Content warning: Discussion of eating disorders below.
A report recently published by the Centers for Disease Control and Prevention (CDC) has shown that during the pandemic, weekly emergency department visits among teen girls nearly tripled for tic disorders and more than doubled for eating disorders.
For girls between the ages of 12 and 17, visits for eating disorders in the first month of 2022 surged to an average of 101 per week, up from 50 visits per week during the same time period in 2019 (102% change). Visits for tic disorders among teen girls reached their peak in 2021, surging to an average of 38 emergency room visits per week, up from an average of 11 per week in 2019 (a 241% change).
These findings denote a dramatic overall increase in distress among teen girls during the pandemic, notes The American Academy of Pediatrics (AAP). The results also coincide with the AAP’s own declaration of the mental health crisis in kids as a national emergency late last year, and the fact that the helpline of the National Eating Disorders Association (NEDA) has experienced a 107% increase in contacts since the start of the pandemic.
And while the pandemic-related restriction of activities (such as school, sports and social activities) and reduced access to mental health services for this age group is partly to blame, experts in the field are calling out social media for its role in the rise of both eating disorders and tic disorders.
The link between social media and disordered eating
“Eating disorders were on the rise even before the pandemic,” notes Cynthia Flynn, PhD, clinical assistant professor and adolescent psychologist at Seattle Children’s and the University of Washington. “During the pandemic, we have seen a very significant acceleration of this trend.”
And while we still have much to learn about pandemic-related factors, Dr. Flynn notes that aside from school closures and sports cancellations, and anxiety centered around the pandemic itself, increased exposure to social media, particularly related to eating and appearance, is a possible factor that may be contributing to the increase.
Combine more time at home with heightened anxiety, reduced access to mental health care and add in an absence of daily routines plus an increased use of Instagram and TikTok, and it’s easy to see how that may equate to more cases of mental health conditions, one of which is disordered eating.
“We know that teens who spend the most time on social media are nearly twice as likely to dislike their appearance as teens who spend less time on social media,” remarks Shelby Knox, a campaign director at ParentsTogether, a national parent advocacy organization with more than 3 million members across the United States. “We also know from NEDA that eating disorders in teens ages 16 to 24 are more likely to be fatal. So these teens who are showing up at the ER are particularly at risk for complications from their eating disorders.”
TikTok and tic disorders
But it’s not just eating disorders sending teens to the ER. Tic disorders, which are typically very rare in girls, are becoming more and more common among this demographic.
“Tic disorders usually begin earlier in childhood and are more prevalent among males,” note the authors of the CDC report. “Stress of the pandemic or exposure to severe tics, highlighted on social media platforms, might be associated with increases in visits with tics and tic-like behavior among adolescent females.”
A spate of recent research has linked the popularity of TikTok influencers with Tourette syndrome to the rise of functional tics in teen girls. One small case study of six teens who each developed abrupt-onset tic-like movements were all found to have regularly watched the same TikTok influencer with Tourette syndrome.
Teens who have been previously diagnosed with anxiety or depression may be more susceptible to developing tic-like behaviors. In some cases, physical symptoms of stress can manifest in a manner that a patient has seen exhibited in another person, notes Donald Gilbert, MD, a neurologist at Cincinnati Children’s Hospital Medical Center who specializes in pediatric movement disorders and Tourette syndrome, in The Wall Street Journal.
With millions of watchers, some worry that content highlighting tics may be triggering a type of mass functional illness. Historically, these phenomena were previously seen in those living in the same location. “In these outbreaks, social connection existed between two or more of the affected individuals, and symptoms spread through sight, sound or verbal communication,” notes Hull (2021). But the widespread access to social media has created a much more diffuse outbreak that isn’t location-specific.
And it’s not like teens are necessarily seeking out this content—it sometimes just finds them. “Because of the way that social media companies design their algorithms, kids that are most vulnerable to seeing a certain type of content will be served more and more and more of it,” notes Knox. “And so when these kids are served videos about tic disorders, and they continue to click on them, they are connected to more and more videos about them.”
How to spot the signs
If you start to notice any new behaviors or patterns in your child centered around food and eating or involuntary movements, or even social media addiction, your first step should be to bring up your concerns with your child’s pediatrician, says Knox. Eating disorders especially can have serious medical consequences, says Dr. Flynn, so seeking help quickly is important. “Weight loss is definitely one of the signs to watch for, but eating disorders can be present at any weight,” Dr. Flynn notes.
Symptoms of an eating disorder in teens may include:
- Changes in eating habits that seem excessive, such as limiting types of foods to only a few “healthy” categories
- Declining to eat around others
- Skipping meals
- Excessive exercise
- Behavior that seems more isolative or secretive, especially as related to food and eating
- A marked reduction in flexibility and increased distress around food and eating
Tics are uncontrolled, sudden movements or sounds that may be repetitive. Tics may be verbal (vocal tics) or physical (motor tics) in nature. While Tourette syndrome is genetic, functional tics can develop without a genetic predisposition, though tic conditions were previously more commonly seen in boys than girls. Tic types may change over time and tics may come and go. They tend to worsen during periods of stress or anxiety.
Symptoms of a tic disorder in teens may include:
- Simple motor tics, such as nose wrinkling, eye blinking, shoulder shrugging or facial grimacing
- Complex motor tics, such as kicking, skipping, jumping
- Simple vocal tics, such as coughing, throat clearing or grunting
- Complex vocal tics, such as repeated words and phrases, animal sounds, yelling
What to do next
Early intervention is key for both eating disorders and tic disorders, and seeking medical treatment and mental health therapy for any new symptoms or concerns you may have about your teen’s behavior is the first step.
But if you’re concerned about their social media use in general, establishing an agreed-upon device use policy may help, as can taking regular social media breaks and blocking certain types of pro-eating disorder content and tic-focused content on social media.
Calling out Big Tech
However, parents shouldn’t have to be the only ones trying to keep kids safe and protected when using their devices. “The burden of keeping kids safe online has fallen almost exclusively to parents while big tech companies are making billions of dollars off of our kids,” explains Knox. “We're really exhausted. And it's time for the tech companies to pull their weight in keeping kids safe.”
Knox explains that Big Tech should recognize that these are teen accounts and work harder to restrict dangerous content shown to teens, as well as better managing the recommender algorithm that finds new videos for users to watch.
ParentsTogether has advocated for ‘mirror accounts’, which allows a parent to see exactly what their kid is watching online. “This is a tool to allow parents to have conversations with their kids about what they’re seeing online,” Knox notes. “We are not naive enough to believe that parents are going to be able to keep their kids off social media forever, and it’s now become an integral part of socialization for young people. You could argue that it’s harmful or difficult for kids not to be on social media.”
Providing parents with the tools to monitor what their kids are doing online is a no-brainer. “When a tech company doesn't allow parents to do that, in fact, when they set up barriers to parents seeing what their kids are seeing, they're interfering with parents’ ability to parent their children the way that they feel is right,” says Knox.
There’s already so much shame, guilt and stigma surrounding kids’ use of technology these days that placing the burden on parents to protect their children feels like piling on. Having parental controls is one thing, but making them simple to use is a whole different discussion. And it’s safe to say that most parents don’t have hours to devote to keeping tabs on what their kids are doing online.
“This is just another thing that parents are made to feel bad about,” Knox continues. “Any parent who feels guilt or shame should remember that these companies are making billions of dollars a year profiting off of their children and their children's information. And what parents need to be doing is standing up and holding the tech companies accountable and saying, ‘You can do better, and you must do better for our children.’”
Here’s where you can get involved with ParentsTogether’s advocacy work.
Hull M, Parnes M. Tics and TikTok: functional tics spread through social media. Movement Disorders Clinical Practice. 2021 Nov;8(8):1248-52.
Radhakrishnan L, Leeb RT, Bitsko RH, et al. Pediatric Emergency Department Visits Associated with Mental Health Conditions Before and During the COVID-19 Pandemic — United States, January 2019–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:319–324. doi:10.15585/mmwr.mm7108e2
Cynthia Flynn, PhD, is a clinical assistant professor and adolescent psychologist at Seattle Children’s and the University of Washington. Her specialties include eating disorders, youth and adolescent psychology, behavior disorders, and more.
Shelby Knox is a campaign director at ParentsTogether, a national parent advocacy organization with more than 3m members across the United States.