body and vocalizations dominated by swear words and insults ( 1, 5– 12). However, currently, a tremendous increase in FTB has been noticed ( 1, 5– 12) with a remarkable clinical overlap including teenage age, female preponderance, relatively abrupt onset of mainly complex tic-like symptoms and socially inappropriate behaviors. Functional tic-like symptoms have been considered a relatively rare manifestation of functional neurological disorders (FND) accounting for only 2–5 % of all FND ( 3, 4). In Germany, we now identified an outbreak of functional Tourette-like behavior (FTB) spread via social media and suggested the more specific term “mass social media-induced illness” (MSMI) ( 1). So far, it was believed that outbreaks of MSI in any case require direct face-to-face contact among persons affected ( 2). Only recently, our group suggested the concept of a new type of mass sociogenic illness (MSI) spread solely via social media ( 1). 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. 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. In all patients, we identified timely-related psychological stressors, unconscious intrapsychic conflicts, and/or structural deficits. Typically, symptoms started abruptly at a mean age of 19 years and deteriorated gradually with no differences between males and females. 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. 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. 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. 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. 4Department of Audiovisual Media Studies, Film University Babelsberg, Potsdam, GermanyĬurrently, we are facing a new manifestation of functional neurological disorder presenting with functional Tourette-like behavior (FTB). 3Department of Bioethics, Medical University of Warsaw, Warsaw, Poland.2Department of Neurology, Medical University of Warsaw, Warsaw, Poland.1Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany.Carolin Fremer 1 Natalia Szejko 2,3 Anna Pisarenko 1 Martina Haas 1 Luise Laudenbach 1 Claudia Wegener 4 Kirsten R.
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