Fidgeting, on its own, is not a sign of a mental health condition. In fact, it just might be good for you. But when people use the word “fidget,” they may be talking about many different things.
Various studies have shown that small, spontaneous motor actions and postural adjustments we call fidgeting are accompanied by significant brain activity changes in humans and animals. Scientists have posited that fidgeting may reduce muscles’ passive stiffness or serve to “pre-adapt” our neurons. Other research has demonstrated that fidgeting could be important in generating accurate sensory-motor maps or may represent a leakage of motor commands from the brain. In other words, there’s no need to pathologize a reasonable degree of fidgeting, so long as it doesn’t cause any harm or disruption.
However, fidgeting could indicate an underlying mental health condition when it becomes excessive, distressing, or accompanied by other concerning symptoms. This article aims to investigate why people fidget, define the point at which fidgeting behavior becomes excessive, discuss two conditions that can be misidentified as excessive fidgeting, and introduce you to a highly effective approach for treating them.
What is fidgeting?
Fidgeting refers to small, often repetitive movements or behaviors that people engage in, usually with their hands or feet. These movements can include tapping fingers, bouncing legs, twirling hair, or playing with objects like pens, stress balls, and aptly named fidget spinners. Fidgeting can also refer to more subtle actions like shifting one’s weight or adjusting clothing. We’ve already discussed some emerging hypotheses about the physiological benefits of fidgeting, but now, let’s look at why people fidget—largely, for self-soothing and emotional regulation. Here are various functions that fidgeting can serve:
An outlet for nervous energy: Fidgeting can be a way to release excess energy, especially in situations where we may feel anxious, stressed, or excited. It can serve as a physical outlet for pent-up emotions.
Attention regulation: Some people find that fidgeting helps them concentrate or focus. It can provide a sensory input that helps maintain alertness and attention, particularly in situations that might otherwise be monotonous or mentally demanding. In some cases, they can even serve to benefit executive functioning.
Self-soothing: Fidgeting can also be a calming mechanism. These movements can help us feel more relaxed or centered, potentially reducing feelings of restlessness or agitation.
Stimulation seeking: People have different sensory preferences, and some of us might seek out additional sensory input. Fidgeting can provide this extra stimulation, aiding in maintaining a state of alertness or engagement.
Habitual behavior: For some, fidgeting simply becomes a learned behavior over time. It may start as a response to certain situations or emotions, and then become a habitual action even when those feelings aren’t present.
Physical discomfort or restlessness: Sometimes, people fidget because they are physically uncomfortable or restless. This could be due to an uncomfortable chair, tight clothing, or simply a desire to move around.
It’s important to remember that while fidgeting can serve a purpose for some people, it may be seen as distracting or inappropriate in certain situations or environments. If a person finds it hard to stop disruptive fidgeting after it’s brought to their attention, it may be a sign of an underlying mental health condition.
What mental disorders is excessive fidgeting associated with?
It’s important to know that fidgeting alone does not indicate any specific disorder. That said, several mental disorders may involve fidgeting as a symptom. Hyperactivity and impulsivity are key features of Attention-Deficit/Hyperactivity Disorder (ADHD), and people with the disorder may exhibit fidgeting behaviors due to their excess energy, or as a way to help manage emotional regulation and/or executive functioning issues.
Generalized Anxiety Disorder (GAD), Social Anxiety Disorder, and Panic Disorder can also lead to restlessness and fidgeting. This can include tapping fingers, shaking legs, or constantly moving.
Additionally, autistic people may engage in repetitive behaviors, including fidgeting or stimming (self-stimulatory behaviors like hand-flapping or rocking) to self-regulate.
Some other conditions can look like excessive fidgeting that we’ll look at in a little more detail: tic disorders, including Tourette’s Syndrome, and body-focused repetitive behaviors (BFRBs).
What are tic disorders?
Tic disorders are neurological conditions characterized by repetitive, sudden, and involuntary movements or vocalizations known as tics. Tics can manifest in various ways, including eye blinking, head jerking, throat clearing, or making unusual sounds. They can be simple, involving isolated movements or sounds, or complex, involving coordinated sequences of movements or vocalizations. Tourette’s syndrome is the most well-known tic disorder and is characterized by both motor and vocal tics lasting for at least a year.
“These disorders often emerge in childhood and can vary in severity and frequency over time,” says Dr. Farrell. While the exact cause remains unclear, genetic and environmental factors are believed to play a role. Stress and anxiety can exacerbate tic symptoms, though they tend to lessen during periods of relaxation or focused concentration. In most cases, tic disorders do not significantly impair daily functioning, but in some instances, they can be severely socially, academically, and emotionally challenging.
Telling tic disorders and fidgeting apart
Tic disorders and fidgeting can be differentiated based on several distinct features:
Involuntary nature: Tics are sudden, rapid, and repetitive movements or largely involuntary vocalizations. They often occur in response to an irresistible urge or sensation. Conversely, fidgeting involves purposeful, voluntary movements that people may use to relieve excess energy or aid concentration.
Complexity of movements: “Tics can range from simple—like eye blinking or facial grimacing—to complex—such as touching objects in a specific sequence or making coordinated vocalizations,” explains Dr. Farrell. “Fidgeting, on the other hand, often involves simpler, repetitive actions like tapping fingers, bouncing a leg, or twisting a pen.”
Awareness and control: People with tic disorders may be aware of their tics but have limited control over them. In contrast, fidgeting is usually a conscious and controllable behavior.
Presence of vocal tics: Tic disorders can involve vocal tics, which are involuntary sounds or words. This can include throat clearing, grunting, or even the utterance of words or phrases. Fidgeting does not involve vocalizations.
Duration and frequency: Tics tend to be more frequent and persistent than fidgeting. They can occur multiple times a day, sometimes for months at a time. Fidgeting, while repetitive, is generally less intense.
Potential social impact: “Tics, especially vocal tics, can sometimes draw attention or be socially conspicuous,” says. Dr. Farrell. “This can lead to social discomfort and functional impairment in some cases. Conversely, fidgeting is usually less noticeable and typically doesn’t draw significant attention from others.”
Diagnostic Criteria: Tic disorders, such as Tourette’s syndrome, are recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as neurological disorders. Fidgeting, as a common behavior, is not classified as a disorder in itself.
What are body-focused repetitive behaviors (BFRBs)?
BFRBs are a group of psychological disorders characterized by recurrent, self-inflicted actions directed towards one’s own body.
These behaviors often serve as coping mechanisms for autistic folks and those with ADHD, or as regulation tools for stress, anxiety, or emotional distress and regulation—and they’re highly distinct from fidgeting. Examples of BFRBs include conditions like trichotillomania (hair-pulling disorder), dermatillomania (skin-picking disorder), and onychophagia (nail-biting).
“People with BFRBs may engage in these actions compulsively, finding temporary relief from their underlying emotional turmoil,” explains Dr. Nicholas Farrell, Regional Clinical Director at NOCD. “However, over time, these behaviors can lead to physical and emotional consequences, potentially exacerbating the distress they were initially meant to alleviate.”
Differentiating BFRBs and fidgeting
Several key characteristics distinguish body-focused repetitive behaviors (BFRBs) and normal fidgeting:
Frequency and intensity: BFRBs are typically more frequent and intense than normal fidgeting. They involve repetitive, often ritualistic actions that may last for extended periods, sometimes to the point of causing physical damage.
Purpose and function: BFRBs often serve as a way to cope with underlying emotional distress, anxiety, or tension, and are also often correlated with autism or ADHD. They provide a temporary sense of relief or gratification. In contrast, fidgeting is a natural, unconscious movement that can help some people concentrate or release excess energy without a strong emotional component.
Conscious awareness: People with BFRBs are often acutely aware of their behavior and may feel a sense of shame or guilt associated with it. Fidgeting, on the other hand, is typically more automatic and may not be consciously recognized.
Potential damage: BFRBs have the potential to cause physical damage over time. For example, hair-pulling can lead to noticeable hair loss, while skin-picking can result in wounds, infections, or scarring. Fidgeting, on the other hand, rarely causes physical damage.
Interference with daily life: “BFRBs can significantly interfere with daily functioning, social interactions, and self-esteem,” says Dr. Farrell. “They can become time-consuming and lead to avoidance of certain situations or activities. Fidgeting, in contrast, is usually less intrusive and doesn’t significantly disrupt daily activities.”
Diagnostic criteria: BFRBs are recognized as psychological disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), whereas fidgeting is considered a normal, common behavior observed in many people.
What BFRBs and tic disorders share in common—other than being misidentified as fidgeting—is that they can often be managed by a distinctive therapeutic approach called habit reversal training (HRT).
What is habit reversal training (HRT)
HRT is an evidence-based therapeutic technique designed to help people gain control over unwanted repetitive behaviors, including those that can look like fidgeting. The underlying principle of HRT is to replace a problematic habit with a more constructive or neutral behavior.
HRT has shown significant effectiveness, especially in treating disorders characterized by repetitive behaviors. Research has demonstrated its effectiveness in conditions such as Tourette Syndrome, Trichotillomania (hair-pulling disorder), excoriation disorder (chronic skin-picking), and onychophagia (nail biting).
People who work with a therapist trained in HRT will first learn to recognize when they are about to engage in unwanted behavior. This allows them to develop heightened self-awareness and identify the situations that tend to trigger their behaviors before they occur.
They’ll then develop a competing response, or alternative behavior to perform when they feel the urge to engage in the problematic habit—one that physically prevents them from engaging in the behavior they’re trying to stop. For example, if the habit is hair-pulling, a competing response might be to gently squeeze their hands into fists.
Patients are typically given exercises to practice outside of therapy sessions, reinforcing the new behavior and breaking the harmful habit long-term. They’ll track their progress, and the therapist may adjust their competing response as necessary. Family members or close friends may be involved in the treatment to offer support and reinforcement as their loved one progresses through treatment goals and regular practice.
Under the guidance of a trained therapist, HRT can lead to substantial improvements in overall well-being and functioning, allowing people with BFRBs and tic disorders to regain better control over their own behaviors and health.
Get help today
If you or someone you know struggles with behaviors that match the descriptions of a BFRB or tic disorder, help is at hand. Schedule a free call today with the NOCD Care Team to learn more about how a licensed therapist trained in HRT can help.