The Twitching Generation

Three years ago, the psychiatrist Kirsten Müller-Vahl began to notice something unusual about the newest patients at her clinic in Hannover, Germany. A typical Tourette’s patient is a boy who develops slow, mild motor tics—blinking or grimacing—at about age 5 to 7, followed later by simple vocalizations such as coughing. Only about one in 10 patients progress to the disorder’s most famous symptom—coprolalia, which involves shouting obscene or socially unacceptable words. Even then, most patients utter only half a dozen swear words, on repeat.

But these new patients were different. They were older, for a start—teenagers—and about half of them were girls. Their tics had arrived suddenly, explosively, and were extreme; some were shouting more than 100 different obscenities. This last symptom in particular struck Müller-Vahl as odd. “Even in extremely severely affected [Tourette’s] patients, they try to hide their coprolalia,” she told me. The teenagers she was now seeing did not. She had the impression, she said, that “they want to demonstrate that they suffer from these symptoms.” Even more strangely, many of her new patients were prone to involuntary outbursts of exactly the same phrase: Du bist hässlich. “You are ugly.”

Müller-Vahl, a professor of psychiatry at Hannover Medical School and the chair of the European Society for the Study of Tourette Syndrome, was not the only one puzzled by this phenomenon. The global community of Tourette’s researchers is tight-knit, and as they talked it became clear that a shift in patients and symptoms was happening all over the world, at the same time. Before the pandemic, 2 to 3 percent of pediatric patients at the Johns Hopkins University Tourette’s Center, in Baltimore, had acute-onset tic-like behaviors, but that rose last year to 10 to 20 percent, according to The Wall Street Journal. Texas Children’s Hospital reported seeing approximately 60 teenagers with sudden tics between March 2020 and the autumn of 2021, compared with just one or two a year before that.

At an online conference last October, doctors in Canada, France, the United Kingdom, and Hungary pooled their knowledge. They had all seen an increase in