To add to the limited existing reports on the demographics, clinical history, phenomenology, and treatment response of patients with functional tic-like behavior (FTLB), with the addition of gender-identity associations.

Reported numbers of young adults presenting with FTLB has increased recently, partly related to the COVID-19 pandemic and social media. Patients with FTLB are predominantly young females with rapid symptom onset. Gender identity has not been assessed. Response to therapy and medications has been variable.

This single-center case series included patients that presented to the Northwestern University Parkinson’s Disease and Movement Disorders Center with FTLB between February and September 2021.

The mean age of onset and diagnosis were 22 and 22.4 years old (n=8), respectively. All patients were female sex at birth, and 5 (62.5%) identified their gender as non-binary. Three patients (37.5%) had comorbid functional neurological disorders. The majority (n=7, 87.5%) had depression and anxiety, 2 (25%) had ADHD, and 2 (25%) had OCD. Three-quarters (n=6, 75%) of patients were on psychiatric medications. Half (n=4, 50%) of the patients used substances, including alcohol, nicotine, marijuana, or drugs. One patient had isolated motor tics and the rest (n=7, 87.5%) had complex motor and verbal tic-like movements with frequent self-injurious behavior. All patients were recommended to start comprehensive behavioral intervention for tics with habit reversal therapy (CBIT/HRT), guanfacine, and gingko biloba. One year follow up was available for 5 patients. Tics improved in 2 patients (25%) following CBIT/HRT and in 1 patient (12.5%) using guanfacine and gingko biloba. Tics were stable in 2 patients (25%) without intervention.

All patients were young adults of female sex, with abrupt onset of FTLB during the COVID-19 pandemic. Interestingly, the majority identified their gender as non-binary. Several patients experienced tic reduction after using CBIT/HRT, alpha-agonists, and/or gingko biloba, suggesting that these may be beneficial treatments.