Tics, TikTok and the teen mental health crisis

Jules Evans
9 min readFeb 17, 2023


What do you get if you cross the Diagnostic and Statistical Manual with High School Musical? TikTok!

Occasionally some data appears that looks so awful it makes you do a doubletake. That was the case for me this week, when the Centre for Disease Control released data suggesting that American teen girls are ‘engulged in a wave of despair and violence’. Apparently 59% of teenage girls felt persistently sad or hopeless, and one in three considered suicide.

What the hell? What’s going on with American teenage girls? One thing that appears to be happening is a sudden steep rise in sexual violence. The CDC reported that 1 in 5 (18%) teenage girls experienced sexual violence in the past year — up 20% since 2017, when CDC started monitoring this measure. And more than 1 in 10 (14%) had ever been forced to have sex — up 27% since 2019 and the first increase since CDC began monitoring this measure.

Again, what the hell? A 30% rise in teenage rape in three years? During the pandemic? Either a generation of teen boys suddenly became 30% more rapey in three years when everyone was confined at home, or American teen girls became more aware of issues of consent and more likely to see previously accepted sexual behaviour as predatory, violent, and rape? I don’t know — but it clearly merits serious investigation.

It would have been great if the CDC had looked into what else might be causing this apparent epidemic in teenage despair — perhaps one thing might have been the lockdowns during the pandemic demanded by…the CDC! But another factor I want to look at today is the internet, social media, and especially the role of TikTok in shaping how teenagers think about mental health and mental illnesses.

TikTok is rapidly becoming the most popular social media app with American children and teens. According to some organisations, it’s already overtaken YouTube — parental control software maker Qustodio estimates kids spend an average of 82 minutes a day on TikTok compared to 75 minutes on YouTube. It’s marginally more popular with girls than boys. TikTok is shaping young people’s self-talk, self-perception, world-perception and sense of reality — particularly when teenagers are not at school and not seeing friends in person. TikTok becomes their school, their peer-group, their mirror, the voice in their head.

So how does TikTok cover emotions and mental health?

In general, it’s fair to say TikTokers are not shy of sharing their emotions. Gen Z wears its emotions on its sleeve — despair, euphoria, nihilism, ecstasy, compulsive sobbing, it’s all out there and on display, especially on TikTok, where dramatic performance gets you attention. TikTokers, both female and male, also talk a lot about mental health concerns — ADHD, depression, anxiety, self-harm, Tourettes, gender dysphoria. This should be something to celebrate. 20 years of mental health campaigning seem to have ‘worked’ — teenagers are now much more likely to disclose having mental health problems.

But the issue is how Tik-Tokers talk about mental illness. When I searched for mental health content, and content related to specific disorders, I found a lot of videos describing the symptoms or the experience of having a disorder, and very little describing how to deal with it.

Let’s start with ADHD, which is one of the trendiest mental illnesses on TikTok. Most of the videos are things like ‘5 Signs You Have ADHD’, with a TikToker bopping around while counting off five very common traits, like ‘Listening to the same song a lot’ or ‘Losing interest in hobbies’ or ‘Reacting like people expect you to react rather than how you feel inside’.

Or take anxiety, another popular hashtag on TikTok — all the videos are about what it’s like, dramatizing and to some extent fetishizing it as a vibe, rather than discussing how to manage it, deal with it, recover from it.

This, for example, is the actress Eliana Ghen, for example. You probably haven’t heard of any of her acting roles, but she has 8 million followers on TikTok and four million on YouTube, and she wins the Oscar for re-enactment of mental illness. Her viral videos perform anxiety, in flawless makeup with moody shots and background music. She’s built up a huge following, but as far as I can see there’s rarely any messaging on how to deal with anxiety.

It’s a similar story with TikTok #depression — it’s all about the enactment or even the aesthetics of it, and there’s very little content on how to deal with it.

I found a lot of videos under the tag ‘mental health awareness’, but the vast majority are like this — basically describing the symptoms of despair and then saying ‘you’re not alone’ — without offering any suggestions on who to contact or how to cope.

Internet groups have played an important role for mental health support for over 20 years — I used to visit a social anxiety online support group back in the mid-Noughties when I was in recovery. But I noticed online groups could be both healing and harmful. They could provide solidarity, sympathy and suggestions for how to get better. But they could also be places just to vent, wallow, even to encourage each other in catastrophizing, doom-mongering and suicidality.

With TikTok, I wonder if something even weirder is happening. Has TikTok made it fashionable to self-diagnose as suffering from a mental disorder? Is this Munchausen syndrome on a global scale? This possibility is discussed in this great video by YouTuber Casey Aonso. She highlights all the ‘signs you may have ADHD’ videos, and suggests people may be over self-diagnosing to jump on the TikTok trend. She says:

Why would someone want to fake a disorder? We can look back at Tumblr for an explanation — illnesses like depression and OCD were to Tumblr what ADHD is to TikTok. They were the mental illnesses constantly intertwined into people’s online personalities and aesthetic that people would want to fake them to be in the group.

TikTok and social media in general encourages imitation and social and emotional contagion. Because we’re now so interconnected online, trends sweep through global populations like epidemics — dance trends, activism trends, linguistic trends, the ‘hang yourself’ trend (yes that’s another fun TikTok game), and also trends in mental illness, like ADHD — leading to a 400% rise increase in the number of adults seeking an ADHD assessment since 2020.

During the pandemic, TikTok gave rise to a tic craze — videos went viral of teenage girls displaying their Tourette-like tics. This video has 8.5 million views for example:

Other teenage girls watched these videos and…imitated the Tik-Tok tics. Suddenly there was a global epidemic of ticking teen girls!

Doctors at Great Ormond Street, the leading children’s hospital in the UK, wrote a letter to the British Medical Journal saying that they used to see two to three cases a year of teenagers who’d developed Tourrette’s type tics. During the pandemic, they were referred two to three cases a week. The doctors write:

There is some concern that social media and websites such as TikTok may have a part to play. These sites appear to have exploded in popularity; for example, the site TikTok #tourettes has 2.5 billion views, having approximately doubled in viewing in the last month (January–February 2021). Some teenage girls report increased consumption of such videos prior to symptom onset, while others have posted videos and information about their movements and sounds on social media sites. They report that they gain peer support, recognition and a sense of belonging from this exposure. This attention and support may be inadvertently reinforcing and maintaining symptoms

Some psychologists and sociologists suggest this is an instance of ‘mass psychogenic illness’ — a form of social and emotional contagion that particularly affects teenage girls, especially when they’re confined in close quarters, like a boarding school, a nunnery, or at home and online during a pandemic. There are historical records of sudden epidemics of fainting schoolgirls, or nuns acting possessed, or medieval dance manias — yes dance crazes existed before TikTok!

It’s possible that this is also ‘mass Munchausen syndrome’ — TikTok is leading teens (both girls and boys) to self-diagnose based on vibey videos, and to imitate or fake the symptoms of mental illness because it’s a trend, and it gets you attention, sympathy and likes online. The wave of viral TikTok tic videos has promoted a viral backlash, also on TikTok, of people accusing each other of faking Tourette’s. And at least one leading TikTok Tourette’s ‘mental health advocate’ did turn out to be faking it for likes. This is not unheard of — there’s a documentary called Bad Influencer about how wellness influencer Belle Gibson faked having cancer for likes and attention.

Where are the videos about coping methods? Or recovery stories? People dealing with their shit?

I searched for CBT on TikTok — most of the videos I found were criticizing it for‘gaslighting’ and vapid ‘positive thinking’. Taking responsibility for your emotions and using your reason to challenge them is counter to the whole TikTok vibe, which is to feel your emotions, display your emotions, and vent for the webcam. Therapy in general gets more positive coverage, but it’s still weirdly dramatized for a TikTok audience — for example, a one-minute show-reel of someone getting therapy…Ta-da! Everyone on TikTok seems to have gone to drama school.

There are other coping skills which are highlighted on TikTok. The hashtags meditation and mindfulness are really popular, with billions of views

Although the most popular videos are not what you would describe as traditional meditation — after all, sitting still and counting your breath doesn’t really make for a compelling one minute video, when you could be dredding your hair into Eywa.

Other TikTok trends could be categorized under self-improvement or self-care. Cleaning videos — videos of people cleaning their house — are really, really popular:

Also very popular are videos of people describing their medication, what it’s like, filming themselves on it, going to get it, unwrapping it, or otherwise celebrating it. After all, nothing goes with a one-minute TikTok dance video like amphetamines!

So is TikTok harming teenagers’ mental health, and could it be a factor in the wave of teen despair reported by the CDC? It could be. There is some evidence that the TikTok algorithm reinforces negative mental health traits like self-harming. And it does seem to be encouraging superficial self-diagnoses, especially of ADHD, which may be a factor in the global shortage of Adderall at the moment. And by the way, clinics selling home-delivery of Ritalin and Adderall are also making superficial TikTok videos about ADHD — so they are feeding and capitalising on teenagers’ online suggestibility to sell amphetamine.

If TikTok is harming mental health by making mental illness fashionable, what is the solution? If you’re a parent, the simplest response might be to keep your child off TikTok, to stop them turning into a ticking, pill-popping, sobbing, self-asphyxiating teenybopper. But it’s not easy to prevent a teenager from accessing a social media app other than policing their phone. I guess you could have a conversation with your teenager about TikTok and how it can cause harm. Perhaps practice social media harm reduction rather than outright forbidding. Or just send them to a Mennonite farm until they’re 18.

If you’re a mental health charity, you may need to enter the inferno and try to reach teenagers where they are, on TikTok, in order to put out more positive messages of coping, resilience and recovery from mental illness. TikTok has itself partnered with Mind and the Jed Foundation to try and promote ‘well-being’, but neither Mind nor the Jed Foundation has more than a few thousand followers. Likewise Young Minds, the UK’s leading youth mental health charity — it has less than 2000 followers on TikTok, despite its annual income of £5 million. The Wellcome Trust has £250 million committed to mental health research and promotion, focusing especially on teenage mental illness. It doesn’t have a TikTok account. This is not unusual — a recent academic study found that TikTok is ‘poorly used’ by public health institutions trying to promote healthy behaviour in teens. The boomers and Generation X’ers are all shouting about mental health on Twitter, meanwhile their children are going nuts on TikTOk.

Perhaps the easiest way for mental health charities to try and have a positive impact on TikTok might be to partner with influencers who already have a big following for campaigns. But mental health campaigns can no longer just focus on ‘awareness’, ‘anti-stigma’, and celebrities bravely disclosing their diagnoses. We have passed that stage. There now (to my mind) has to be more of an emphasis on coping skills, resilience, and celebrating people for managing or even recovering from mental illness, rather than simply disclosing it and dramatizing it for the webcam.

That’s easy to say. In practice, it’s hard to control online culture if you’re not Xi Jinping, who banned unregulated use of TikTok in China, while supporting its proliferation abroad. Meanwhile, India banned the app because of spying fears, and the US government is now considering doing the same. This could be a public health issue, as well as a security one.

Here is an article by my friend Louis Weinstock, who is a psychotherapist specializing in teen mental health, on how parents can protect children from social media harm.