ABSTRACT
I. Introduction 369
II. Epidemiology 370
III. Diagnostic Categories of Psychogenic Movement Disorders 371
IV. Clinical Features and Clues to the Diagnosis 371
V. Approach to Treatment 375
References 376
I. INTRODUCTION
Today, as in 1921, the words of Sir Henry Head resonate: “ . . . Hysteria is sometimes said to imitate organic affections; but this is a highly misleading statement.
The mimicry can only deceive an observer ignorant of the signs of hysteria or
content with perfunctory examination” (1). In most cases of psychogenic move-
ment disorders, especially tremor, the nature of the movement is quite obvious to
the examiner but in some instances it may be quite challenging. The diagnosis
requires careful review of the history and clinical examination as well as the phe-
nomenology of the abnormal movements. Furthermore, prolonged periods of
observations are necessary to clarify the nature of the movement. It is also
quite helpful to carefully analyze the context or surrounding in which the
movement disorder occurs or the circumstances that led to the onset of the
abnormal movement. Psychiatry and legal issues may affect the evaluation, diag-
nosis and treatment of such patients; therefore, both should be carefully
considered.
