Is fidgeting a sign of a mental health condition?

Do you ever find yourself bouncing your leg for no reason? Or maybe you’re writing with a pen and keep clicking it over and over again. Maybe you’re playing with your hair unintentionally when someone is taking pictures of you and your friends, wondering “Why am I so fidgety on camera?” These are all examples of fidgeting, which refers to the small, unconscious, repetitive movements we make with our hands or feet. 

When people use the word “fidget”, they may be talking about many different things. Fidgeting, like tapping your foot or shifting in your seat, has been shown to cause changes in brain activity. Scientists believe it might help reduce muscle stiffness or prepare your brain for movement. Other studies suggest fidgeting can help keep our movements accurate, or simply be a small overflow of motor commands from the brain. Some people find fidgeting to be helpful. It can relieve stress, burn calories, and even help with focusing on a task. In short, something like fidgeting fingers in moderation is totally normal and shouldn’t be seen as a problem unless it’s disruptive. 

However, fidgeting can indicate an underlying mental health condition when it becomes excessive, distressing, or is accompanied by other concerning symptoms. This article aims to investigate why people fidget, define the point at which fidget-like behavior becomes excessive, discuss two conditions that can be misidentified as excessive fidgeting, and introduce you to a highly effective approach for treating them. 

Why do people fidget?

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. So why exactly do people fidget? Here are various functions these behaviors 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 health conditions are associated with excessive fidgeting? 

Fidgeting alone does not indicate any specific disorder. That said, several mental health conditions may involve fidgeting as a symptom. Hyperactivity and impulsivity are key features of attention deficit hyperactivity disorder (ADHD), and people with ADHD may exhibit fidgeting behaviors due to their excess energy, or as a way to help manage emotional regulation. For example, people with ADHD may use finger tapping as a way to cope with feelings of tension or discomfort.

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. 

Sometimes, behaviors may look like and imitate fidgeting, but they’re actually something else. For example, obsessive-compulsive disorder (OCD), tic disorders like Tourette’s Syndrome, and body-focused repetitive behaviors (BFRBs) can involve repetitive functions similar to fidgeting but are distinct conditions with different underlying causes.

Fidgeting and OCD

Obsessive compulsive disorder (OCD) is a condition where people get stuck in a cycle of intrusive, unwanted thoughts or fears (obsessions) that lead them to perform repetitive behaviors or mental rituals (compulsions) in an attempt to ease anxiety and discomfort. These compulsions might provide short-term relief, but in the long run, they only reinforce the cycle, making it even harder to find lasting comfort.

Sometimes the compulsions that people may perform can look like fidgets, but it is important to distinguish that they are not. Dr. McGrath, Chief Clinical Officer at NOCD, explains “If you point out to someone who’s fidgeting, they’ll usually be like, okay, and they may stop.” Fidgets are easy to stop for the most part and do not serve a greater purpose. On the other hand, someone with OCD who has a fidget-like compulsion feels like they absolutely must perform the action to chase after the feeling of relief and stop something bad from happening.

For example, someone with OCD has a compulsion that involves tapping things. They are afraid that if they don’t tap something they’ve touched at least 10 times, they will have bad luck. In this case, the tapping isn’t a fidget. It is being performed to serve a serious purpose, and would cause the person great distress if they were forced to stop. However, someone who is simply fidgeting because they are bored may be tapping things around them without even fully realizing it. If they were told to stop, or simply decided to stop on their own, it wouldn’t be a very big deal to them. 

If you feel like your OCD mimics fidgeting, or feel you might be experiencing other symptoms related to obsessive compulsive disorder, it is important to seek professional treatment.  Exposure and response (ERP) therapy is an evidence-based treatment for OCD. ERP involves slowly and gently exposing you to your fears or triggers in a controlled environment and encouraging you to learn how to sit with the discomfort they feel instead of performing compulsions. Over time, this helps to make the symptoms of OCD more manageable and less painful. 

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. Nicholas Farrell, Regional Clinical Director at NOCD. 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.

Tics differ from fidgeting in that they’re much more difficult to control or stop. To help distinguish between the two, here are some key differences to keep in mind: 

• 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 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 people 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. Farrell. “However, over time, these behaviors can lead to physical and emotional consequences, potentially exacerbating the distress they were initially meant to alleviate.

Body-focused repetitive behaviors (BFRBs) differ from fidgeting in both intensity and intention. Fidgeting is typically subconscious and occurs as a way to release nervous energy or stay focused, whereas BFRBs are compulsive behaviors that often serve to relieve tension, stress, or discomfort. 

To help differentiate between the two, here are some important distinctions to consider: 

• 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 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.

Here’s a quick overview of how HRT works:

• You first learn to recognize when you are about to engage in unwanted behavior. This allows you to develop heightened self-awareness and identify the situations that tend to trigger their behaviors before they occur.
• You develop a competing response, or alternative behavior to perform when you feel the urge to engage in the problematic habit. For example, if the habit is hair-pulling, a competing response might be to gently squeeze your 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. You track your progress, and the therapist may adjust your competing response as necessary. Family members or close friends may be involved in the treatment to offer support.

Bottom line

Fidgeting isn’t always a bad thing—it can be a natural response to stress, boredom, or even concentration. However, if your fidgeting is excessive or feels difficult to control, it might be worth exploring potential underlying causes, such as anxiety, ADHD, or whether it’s related to OCD. Regardless of what’s driving these habits, there are effective strategies that can help you regain control and reduce the negative impact on your daily life.