title: Psychopathology and psychogenic movement disorders.
abstract: Psychogenic movement disorder is defined as abnormal movements unrelated to a medical cause and presumed related to underlying psychological factors. Although psychological factors are of both clinical and pathophysiological relevance, very few studies to date have systematically assessed their role in psychogenic movement disorder. We sought to assess the role of previous life stress using validated quantitative measures in patients with psychogenic movement disorder compared with age- and sex-matched healthy volunteers as well as a convenience sample of patients with focal hand dystonia. Sixty-four patients with psychogenic movement disorder (72% female; mean age, 45.2 years [standard deviation, 15.2 years]), 38 healthy volunteers (74% female; mean age, 49 years [standard deviation, 13.7 years]), and 39 patients with focal hand dystonia (37% female; mean age, 48.7 years [standard deviation, 11.7 years]) were evaluated using a standardized psychological interview as well as validated quantitative scales to assess trauma and previous stressors, depression, anxiety, and personality traits. Patients with psychogenic movement disorder reported higher rates of childhood trauma, specifically greater emotional abuse and physical neglect, greater fear associated with traumatic events, and a greater number of traumatic episodes compared with healthy volunteers and patients with focal hand dystonia controlled for depressive symptoms and sex (Bonferroni corrected P < .005). There were no differences in categorical psychiatric diagnoses or scores on childhood physical or sexual abuse subscales, personality traits, or the dissociative experience scale. Our findings highlight a biopsychosocial approach toward the pathophysiology of psychogenic movement disorder, although the association with psychological issues is much less prominent than expected compared with the nonepileptic seizure population. A careful psychological assessment is indicated to optimize therapeutic modalities.
authors.affiliation: Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kranick
authors.forename: Vindhya
authors.initials: V
authors.lastname: Ekanayake
authors.forename: Valeria
authors.initials: V
authors.lastname: Martinez
authors.forename: Rezvan
authors.initials: R
authors.lastname: Ameli
authors.forename: Mark
authors.initials: M
authors.lastname: Hallett
authors.forename: Valerie
authors.initials: V
authors.lastname: Voon
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D008875:Middle Aged; D010551:Personality; D011596:Psychomotor Disorders / Q000175:diagnosis* / Q000523:psychology*; D011599:Psychopathology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires